“Provision of Quality Health Care is Heartbeat of Government,” NAO Report Reveals

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By: Kebba AF Touray

The 2018 Performance Report of the National Audit Office (NAO) has revealed that the provision of quality health care is one of the heartbeats of the Government of the Gambia over the years.

The said statement is highlighted in the 2018 Performance Audit Report for the Ministry of Health and Social Welfare on Storage and Distribution of Drugs by the Central Medical Store (CMS).

“The provision of quality health care has been one of the heartbeats of the Gambia government over the years; as a result, a significant percentage of the health budget is directed towards the procurement of medicines which is also complemented by donor-funded drugs that consist of more than 60% of the drugs used in public health facilities,” NAO’s report reveals.

According to the said audit report, about 85% of the population of the Gambia, mostly those in the middle-income bracket and below, rely on public health facilities, and “as such, the provision of quality health service which includes the availability of essential medicines is of great importance to the Gambian People.”

The report underscored the importance of the availability of drugs to the well-being of Gambian citizens, adding that it is critical for the attainment of positive health outcomes in the Gambia.

As part of the Ministry’s endeavors to strengthen the health sector of the Gambia, the report unveiled that the sustainable development goals (SDG 3) were localized and adopted in November 2015 to ensure healthy lives and promotion of wellbeing for all.

The report explained that during the period under review, the governments of the Gambia and its international partners (Global Fund, UNFPA, UNICEF, World Bank, etc.) have made momentous efforts and developments to improve the health sector to which the availability of essential medicines is key.

The health sector, the report indicated, is the second largest sector in the Gambia attracting more than 5% of the national budget every year.

“A significant amount of this is invested in the procurement of essential medicines. Furthermore, a review of the health budget and medicines from donor agencies revealed that over GMD 797 million has been injected in the procurement of essential medicine during the period under review (2014, 2015, 2016, and 2017),” the report disclosed.

The report also outlined lapses in the management of drugs, stating, “The drug stores and pharmaceuticals are managed by nurses who have little or no training in the management of pharmaceuticals.”

It also indicated that there is no segregation of duties and the management of the drugs is hindered as it is secondary to the duties of the nurses.

“Activities of some health facilities have not been supervised and monitored for more than three years. There are no formal feedbacks or reports documenting the discrepancies found during supervision and action points in bridging those gaps,” the report stated on weaknesses in the provision of technical support to the health facilities.

On the destruction of expired and unusable drugs, the report revealed that the central medical store has not conducted drug destruction exercises for over five years, and as a result expired drugs were found in health facilities stored within the usable drugs.

The report unveiled the recommendations of the NAO and among them is for the MOH&SW in collaboration with CMS to consider providing continuous on-the-job training for the staff handling drugs.

The recommendation also challenged the Ministry to consider recruiting more pharmacy personnel to be posted in health centers, as it will improve the management of drugs, ensuring that drugs are provided with the necessary management techniques.

“The Ministry should facilitate the destruction of the expired drugs at CMS combined with all the other expired drugs at the health facilities. They should consider adopting the best practice of destroying expired drugs every two years,” the report highlighted. 

Among other responses, Management told NAO that the provision of qualified pharmacy personnel is not the responsibility of CMS or the National Pharmaceutical Services; rather it is the responsibility of the government through its education institutions.

“The National Pharmaceutical Services, together with partners do provide annual training on management of medicines, targeting those that will be managing the drugs at facilities as well as stores. 

“In settings where there are insufficient numbers of trained pharmaceutical personnel task-shifting may bridge the gap,” said the Management of CMS.

The Management also replied that the Ministry of Health and partners, through the implementation by National Pharmaceutical Services, is currently training 20 Pharmacy technicians. Five pharmacists are being trained by the Government of the Gambia, through the Ministry of Health.

On lapses in the provision of technical support to health facilities, the Management said that the CMS is responsible for supervising and providing technical support to the health facilities regarding the management of pharmaceuticals.

On the issue of expired drugs, the management clarified that there is no procrastination in regard to the destruction of the expired drugs. The expired medicines do take up valuable space and as such it is in no way favorable to the CMS to have them within the store.

“As explicitly explained to the audit team, destruction of expired items is a strenuous exercise with a heavy financial burden. It cannot merely be performed by the NPS but involves participation from external bodies, including the National Audit Office,” replied management.

The management added that there were no “claims” made as to the efforts made by CMS to secure funds for the destruction of the drugs, the audit team was purview to the correspondences made to the MoH in such effect.