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Medical doctors, for the second time in 2012, have publicly expressed concern over medicine shortages in the Maldives.

In addition to official routes of raising concerns with relevant authorities, doctors have brought the issue of essential drugs shortage to the public’s attention and appealed to the government and the legislature through social media.

Dr Abdulla Niyaf, Chief Medical Officer and Senior Pediatric Consultant at ADK Hospital, has repeatedly expressed concern about the issue, specifically noting the recurrent problem of stock shortages in essential drugs such as neostigmine and phenobarbitone.

“As a paediatrician, we go in after each birth or cesarean to check on the newborn, full of concern that something might happen to the baby. If, say, the child’s heart malfunctions, and we are out of adrenaline, then there is nothing more that even us doctors can give,” explained Niyaf to Minivan News.

Niyaf said that the systematic issue of running out of stock of critical drugs was very serious, posing risks to the lives of many. He said that it is a huge concern as a doctor that he would be unable to provide immediate medication to patients who are in crucial need of specific medicines, due to complications with stock renewal.

Niyaf further said that he had previously sat down to discuss the matter with the State Trading Organisation (STO), the sole company licensed to import controlled drugs, and other relevant authorities. The answer had always been that the suppliers were facing issues of licensing, permits, delays in customs and so on.

“For how long can we, as doctors, keep listening to these justifications? All I want is for the issue to be resolved and for patients to have the chance of getting the best possible medical attention,” Niyaf said, expressing concern that the relevant authorities had so far not been able to resolve the issue.

Dr Faisal Saeed, another practicing doctor, told Minivan News that the matter was “a very real concern”.

“It is true that many medicines are often out of stock, but that doesn’t lessen the gravity of the problem. I don’t believe it is an option to be ever out of stock. What will any patient do if a critical medicine is unavailable at the time they most need it?”

Saeed further confirmed that there was a current shortage, stating: “As doctors, we worry about this. If something happens, it is we who must take responsibility. Our question is, when this country runs out of medicine, who is to be held accountable? Who will take responsibility for this?”

Dr Fathimath Nadhiya stated that the issue of shortages of even the most essential drugs has been a longstanding concern for a long period of time, further saying that if shortages were such an issue in the capital island Male’, then the loss must be felt even more harshly at remote island health facilities.

“Hospitals and health centres store the minimum required amounts of critical medicines at any given time. But we are not aware who carries the oversight responsibility to check whether this minimum is always maintained,” Nadhiya said.

She further spoke of her worry that with the lack of monitoring, island health facilities may have an even harder time to obtain many of the critical medicines. She said that in many islands, there were only one or more pharmacies run by private businessmen, who would prioritse medicine supplies not based on their medical importance, but rather on their sales statistics.

Ahmed Afaal, Managing Director of ADK, has also expressed concern on the matter on social media network, Twitter. He sent a message to President Dr Mohamed Waheed Hassan, urging him to look into the matter, stating that “tomorrow we may have to stop surgeries [because of an] injection neostigmine shortage. The only supplier is out of stock. Please help.”

Not yet a “doomsday scenario”: government

While many practicing clinicians have expressed concerns on the matter, the government denies the issue is as serious as claimed by the doctors.

“Checked with Health Minister and STO MD. There is no reason to worry about medicines,” President Waheed said,  in a short statement on Twitter.

Minister of Health, Dr Ahmed Jamsheed, backed the statement, saying at a press conference on Sunday that “although some social media messages on Twitter by practicing doctors may make the public dread a doomsday scenario, things aren’t all that bad yet”.

Jamsheed however did confirm that medicine shortages were a recurring problem in the health sector, stating that the Ministry of Health was planning to start a programme with the assistance of UNOPS and WHO to create a procurement/supply chain management system. Jamsheed said he believed that all the current concerns would be addressed and found a solution to through this programme.

“There is a common misconception that I would like to clarify. Although people usually assume otherwise, the health sector has never been involved in importing and supplying medicines. This is left to the private sector and the government-owned company STO,” Jamsheed explained.

“What we are seeing is that those responsible are not able to sufficiently supply medicines. I think we need to change this system if we are to find a solution. If we are to get a permanent solution, then we must make supplying medicines to patients the responsibility of the service provider, regardless of who imports it.”

Although some local practitioners say that the complaint is that the first choice medicines are unavailable, Jamsheed alleged that some of the complaints were because brands of medicine preferred by an individual doctor were not widely for sale.

“If there is an emergency, then the routine is that hospitals or the government flies in the medicine from neighbouring countries at the earliest,” Jamsheed said.

“If those staff in medical facilities who are responsible for these tasks are able to perform their jobs correctly, then it wouldn’t come to such a critical stage where provision of services are interrupted,” he stated.

Meanwhile, some doctors who spoke to Minivan News rejected the idea that emergency stocks were a solution, insisting that stock records ought to better kept and that patients in critical conditions do not have the option of waiting for medicine stocks to be flown in.

Legislative intervention

Maldives Democratic Party (MDP) MP Ibrahim Rasheed ‘Bonda’ submitted an emergency motion to the parliament on Monday, calling on the legislature to take action to “immediately resolve” the problem of medicine shortages.

Rasheed claimed that this failure to provide critical “life-saving medicines” to patients in crucial need of them was causing loss of lives.

“When practising doctors take the initiative to raise concerns, we realised the gravity of this problem. We then researched the issue in depth,” Rasheed told Minivan News.

“Millions of rufiya worth medicines need to be disposed of due to the failure to manage stocks. The stock is still managed manually. There is also a lot of corruption involved in the procurement and supply of medicines,” he said.

“There are permanent parliament committees within whose mandate this issue will fall. The problem is there are already a large number of pending bills that need to be worked on by these committees. We are now discussing within our party to determine what the most effective course of action will be,” Rasheed said.

During the one hour debate that ensued after the submission of the motion, Dhivehi Rayyithunge Party MP Ahmed Mohamed claimed that health services in his constituency had deteriorated, calling the condition of health care provision “regrettable”.

Progressive Party of Maldives (PPM) MP Adam Ahmed Shareef stated that health centres in the constituency he represented did not have the capacity for “the most basic tests”, adding that the pharmacy was managed by the women’s committee.

STO Spokesperson Ismail Sadiq was unavailable to speak to Minivan News this afternoon, and was not responding to calls.

Minivan News was not able to contact the Director General of Maldives Food and Drug Authority, Shareefa Adam, as her phone was switched off up to the time of press.

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