Parallel trading
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16 September 2013
Krisis: klinik-klinik kesihatan sudah habis ubat
Klinik-klinik kesihatan di Negeri Sembilan menghadapi kehabisan dan kekurangan stok tiga puluh (30) jenis ubat-ubat yang asas dan penting.
Ubat-ubat ini digunakan untuk merawat:
• darah tinggi
• kencing manis
• asma
• kekurangan zat besi dalam wanita hamil
• sawan
• sakit jantung dan strok
• sakit buah pinggang
• masalah prostat
Ubat-ubat yang terbabit digunakan untuk merawat majoriti pesakit yang datang ke klinik-klinik kesihatan.
Nama ubat-ubat ini adalah disenaraikan di lampiran no. 1 yang disertakan.
Ubat-ubat asas ini seharusnya ada di setiap klinik pada setiap masa.
Tetapi kini klinik-klinik dan hospital terpaksa pinjam-meminjam dan berkongsi bekalan ubat sesama mereka.
Ada sesetengah klinik dan hospital yang mengumpul dan menyorok stok ubat kerana kurang senang meminjamkan ubat mereka.
Semua ini mempunyai kesan buruk terhadap kebajikan para pesakit.
Biasanya, pesakit-pesakit darah tinggi dan kencing manis diberikan bekalan ubat mereka yang boleh bertahan selama empat (4) ke enam (6) bulan, berdasarkan tahap kawalan kencing manis dah darah tinggi mereka.
Tetapi sejak awal tahun ini para pesakit diarahkan datang ke klinik-klinik kesihatan untuk mengumpul ubat-ubat mereka setiap satu (1) atau dua (2) minggu sekali.
Dengan kehabisan dan kekurangan stok ubat yang dialami sekarang, masalah pemberian ubat bertambah rumit.
Tiada jaminan para pesakit akan menerima bekalan ubat mereka setiap dua minggu sekali pun.
Kini bekalan ubat penting dalam pengawalan kencing manis, iaitu insulin, juga didapati terhad. Pesakit disuruh menunggu satu minggu tanpa insulin.
Ramai pesakit yang terdiri daripada warga tua, orang yang kurang sihat, dan yang miskin terpaksa berulang-alik ke klinik semata-mata untuk mengetahui sama ada mereka akan menerima bekalan ubat mereka atau tidak.
Apabila mereka tidak mendapat ubat mereka, para pesakit disuruh membeli sebahagian dari ubat mereka dari kedai farmasi di luar. Ini termasuk ubat untuk merawat darah tinggi.
Lebih-lebih lagi, staf klinik seperti doktor dan pegawai farmasi ditegah oleh pegawai atasan mereka daripada memberitahu para pesakit bahawa stok ubat di klinik sudah habis.
Larangan memberi maklumat tentang keadaan sebenar situasi ini mungkin berpunca daripada arahan umum Ketua Pengarah Jabatan Perkhidmatan Awam (JPA).
Arahan tersebut secara jelas menegah semua penjawat awam kerajaan daripada:
“membuat pernyataan awam iaitu pegawai awam tidak boleh, secara lisan atau bertulis atau dengan apa-apa cara lain membuat apa-apa penyataan awam yang boleh memudaratkan apa-apa dasar, rancangan atau keputusan Kerajaan tentang apa-apa isu atau yang boleh memalukan atau memburukkan Kerajaan atau membuat ulasan mengenai apa-apa dasar, rancangan atau keputusan Kerajaan...” (Rujukan: JPA.BK(S)223/8/2-3 Jld.4(56))
Dokumen ini disertakan di sini sebagai lampiran no. 2.
su yang ditonjolkan di surat ini menunjukkan adanya masalah bajet atau kewangan di Kementerian Kesihatan Malaysia yang serius dan berlarutan. Kerajaan harus berterus-terang tentang masalah kewangan ini.
Selain masalah bekalan ubat, masalah kekurangan bahan makmal untuk membuat ujian darah yang asas pernah berlaku sebelum ini (lihat di sini ).
Juga, baru-baru ini, terdapat rancangan untuk memotong gaji tambahan doktor-doktor dan staf sokongan di klinik-klinik kesihatan . Ini akan dilakukan dengan melaksanakan sistem 'shift' tanpa gaji tambahan untuk mengurangkan kos. Maklumat tentang rancangan ini boleh didapati di dalam lampiran no. 3.
Isu tahap nasional seperti ini tidak harus disembunyikan di sebalik sekatan bersuara.
Para pesakit dan masyarakat am berhak mengetahui situasi yang sebenar agar mereka dapat mengambil langkah-langkah yang sepatutnya.
Oleh itu saya menggesa Menteri Kesihatan Datuk Seri Dr. S. Subramaniam untuk:
(i) memberi penjelasan tentang situasi ini,
(ii) mengambil langkah serta-merta untuk menyelesaikan masalah ubat ini, dan
(iii) meyakinkan seluruh rakyat Malaysia bahawa perkara seperti ini tidak akan berulang lagi.
Sekian.
MASIH BERKHIDMAT UNTUK NEGARA
Seorang pesara kerajaan Malaysia.
*******************************
To:
The authorities concerned.
16 September 2013
Crisis: health clinics are out of medicines
Malaysians ought to be informed that the health clinics in Negeri Sembilan have run out of and are facing a shortage of thirty (30) different types of basic and important medicines.
A lack of these medicines will have a detrimental effect on patients suffering from:
• high blood pressure
• diabetes
• asthma
• iron deficiency in pregnant women
• seizures and epilepsy
• heart disease and stroke
• kidney failure
• prostate problems
These medicines are used to treat a majority of patients who come to the health clinics.
These are basic medicines that should be available in every clinic at all times.
The names of the medicines concerned are listed as found in attachment no. 1.
(Attached in the Malay version.)
The situation has deteriorated to the point where clinics and hospitals have to borrow and share these medicines amongst themselves.
Some clinics and hospitals have begun collecting and hoarding these medicines and are reluctant to share their stock of these medicines.
This has an adverse effect on the welfare of patients.
In most cases, hypertension and diabetic patients are given a supply of these medicines by their doctor that can last for four (4) to six (6) months depending on the level of the patients' control of their diabetic and hypertension conditions.
However since the beginning of this year, the patients were directed to come to their health clinics to collect their supply of medicinesevery one (1) or two (2) weeks.
With the current depleted stocks or shortage of medicines, the problems associated with dispensing medicines are compounded.
There is no guarantee the patient will receive their supply of medicines even after a two-week interval.
Now even the supply of an important medicine for controlling diabetes, that is insulin, is in low supply. Patients have been told to wait for one week without insulin.
Patients consisting of the elderly, the unwell and the not so well-off are forced to commute to the clinic just to find out whether they will receive their supply of medicines or not.
If they do not receive them, the patients are sometimes requested to buy some of them from pharmacies outside. This also includes medicine for treating high blood pressure.
This is because the clinic staffs such as doctors and pharmacists are forbidden by their superiors from telling the patient that their clinics have run out of stock.
This prohibition over the provision of information about the actual state of affairs originates from a general directive issued by the Director of Public Service Department (PSD).
The directive from the PSD explicitly prohibits all government civil servants from:
“making public statements, that is, no public officer may, orally or in writing or in any other way make any public statements that is detrimental to any Government policy, plan or decision regarding any issues, or matters that may embarrass or tarnish the Government or make comments about any Government policy, program or decision...” (Reference: JPA.BK(S)223/8/2-3 vol.4 (56))
The document containing this directive is included here as attachment no. 2.
(Attached in the Malay version.)
The problems highlighted in this letter indicate a serious and prolonged financial or budgetary problem in the Ministry of Health.The government must come clean about it.
In addition to the problem of supplying medicines revealed here, there was before a shortage of laboratory materials for carrying out basic blood tests in clinics and hospitals (see here ).
It has also come to light that there are plans to withdraw the additional salaries of doctors and support staff at health clinics. This will be carried out by implementing a 'shift' system without extra pay as a cost-cutting measure. Information about this plan can be found in attachment no. 3.
(Attached in the Malay version.)
The disruption of basic supplies of medicines cannot be tolerated in any country except in times of war.
National issues such as the one brought up here should not be kept hidden behind gag orders.
I urge the Health Minister Datuk Seri Dr. S. Subramaniam to:
(i) explain this situation,
(ii) take immediate steps to end this medicine problem, and
(iii) assure all Malaysian this will not happen again.
STILL SERVING THE COUNTRY
A retired civil servant.
************************
Greece 'facing medicine shortage'
Greece is reportedly facing a severe shortage of medicine, with pharmaceutical companies reluctant to ship drugs to the country due to low profits and unpaid debts.
Greece's hospitals and social insurance funds owe around £1.6bn to various pharmaceutical companies, with £434m expected to be paid this month.
The country's pharmaceutical drugs are said to be priced around 20 per cent lower than the next lowest prices in Europe.
Under EU trade legislation, it is legal for Greek wholesalers and pharmacists to sell the medicines on to wholesalers in other countries.
There are fears in the pharmaceutical industry that middlemen are exploiting this for profit, a practice known as "parallel trading", according to a report in the Guardian.
More than 200 products have been affected, including antibiotics, treatment for hepatitis C, cholesterol lowering drugs and immunomodulators used to treat bowel disease.The Greek government has compiled a list of more than 50 companies that it says have delayed or halted shipments into the country.
The list includes multinational companies such as Pfizer, Roche, Sanofi and GlaxoSmithKline.
Whilst Pfizer, Roche and Sanofi admitted some products had been withheld, GlaxoSmithKline denied the claims.
Pfizer admitted that it had withheld the sale of four medicines in the country because "alternatives were available, and because of the parallel trade situation in the country".
Roche said it had not halted shipments of medicines to Greece but was restricting supplies to the country's public hospitals, who owe the company £173m.
A spokesman for the company added that it was still supplying the hospitals with "critical medicines", and patients were still able to get their products through pharmacies.
A spokesman for Sanofi, Angeliki Angeli, said most of the company's drugs on the government list were still available, with the "exception of a couple of dosages/forms where alternatives exist".
GlaxoSmithKline Greece denied the claims, saying it had "maintained the uninterrupted supply [to] Greek public hospitals with all its products, irrespective of the accumulated debts."
To help combat the problem, Greece's regulator has banned the export of nearly 60 medicines, and is considering bans for a further 300 products.
It has also begun investigations into 10 wholesalers and 260 pharmacists who are suspected of breaking the export ban.
This month Greece must, with the assistance of its creditors, decide the annual pharmaceutical budget.
The budget has been cut severely since the beginning of the economic crisis. The budget fell from 3.7bn (£3.2bn) to 2.4bn (£2.1bn) last year, and commentators are speculating it could be cut to 2bn (£1.7bn) this year.
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