By Kebba AF Touray
The National Audit Office (NAO) has challenged the Ministry of Health (MOH) to ensure the full utilization of the mental health budget by increasing the quantity of psychotropic medication procured.
The audit office also challenged the Health Ministry to recruit more psychiatric nurses to offer mental health services in health facilities, and for them to work on a strategy to retain health staff.
Furthermore, the audit office challenged the Ministry of Health to improve its supply chain of psychotropic medication by ensuring that the Central Medical Stores (CMS), supply the drugs without delay and for pharmacy store managers to make their requests on time.
The National Audit Office called for these challenges from the Health Ministry in its audit performance report on the provision of mental health care by the MoH from 2018 to 2023.
The audit said the review of the GoTG budget estimates and expenditure for the mental health program 2018-2021, was under-utilized, adding that out of a total approved budget of D4, 737,000, only D1, 337,000 was spent.
The audit office also deliberated on the unavailability of psychotropic medication in health facilities and said the Ministry should ensure the availability of psychotropic medicines.
The audit report also explained the sampled essential psychotropic drugs and their unavailability in the health facilities they visited.
The audit report also showed that Phenobarbital and Phenytoin were the least available drugs accounting for 70 percent and 60 percent unavailability in health facilities visited respectively.
“While Carbamazepine and Diazepam had the lowest percentage of unavailability representing 9 percent of unavailability, during our visit to sampled health facilities, we noted disparity in terms of availability of anti-psychotic drugs,” the NAO audit report said.
The audit office also cited the gap between the number of psychotropic drugs that should be available and what was available during their visit and cited eight essential psychotropic drugs as an example that none of the health facilities have.
The audit report said Essau District Hospital (EDH) has the lowest number of the sampled drugs with a 62.5 percent unavailability rate, noting that for the rest of the health facilities visited, the unavailability of drugs was attributed to delayed supply from the RHD or CMS.
“We also verified drugs at some Regional Health Directorates that supply three of the health facilities visited, to establish the cause of unavailability of drugs at the health facility levels,’’ the audit report said; that according to their interview with officials of the Regional Health Directorates, the unavailability of drugs at these health facilities were attributed to delayed requests for the supply of drugs from these health facilities.
It said drug supplies are sometimes delayed at the CMS and this shows the percentage of unavailable drugs at the sampled RHDs.
According to the audit office, they also verified drugs at CMS to establish why they were not available in health facilities and Regional Health Directorates that get their supplies from CMS.
“Eight of the health facilities visited (EFSTH -Poly Clinic, ‘Tanka Tanka’, Kanifing, Bwiam, Bansang, and Farafenni General Hospitals, Brikama and Basse District Hospitals) usually receive a supply of anti-psychotic drugs from the Central Medical Stores (CMS),” the audit report said.
“We found during our verification at the CMS that all the drugs in our sample were available during the time of our visit except for one drug (phenobarbital) which was under quality control. According to the officer at CMS, drugs do not get to the health facilities,” the NAO report added.
The audit office is of the view that when they are under quality control checks, drugs requested would not be supplied until the check is completed.
“We were informed that quality control check takes between forty-five to sixty days to be completed because they are done outside the country,” NAO reported.
According to their interview with officials at the CMS, they said the procured essential psychotropic medications are usually less than the required quantity.
“Thus warranting for rationing of the psychotropic medications which results in health facilities being supplied less than required, and the drugs running out quickly which affects availability,” the audit office said.
This as alluded to by NAO, is corroborated by the 2016 Mental Health Policy which highlights that the quantities of medicine ordered are not sufficient to cater for the number of people suffering from mental disorders and requiring medication, due to a lack of available funds.
The NAO report concluded that given the above, outpatient Mental Health Services have been integrated into all general and district hospitals.
However, it is reported that the integration of the services in major and minor health centers remains low, and inpatient (admission) services remain limited in terms of access with only one unit providing such services.
“As stated in our report, MoH will continue to ensure drugs are available at all levels for mental health patients,” the Health Ministry Management said in their response.
