There is a lack of coordination in the procurement of medical equipment required for the treatment of coronavirus patients and containing the transmission of the virus. This lack of coordination has been observed between two organisations under the health ministry. One is the Directorate General of Medical Services (DGHS) and the other is Central Medical Store Depot (CMSD).
These two organisations are giving contradictory statements regarding the stock of medical equipment. According to the CMSD authorities, the demand for medical equipment has skyrocketed due to the second wave of Covid-19. They can only meet the demand for the next 15 to 20 days with the stock they have. Despite repeated reminders, DGHS has failed to provide them with any procurement plan.
On the other hand, the DGHS officials say that there is nothing to worry about concerning the stock of medical and protective equipment. A three-month plan has been provided already. There will be no problem if the procurement goes according to that plan.
Public health experts are saying that coordination is key at this time of pandemic. These two organisations should be in harmony. This is not the time to blame each other. Rather, they should jointly assess whether there are any deficits, discuss future preparations and take necessary steps.
Various deficits have been observed at different hospitals during the early period of the second wave of the pandemic. However, life-saving equipment and items worth Tk 10.02 million (Tk 102 crore) were lying idle at the airport for 10 months. These were not being released simply due to lack of initiative. Yet these medical supplies had been procured for emergency use.
All the complications were finally resolved within a matter of seven days following the instructions of the secretary of the health services division after a report regarding this issue was published in Prothom Alo on 13 April. The medical equipment which had been stuck at the airport for ten months is finally being released.
A lack of coordination is now observed between DGHS and CMSD. On 1 April, the CMSD authorities asked the DGHS to send the procurement plan for the next six months within two working days. Despite that, the DGHS did not send any complete proposal.
According to the CMSD, it is the responsibility of the Health Services Division and the DGHS to plan for future procurement in advance as part of preparations to deal with the epidemic by monitoring the nature of the pandemic. However, CMSD has not received any kind of procurement plan from either of the sources. Even in this the sudden vulnerable pandemic situation in the country, they have failed to receive any procurement plan.
Director general of DGHS, Abul Bashar Mohammed Khurshid Alam, told Prothom Alo on Monday, “There is no shortage of medical products or equipment except the Remdesivir injections. However, there is difference of opinion among the doctors regarding the use of this injection. Despite that, we will ensure the availability of this injection within a short time.”
Regarding the six-month-procurement plan, the DGHS director said, “Expenditure increases in case of a six-month planning and complications arise in the disbursement of funds. Therefore, we have prepared a procurement plan for three months.”
Deficits mentioned in CMSD letter
The CMSD authorities issued a letter to the secretary of the Health Services Division regarding the overall stock of medical equipment on 8 April. In that letter it was said that they can only meet the demand of the next 15 to 20 days with the stock they have. It takes about three to three and half months to get the supply in an open tender process, abiding by all the regulations of the Public Procurement Act (PPA) -2006 and 2008.
Even after a direct procurement process is adopted, it takes one to one and a half months to get the supply. It was also mentioned in the letter that communication with the source countries of medical equipment is being disrupted due to the deteriorating pandemic situation at present.
CMSD further said that the demand for the medical equipment has skyrocketed due to the recent surge in coronavirus cases. At present, the CMSD has 18 vials of injections (Remdesivir), 139 ventilators, 313 5/3 functional electronic ICU beds, 252 high flow nasal cannulas, 2,058 oxygen concentrators, 7,220 oxygen cylinders and 25 portable X-ray machines in their stock.
While supplying ICU beds or setting up ICUs in different Covid-19 centres, there is also demand for patient monitors, ABG machines and suction machines apart from ICU beds and ventilators.
However, the CMSD only has 50 patient monitors, one ABG machine and one suction machine, which is inadequate compared to the demand. According to the letter, there are about 330,000 Rt-PCR kits in the lab and with this amount of kits, coronavirus tests can be conducted for the next 15 to 20 days at most.
When asked about this, Nasima Sultana, additional director general (administration) of DGHS, “There is no shortage of kits, and there would be no shortage in future. We have arrangements to collect kits at the right time.”
Rush after instructions from the Health Services Division
Copies of the letter from CMSD have been sent to the Prime Minister’s Office (PMO), health minister and the DGHS. Referring to the letter sent to the DGHS on 1 April, it has been said that despite asking for a list of requirements of medical equipment for the next six months on an emergency basis, they did not receive this. After getting the letter from CMSD, the Health Services Division urged the DGHS to send a list of requirements in a letter sent to the director general of the DGHS on 15 April.
According to the sources, after that, the DGHS created a proposal in a rush and sent it to CMSD. However, there was no mention about the estimated expenditure and source of funds in that proposal.
Seeking anonymity, an official of the Health Services Division told Prothom Alo that the DGHS sent the letter through e-mail on 15 April, but dated the letter 5 April. Their incomplete proposal is not acceptable either. Therefore, the CMSD has asked them again for a complete proposal.
Speaking to Prothom Alo, Abu Hena Morshed Zaman, director of CMSD, said, “We could face an acute crisis of medical equipment as a result of the delay from the DGHS in sending the procurement proposal, especially the kits. Despite sending letters repeatedly, did not send any procurement proposal. Two days ago, they sent us a letter mentioning some requirements which cannot be regarded as a proposal. However, we are trying to collect kits from other sources.”
"Health ministry should intervene"
There was an disconcerting situation in the health sector during the early days of coronavirus pandemic. After that, the government institutions got some time to prepare before the second wave of pandemic. However, the exchange of letters in the health sector has revealed that there is lack of coordination and preparation, for which the coronavirus patients are suffering.
Member of the Public Health Advisory Committee of the DGHS, Abu Jamil Faisal told Prothom Alo, “The lack of coordination between the two organisations of the health sector at this time of pandemic is unfortunate. If there is lack of coordination, the health ministry should intervene.”
*This report appeared in the print and online editions of Prothom Alo and has been rewritten in English by Ashish Basu