Health

The findings of the Auditor General of South Africa on the performance audit of the management of pharmaceuticals by the Department of Health did not bode well for the Department, with inefficient and ineffective practices within the value chain being one of the key findings. These findings were for the entire health sector in all nine provinces and were very important with medicine being one of the key deliverables in the Department of Health.

The policies and planning stage revealed three key findings: 1) standard operating procedures were not being implemented and that adherence to them was not monitored; 2) the budget was incrementally based on historical information instead of actual health care needs and 3) shortage of pharmacists and pharmacist assistants to deliver pharmaceuticals and to provide operational support. The third finding was especially worrisome because it meant that there were no pharmacists at health care centres and clinics and therefore their work was done by nurses, possessing competencies less than what was required. This dire situation meant that hundreds of people travelled long distances without receiving adequate service and were unable to leave without the medication their health depended on. The AGSA said this situation was the root cause of the lack of adherence to medical dispensing procedures.

The common issues that reflected the state of despair of pharmaceutical management were leadership and oversight, funding, project management and operations, and inter-governmental coordination. Leadership and oversight was lacking at all levels. In some provinces vacancies remained unfilled even though positions were advertised. The area of funding seemed baffling because in the AGSA’s investigation thereof it did not reflect the current need but only reflected historical accounts.

The Committee asked where the AGSA got its numbers from when they said that there was a mismatch between disease and medicine and recommended an investigation be conducted as to why the departments did not adhere to the standard operating procedures. A general area of concern was why few people were attracted to the pharmacy discipline. The amount of pharmaceuticals lost in transit was also questioned because stories had been heard of trucks with stocks being diverted to other areas. This shows a clear lack of concern for the health of the poor and sick in especially rural areas. The area of medicine storage depots and late payments could not be looked at in isolation. The delayed payment issues were deep seated in poor management of human resources and slowness in the value chain, lack of accountability, and the non-compliance and non-adherence to basic operating controls which did not allow things to be captured. Expired stock was also a serious concern and pointed to poor monitoring in terms of stock management.

The AGSA’s recommendations were: the development of national core standards, the implementation of standard operating procedures, reconsideration of incremental budgeting, and reviewing and updating of human resource plans. With regard to procurement of pharmaceuticals, AGSA recommended the paying of suppliers within 30 days of receipt of invoice and imposing late penalties for late deliveries, as well as updating the stock visibility establishment. With regards to distributing to patients, they recommended the development and implementation of dispensing registers, instituting measures to update and retain patient records at health institutions and identifying health institutions with insufficient or non-compliant waiting areas, storerooms, dispensaries and consulting rooms. The Committee recommended that ‘the Department implement the recommendations to the fullest.