Between 2021 and 2024, medication shortages affected both developed and developing countries, disrupting access to essential drugs in hospitals and pharmacies.

In Ireland, a surge in COVID-19 and flu cases during winter 2022-2023 led to significant shortages of paracetamol, including prescription products, due to raw material shortages and manufacturing difficulties.

Authorities promoted alternative strengths and brands to maintain treatment continuity, reflecting a broader trend of global shortages requiring multi-faceted management .

In England, hospitals faced critically low levels of intravenous paracetamol, essential for post-operative pain management, with shortages attributed to manufacturer capacity constraints and exacerbated by pandemic-related and geopolitical supply chain disruptions.

Alternatives like oral morphine were less effective, raising concerns among healthcare professionals .

In the U.S., a serious shortage of amoxicillin, a common antibiotic for childhood infections, was reported, with nearly two-thirds of pharmacies unable to obtain it.

Causes included raw material shortages and increased demand from respiratory illnesses, contributing to a broader trend of 183 drugs in short supply .

Chemotherapy drug shortages were particularly acute, with 72% of cancer centers reporting carboplatin shortages and 59% cisplatin shortages, leading to treatment delays and rationing.

The FDA responded by allowing imports of chemotherapy drugs from overseas manufacturers, while healthcare providers adjusted regimens and shared resources to manage limited supplies .

Developing countries faced similar and sometimes more severe challenges.

In Kenya, about 1,000 lung cancer patients endured a five-month shortage of medication due to importation payment delays, forcing patients to seek alternative treatments while the government worked to resolve the issue .

Between 2021 and 2024, medication shortages affected both developed and developing countries, disrupting access to essential drugs in hospitals and pharmacies.

In Ireland, a surge in COVID-19 and flu cases during winter 2022-2023 led to significant shortages of paracetamol, including prescription products, due to raw material shortages and manufacturing difficulties.

Authorities promoted alternative strengths and brands to maintain treatment continuity, reflecting a broader trend of global shortages requiring multi-faceted management .

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Content: Advertisement

U.S. cancer centers report ongoing shortage of chemotherapy drugs

By Cara Murez, HealthDay News
In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin. Photo by klbz/Pixabay

U.S. cancer centers continue to have shortages of commonly used chemotherapy drugs, a new survey shows, though the medications are not as scarce as they were last June.

The National Comprehensive Cancer Network (NCCN), a nonprofit alliance of leading cancer centers, surveyed its network in September.

In all, 72% of cancer centers surveyed reported a continued shortage of carboplatin. And 59% were still seeing a shortage of cisplatin.

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These two platinum-based generic chemotherapy medications are recommended for treating many different cancers. Overall, 86% of centers surveyed said they were short on at least one type of anti-cancer drug. A survey in June showed that 93% of cancer centers had a shortage of carboplatin, and 70% of cisplatin.

"Everyone with cancer should have access to the best possible treatment according to the latest evidence and expert consensus guidelines," said Dr. Robert Carlson, chief executive officer for NCCN.

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"Drug shortages aren't new, but the widespread impact makes this one particularly alarming. It is extremely concerning that this situation continues despite significant attention and effort over the past few months. We need enduring solutions in order to safeguard people with cancer and address any disparities in care," Carlson said in a NCCN news release. Twenty-nine of the NCCN's member institutions responded to the September survey. They include leading academic centers across the United States. The findings may not reflect additional challenges that smaller community practices serving rural and marginalized patients are experiencing. The centers surveyed were using strict waste management strategies, so nearly all were still able to provide the medications to all patients who needed them. Other medications in short supply included methotrexate, with 66% of centers reporting a shortage; 5-fluorouracil, with 55% falling short; fludarabine at 45%; and hydrocortisone at 41%.

"These drug shortages are the result of decades of systemic challenges," said Alyssa Schatz, NCCN's senior director of policy and advocacy. "We recognize that comprehensive solutions take time."

Schatz said the network appreciates those who have put forth proposals to improve investment in generics.

"At the same time, we have to acknowledge that the cancer drug shortage has been ongoing for months, which is unacceptable for anyone impacted by cancer today," Schatz said. "These new survey results remind us that we are still in an ongoing crisis and must respond with appropriate urgency."

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The organization is continuing to advocate for more supplies.

CNN recently reported that two other drugs used for cancer, vinblastine and dacarbazine, went into shortage in September.

"These drugs are particularly used to treat patients with Hodgkin's lymphoma. Hodgkin's lymphoma is probably one of the most curable types of cancers out there," Dr. Doug Hawkins of the Children's Oncology Group, a research organization, told CNN.

"The problem is never-ending. It is horrible," he added. "I mean, to say to a patient, 'we know how to treat your child, but we can't get the drugs,' and this is America, and it's 2023 -- it's crazy."

More information

The White House has more on strengthening the supply chain for cancer drugs.

Copyright © 2023 HealthDay. All rights reserved.

Latest Headlines

In England, hospitals faced critically low levels of intravenous paracetamol, essential for post-operative pain management, with shortages attributed to manufacturer capacity constraints and exacerbated by pandemic-related and geopolitical supply chain disruptions.

Alternatives like oral morphine were less effective, raising concerns among healthcare professionals .

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Content: BONELA calls for axing of incompetent medical supply officers

  • Says shortage of medicines is a matter of life and death
  • MoH blames it on COVID-19

GAZETTE REPORTER

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) has called on President Mokgweetsi Masisi to fire incompetent officers for their failure to procure medicines and drugs for public health facilities.

The Assistant Minister of Health and Wellness (MoH), Sethomo Lelatisitswe, recently told Parliament that public health facilities were running short of medicines and condoms, saying the situation was being addressed.

According to BONELA, the situation got worse after the outbreak of COVID-19.

In an interview with The Botswana Gazette this week, the Executive Director of BONELA, Cindy Kelemi, said those responsible for the dearth of drugs and medicines should be fired.

“There is a serious shortage of medicines,” Kelemi said. “Whether you are talking about hypertension medication or anti-retroviral drugs, there are shortages. This is a concern for us because BONELA exists to ensure that the right to health is made a reality in Botswana.”

“The question we often ask is what the ministry is doing to address this, especially for people in hard-to-reach areas? We have always maintained that we have not explored fully our procurement potential, including looking at the private sector.”

She added that in addition to medicines and drugs, condoms are also in short supply at public health facilities. “We have had condom shortages since last year and we were informed that logistical problems were preventing distribution of a donation through the US embassy,” she said. “Central Medical Stores must understand that this is a life and death situation.”

Kelemi expressed hope that the budgetary vote for MoH being the largest, medical supplies to public health facilities will be replenished.

“But we had this problem even before COVID-19,” she noted. “This goes to show that we can throw money at a problem when there are underlying problems.”

The Chief Public Relations Officer at MoH, Dr Christopher Nyanga , has acknowledged the shortage of medicines and drugs at public health facilities but blames it on COVID-19 slowing down production and delivery timelines.

“Health facilities in Botswana and across the world have been experiencing shortages and delayed delivery of certain drugs and medical supplies,” Nyanga said.

He added that the problem has become more pronounced since the last quarter of the 2020/2021 financial year.

In the U.S., a serious shortage of amoxicillin, a common antibiotic for childhood infections, was reported, with nearly two-thirds of pharmacies unable to obtain it.

Causes included raw material shortages and increased demand from respiratory illnesses, contributing to a broader trend of 183 drugs in short supply .

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Content: Hospitals spanning England face critically low levels of intravenous paracetamol - as a national shortage of the popular painkiller runs on. Paracetamol administered via an IV is the safest and most effective drug to give patients who are in post-operation pain - but staff at one hospital trust in particular have been told to pull the plug on the drug from anaesthetic rooms immediately.

The shortage of IV paracetamol is expected to run into November at earliest, with a Department for Health and Social Care spokesman blaming 'capacity constraints with a manufacturer' as the cause. One hospital worker detailed how deeply worried they were at the shortage - citing how it is much more effective than the orally consumed version.

They said: "It is deeply worrying. We use IV paracetamol because tablets taken orally are only 30% effective. Given by IV it is a potent and direct drug and it restricts pain very quickly."

Read more: Doctor warns that silent pandemic 'scarier' than Covid-19 is already killing a million a year

It is reported by The Mirror that they went on: "The alternatives are oral morphine, which is very slow-acting, or nonsteroidal anti-inflammatories such as ibuprofen and aspirin, which can have negative side effects such as bleeding and allergic reactions."

Drug shortages have become a global problem, worsened by the recent Covid pandemic, the ongoing war in Ukraine, the energy crisis and record levels of inflation. Last winter, France completely culled the internet sales of paracetamol products in a widespread shortage blamed on a Chinese export ban on raw materials.

In Great Britain meanwhile, it is Brexit which is primarily blamed for making matters worse. This is because drug imports from the EU - which historically make up two thirds of the National Health Service's supply - are at their lowest ever levels since leaving.

The health department’s spokesman, said: "Guidance has been issued to the NHS advising on how to manage the issue and we are working with those in the supply chain to resolve this as soon as possible."

Labour’s shadow health minister, Liz Kendall, said: "Concerned staff and patients will understandably be seeking reassurance that the pain relief they need is available. The Government must spell out the urgent steps being taken to resolve the shortage."

It comes after a Covid Inquiry heard that a lack of nurses left the NHS and Great Britain vulnerable to the pandemic - with the infection control lead at the Royal College of Nursing telling of a national shortage of PPE due to a lack of planning for an airborne virus.

Rosemary Gallagher, the RCN’s professional lead for infection prevention and control, explained: "The resilience of the health and care workforce is absolutely essential in order to be able to deliver health care services that meet the public's needs. We know that we went into the pandemic with a significant shortage, about 50,000 nurses short.

"That immediately put us at risk when we needed to surge capacity to support patients at home and in hospitals."

The intervention came the same day that a damning international study warned that Britain has fewer nurses than other developed nations.

Chemotherapy drug shortages were particularly acute, with 72% of cancer centers reporting carboplatin shortages and 59% cisplatin shortages, leading to treatment delays and rationing.

The FDA responded by allowing imports of chemotherapy drugs from overseas manufacturers, while healthcare providers adjusted regimens and shared resources to manage limited supplies .

Title:

Content: As drug shortage list grows, many hospitals face tough decisions on rationing care

More than half of hospital pharmacists are reporting a critical shortage of chemotherapy drugs and nearly all are reporting overall medicine supply gaps as prescription drug shortages near an all time high, according to a new survey.

Hospital pharmacists said drug shortages have forced 1 in 3 health systems to delay, cancel or ration care or switch to alternate drugs to continue to treat patients. And 99% are reporting some drug supply shortages, an American Society of Health-System Pharmacists survey of more than 1,000 pharmacists released Thursday found.

The organization reported shortages of 309 drugs, near the all-time high of 320 shortages in 2014. The scarcity of key drugs is prompting hospitals to find or substitute drugs and change treatment plans as needed.

“In some cases, there are no alternatives to the affected drugs, which puts patients at risk," ASHP Chief Executive Officer Paul W. Abramowitz said in a statement. "This issue requires quick action from Congress to address the underlying causes of shortages and ensure patients have the medications they need.”

Cancer drug shortages

In June, the Food and Drug Administration said it will temporarily allow overseas drug manufacturers to import some chemotherapy drugs.

The FDA allowed Qilu Pharmaceutical, a drug manufacturer in China, to import the injectable chemotherapy drug cisplatin in 50-milligram vials. Toronto pharmaceutical company Apotex Corp. will distribute the medication in the United States.

More than a dozen cancer drugs have been in shortage in recent months, including cisplatin and carboplatin, used to treat lung, breast, prostate and gynecologic cancers. The National Cancer Institute said cisplatin and similar drugs are prescribed for 10% to 20% of all cancer patients.

In June, the National Comprehensive Cancer Network released a survey of 27 academic cancer centers that found 93% reported shortages of carboplatin and 70% faced shortages of cisplatin.

When cancer hospitals face such shortages, they attempt to make sure there's enough medication for patients to finish the course of treatment, said Mike Ganio, ASHP's senior director of pharmacy practice and quality.

Cancer hospitals facing such shortages might change medications for new patients starting on chemotherapy, said Ganio, a former pharmacy manager at an academic cancer center.

"You try to keep that patient on the same regimen as much as you can, unless they're failing it for some reason, and then you would switch," Ganio said.

Steroids, hormonal drugs also in short supply

More than 1 in 5 hospital pharmacists also reported shortages for steroids, hormonal drugs and oral liquids such as lidocaine, ibuprofen and amoxicillin.

A smaller number of pharmacists said heart medications, emergency prefilled syringes and drugs used for intensive care unit patients were in short supply. Others reported shortages of attention deficit hyperactivity disorder medicines, antimicrobial drugs and injectable opioids.

In all, about two-thirds of pharmacists said the shortages were "moderately impactful," which means they are managing shortages but patients are affected.

Pharmacists are managing the shortages by offering therapeutic alternatives, buying different vial sizes or concentrations and rationing medicines.

This article originally appeared on USA TODAY: Survey: Drug shortages are widespread, hospitals ration care

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Content: Health

October 31, 2023

Depreciating Naira value pushes medical care beyond Nigerians

•N1, 170 to US$1 monumental tragedy — PSN President

•Medical supplies priced beyond Nigerians, patients seek alternative care

•Wholesalers, retailers hoard essential life-saving drugs

•Pharmacies record low sales

By Chioma Obinna

It is not the best of times to be sick in Nigeria or to require any form of medical treatment as a result of a disease infection or accident trauma. This is because the continuous free fall of the naira value over the last few years has worsened the already weakened healthcare delivery services in the country.

From the pharmaceutical sector to the healthcare delivery services, Nigeria’s treatment of one ailment or the other has been rendered helpless. Hospitals are also not spared.

Apart from escalating the cost of medicines in Nigeria, its adverse effects on the population leave much to be desired.

The Nigerian pharmaceutical industry is facing significant challenges due to rising drug costs, forcing importers and local manufacturers out of business. Many medicines for common ailments are no longer available, and few are accessible to most Nigerians.

Pharmaceutical companies like GSK are leaving the country, and essential medicines are being hoarded by wholesalers and retailers. The depreciating value of the naira to the dollar, coupled with sky-high inflation, has led to a sharp increase in the cost of importation of Active Pharmaceutical Ingredients and APIs, and the importation and manufacturing of finished products at the consumer level.

Currently, Nigeria is rated by the World Health Organisation, WHO, as one of the eight countries in the world with exceptionally exorbitant drug prices.

As you’re reading this article, US$1 is exchanging at the parallel market at N1, 200, as of 24th October 2023, the exchange rate between the naira and the US dollar is about N800, according to the Central Bank of Nigeria, CBN.

Vanguard investigations reveal that the cost of pharmaceutical drugs in Nigeria has increased by over 100 per cent, causing patients to return home without their prescriptions.

Prices for paracetamol, chemotherapeutic treatments, antimalarials, antibiotics, antihistamines, antihypertensives, antidiabetics, and other medications have risen by 200 to 800 percent. This issue is undermining local medicine makers, who rely on imported raw materials. Nigeria, which relies on imports for 70 percent of its medicine needs, may face the worst if immediate action is not taken.

Stakeholders are concerned that the rapid disappearance of pharmaceuticals could lead to a major scarcity of drugs and medicines for disease treatment. Additionally, the cost of medications in Nigeria continues to rise hourly due to the $1 per second increase in the dollar exchange rate.

A Vanguard investigation found that Augmentin, a GSK product for the treatment of infection and pneumonia, is no longer available at a fixed price. The price is now determined by the buyer. Ampiclox, another GSK product that was formerly priced between N500 and N1,000 per sachet, is now priced between N10,000 and N20,000 per sachet, depending on location.

If you can find the medicine to buy, it costs between N26,500 and N45,000 depending on where you live. The 1-gram sachet costs N45,000 in Okota and Isolo, whereas it costs N40,000 elsewhere.

Another life-saving drug – the Ventolin inhaler -that is utilized in treating asthma attacks is now out of supply. A few months ago, the Ventolin inhaler was sold for N1, 600.

Findings revealed that the scarcity of Ventolin inhalers has also pushed the price of another brand of inhaler, Seretide, through the roof.   It was formerly sold for N6, 000, but now goes for N40, 000.

Many Nigerians can no longer afford regular paracetamol; a packet of paracetamol that cost N50 a year ago now costs N200 to N300, depending on the location and brand.

An indeterminate number of patients are abandoning their treatments and adopting alternative methods like traditional healers and prayer houses. Online pharmaceutical marketers exploit the scarcity of drugs to flood the market with substandard and counterfeit medications, impacting patients like pregnant women, asthma, cancer, malaria, pneumonia, hypertension, and diabetes.

For Agnes Onyero, who was on treatment for malaria, it is not just that the drugs are expensive; her main worry is that she is not seeing the results.   “I have been treating malaria for three months now after a short relief it will come back again.   I have decided that after I finish this set of drugs, I will try herbs,” she lamented regretfully.

While Agnes is battling with resistance to malaria drugs apparently due to substandard or fake medicines, another Nigerian, Adebayo Ojo cannot even afford to buy any drug for treatment.   The 35 year-old now patronises herb sellers popularly known as  Alagbo  who hawk concoctions in his area.

Every morning, Adebayo purchases a cup of the mixture for N200, which, according to him, was formerly sold for N100.

“I did not just decide to be taking herbs but the situation of things forced me to do that.  I have no steady job and just manage what I get from the little one I do.   I was at the pharmacy close to my house and I asked for a malaria drug I was told it is now N2,500. The amount is higher than my daily earnings, so I left it, “ he said.

Agnes and Adebayo are not alone. There are millions of Nigerians in the same boat with them. Some are now building their fate in their faith.

Dollar rate determines the price of drugs in Nigeria

The Chief Executive Officer of HealthPeak Pharmacy, Lagos, Pharm. Azubuike Amakase adduced that several factors contributed to the high cost of drugs presently in Nigeria, but the major factor is forex. In his view, most drugs are imported and indigenous pharmaceutical manufacturers also rely on imported raw materials.

Importers are not helping matters as they continue to sell old stock at unreasonable prices, believing that repurchasing the value of the naira in dollars will not fetch them the same quantity of drugs as when they sell to manufacturers in India, China, Europe, or anywhere else.

“Now every morning before they give out products they will ask for the exchange rate and use it to compute the price for the drugs they sell for that day, that is why some days you get the price of a product in the morning by evening time the price will change, so it is affecting the cost of the drugs and other medications.

“The one that affected me emotionally was a day an asthma patient came in here and the commonest drug that we use when there is an asthma crisis is Ventolin inhaler and other brands.   But it happens that Ventolin inhaler is nowhere to be found in most pharmacies in Nigeria.   That was attributed to the fact that the company that manufactures this product, GSK, has left the country but the few stocks that we still have are in the hands of the wholesalers who are hoarding and creating an artificial scarcity.

“Inhaler that was sold at a maximum of N1600 in the past has no price now.   Some wholesalers will tell you they sell at N8,000 for one while some sell as high as N25,000.   For some people that use Seretide another inhaler for asthma, Seretide used to be like N6,000 but today if you ever see one, you will hear prices like N40,000.

“So, the day the woman came in here, she was gasping for breath, she needed an inhaler to get resuscitated but we did not have one.   What we did for her with my experience in clinical pharmacy was to get her some tablets to relieve her but those tablets could not give her immediate relief as should have done by inhaler but by the grace of God she came out of the crisis.”

But her case is one out of the 100s of cases.

Why drug shortage may persist

Azubuike who envisaged a long-term drug shortage supply in Nigeria, said most importers of pharmaceutical products are no longer bringing them in because of challenges at the Ports.

“Customs duties are getting higher and higher.  Before now, Customs used to calculate duties based on an exchange rate of about N500 to $1, but today, they are using an exchange rate of over N700 to $1 to calculate the duties.

“When you come out of the duty problem, you also face the problem of haulage, and logistics, taking these products from the wharf to the warehouses.    These trucks that convey these products from the wharf to the warehouse also run on diesel and the price of diesel is high, it starts from N700 to over N1,000.   There are so many factors that are pushing the prices of drugs in Nigeria.”

Impact on pharmacy sales

Azubuike noted that pharmacies are experiencing low sales due to high costs and the harsh economy, with many good-selling pharmacies now idle due to people’s inability to afford medications.

“Some patients will go to the hospital and bring a prescription but when they come to the pharmacy after you bring out all the drugs they were given in the prescription list, sometimes most of them will abandon the drugs and just walk away without even saying a word, some will now request that you give them something cheaper, some will come with a budget and when they get here the money they budgeted for their drugs cannot even get half of what is in their prescription. A lot of people are dying.

“Instead of buying drugs that are being prescribed for them, people now go to prayer houses while some will go to traditional healers and  alagbo  on the streets in the name of herbs. And these things as we know affect our organs, especially the liver.   If you go to some tertiary hospitals you will see the results of this act.

“People are coming down with kidney problems.   Go to nephrology clinics, patients are there.   This is major because people are not buying the right drugs.   Hospitals like LASUTH and LUTH are battling with these complications. There is a need to address this problem.”

He said drugs used for the treatment of common ailments such as malaria, typhoid fever, infections pneumonia, and respiratory tract infections among others are majorly affected.

“The cheapest malaria products once sold at N250 is now N500, while those sold at N500 then, now start from N800, and the ones sold from N1,000 then are now N2,500 upwards. This is over a 100 per cent increase.

“The commonest ciprofloxacin that you can get before now as cheap as N400 for one pack is selling as high as N800. For higher brands, some are selling for N2,500.   Then you go to drugs like Augmentin, the problem is that you can hardly see it now.   It is a GSK brand and if you can see it, it has no price meaning that the price is determined by the seller and the person seeking to have those drugs.

“It can go as high as N45,000 for the one gram, then about N40,000 for the 625 if you ever see it. The hike in Augmentin has affected the prices of other Amoxicillin, some that were sold for N1,500 in the past, are now over N3,000, and some sold for N2,000 are now sold for N6,000.

“Brands like Amplicox which is one of the brands people are conversant with, sold for N1000 per sachet and is now N10,000 per sachet, It is also a GSK product popularly known as Beecham Ampiclox. Some may be kind enough to sell it for N9000, and a person who needs this Ampicloix will need two sachets to complete treatment. This means that the person must be ready to cough out N20,000 to get a drug he or she will use for five days, going by the right dosage.”

Azubuike emphasized the need for local drug production in the country and urged the government to intervene to address the uncontrollable fall in naira value by ensuring access to Fore for the importing and producing of pharmaceutical products.

Doctors, pharmacists react

President of the Pharmaceutical Society of Nigeria, Prof Cyril Usifoh,  criticised the current exchange rate of N1,170 to US$1, describing it as a significant tragedy. He warned that the 200 to 250 percent differential in drug prices currently being seen could get worse.

Usifoh lamented that Nigeria’s National Drug Policies (NDP) over the years had not achieved their goals and objectives. He argued that Nigeria imports 70 percent of essential drugs, with India and China producing a significant portion of the country’s consumption, noting that the NDP 2005 advocated for 70 percent of essential drugs to be manufactured locally.

Recommending a way out of the problem, he said the manufacturing of essential drugs and APIs in Nigeria has become crucial in the quest for medicine security and to attain a major boost in the contributions of the pharma sector to the GDP in the national interest.

“Achieving the status of an African hub in pharmaceuticals must become a cardinal objective of the Tinubu administration as we mobilize for the growth of the real sector of the economy. One major reason for the skyrocketing prices of drugs is the depreciation of the naira in the Fore market.”

He said: “President Bola Tinubu needs two key portfolios in the pharma sector to bring prosperity to bare and these are the office of an adviser, Pharmaceuticals and a Chairman of a Presidential committee on drugs distribution reform to redress the ills we have highlighted for productivity.”

In his views, a Superintendent Pharmacist, Engraced Pharmacy, Lagos Pharm Jonah Okotie traced the high cost of medicines to multiple factors of high exchange rate as a result of the poor economy and repatriation of funds.

For him, in the last 20 years, the exchange rate has been depreciating consistently at an astronomical rate.

He said some pharmaceutical companies have folded up because of the astronomical increases because, at the time they imported the products, the value of the naira was less than what it was when the payment was due, which threw them into debt.

Okotie emphasized the challenge of repatriating funds for forex trading in the international market, stating that the availability of funds is crucial for accessing essential medicines. If funds are not available, citizens may be excluded from the list of beneficiaries, denying them essential medicines.

“The economy is shrinking and the purchasing power of the citizens is reducing. The incentive for multinationals to come in is dwindling. I remember sometime back in the 1990s when our economy was faced with a similar experience, the companies then left saying that not only was the cost of doing business in Africa high, but the volume of business after conversion from local currencies to the dollar was not enough to take them home.”

Okotie is insisting that there has to be some intervention kind of funds to mitigate the challenges. “Unfortunately, corruption and wickedness on the part of some of the managers may not let the citizens benefit from it.   Take for instance, the Drug Revolving Fund, DRF, scheme, it has become a conduit pipe for those saddled with managing it.    Suppliers are not paid as at when due to give credibility to the system. Those who are supposed to be checkers are themselves the suppliers. Where is the check and balance? If things go right, we must start with sincerity, accountability, responsibility and interest to see that we improve. We may not have all the resources but judicious and responsible use of our lean resources will guarantee maximum benefit.”

In a chat, the Medical Director of St Raphael Hospitals, Lagos, Dr Anthony Omolola who confirmed that in practical terms, drugs and other hospital consumables have gone over 100 per cent, decried that energy consumption has worsened the already bad situation.

He said Hospital general maintenance is hitting the roof, and patients’ capacity to pay hospital ills has gone way down.

“Unfortunately, Health Maintenance Organisations, HMOs are not making business easy for hospitals because they operate tariffs lower than the cost of production in the hospitals. The patients are not smiling and the same with the hospitals.”

On his part, the Chairman, the Ekiti State branch of the Nigerian Medical Association, NMA, Dr. Babatunde Rosiji, said the development has taken medical supplies beyond the reach of average citizens.

Rosiji posited that if the state of affairs in the country continues unchecked, the inevitable might be on the horizon.

“As we all know and can bear witness to, our dear country is passing through a very difficult time and we as citizens bear the brunt. The times are unprecedented! Patients are finding it difficult to present early to the hospitals for economic reasons. “The exchange rate is making the cost of drugs and medical supplies beyond the reach of the average citizens. Patients on medications for chronic illnesses such as hypertension and diabetes are finding it difficult to access an uninterrupted supply of drugs.

“While health insurance is beginning to take root, the price of drugs in the insurance scheme is out of touch with current realities. If this continues unchecked, your guess is as good as mine.”

Developing countries faced similar and sometimes more severe challenges.

In Kenya, about 1,000 lung cancer patients endured a five-month shortage of medication due to importation payment delays, forcing patients to seek alternative treatments while the government worked to resolve the issue .

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Content: Caption for the landscape image:

e-Citizen: Double jeopardy for patients in public hospitals

Olamayiani Naserian has dutifully visited the Kenyatta National Hospital oncology clinic since his wife was diagnosed with breast cancer last year. The 460-kilometer round trips from Oloitokitok to KNH are emotionally and financially draining, but they are the only hope for survival for the relatively young couple.

On Wednesday, February 7, the Nation caught up with Mr Naserian (not his real name) and his wife who had visited for their cancer treatment at Kenyatta National Hospital. They had visited the national referral hospital the previous day, but his wife could not be treated as there was evidence that they had paid for the service on the e-Citizen paybill number, 222222.

“I made the payment around 1 pm on Tuesday, but I only received a confirmation message later that evening. Thereafter, I received a call from the hospital that the money had reflected (on my e-Citizen account) and that we should proceed with treatment. We came today but, unfortunately, the radiotherapy machine has broken down. we have to wait,” said Mr Naserian, while requesting that we do not disclose his real names to avoid jeopardising his chances of accessing the life-saving treatment.

 Read also:

“The government should not introduce such (the eCitizen single paybill) in hospitals, we will lose more people just because of the delays. It is good but not in health facilities,” he said.

When Nation sought a response from KNH regarding the delays, the Chief Executive Officer, Dr Evanson Kamuri, said that all patients who sought services at the hospital received treatment on the same day.

“However, it should be noted that patients come to the hospital with various ailments, some of which may require varying timelines to investigate. Whenever there are any delays, the hospital communicates to clients and liaises with other relevant institutions to have the matter resolved within the shortest time possible. Normal services resume thereafter with patients being given the best care possible,” Dr Kamuri said.

He said the e-citizen platform “has improved our efficiency because of automation. We have integrated the platform well with the hospital systems making service delivery easier and faster for our clients.”

A weeks-long investigation by Nation journalists however indicated that delays on the government eCitizen portal have crippled several services in health facilities.

An estimated 1,000 lung cancer patients are unable to access medication for the past five months as the importer of key medicines has not been cleared to ship them into the country.

Kenyans have taken to various online platforms to express their dissatisfaction with the system, asking the government to revert to the old manual payments.

As part of the government's plan to integrate a one-stop shop for the payment of all services, the state last year prescribed the use of mobile phone paybill number 222222.

The directive has caused a delay in delivery of services.

A company that made an eCitizen payment three months ago to import Pembroxim, which is a new-generation drug, has not been cleared to ship in the medicine.

“We have had complaints from several importers waiting to be cleared to bring in commodities in the country. We can’t do until the payment is reflected on our side and a clearance certificate generated for them to bring the drugs,” said a source at the Pharmacy and Poisons Board (PPB).

The problem has persisted for months, he said.

“You know before the online platform system, it was easier. Whenever there was a shortage, payment was made to our accounts, clearance was done and the commodities were supplied. However, now we must wait for the money to reflect because we are not in charge of the system,” he said.

He said several drugs are in shortage in the country, but the scarcity is not being felt because there are generic forms of the drugs that can be used in place of the original.

“This was a nice way of sealing the loopholes of corruption in the public sector, however some things were not considered before implementation of the platform. It is not just here, things are not moving in government offices,” he said.

He indicated that the reported shortage of inhalers in the country was a result of the faults in the eCitizen payment system.

“We’re asking patients with lung cancer who were on this drug to have a conversation with their doctors to see whether they can be placed on another drug as we wait for the importation payment to reflect. I don’t know when this will happen,” he said.

Lung cancer accounts for 729 deaths annually, ranked 14th among all other cancers, according to Kenya National Cancer Control Strategy 2017-2022 data.

Among the various types of cancer, lung cancer stood out as the leading cause of cancer-related fatalities, accounting for approximately 1.8 million deaths in the same year.

For instance, according to the data from PPB, a vial of Pembroxim injection goes for Sh175,000, which is out of reach for the majority of patients. A patient needs at least four vials for it to be considered a dosage.

With high mortality rates and limited access to quality care, lung cancer continues to be a significant health concern locally and globally. According to the World Health Organisation, cancer is one of the leading causes of death worldwide, claiming nearly 10 million lives in 2020 alone.

Mr Mapelu Elo, the Kenya Network of Cancer Organisation chairman, indicated that they have had recorded several complaints from patients about the shortage of cancer drugs, with hospitals indicating that they cannot procure on time because of the delays in remitting monies from the National Treasury.

“Last week, we asked hospitals why they were not stocking drugs. They told us that there is a huge delay in getting money hence affecting the procurement process. The shortage has not only affected availability of lung cancer drugs but all cancers, we have patients suffering from different cancers including breast, and cervical who have gone for weeks without drugs,” said Mr Elo.

The National referral hospitals including Kenyatta and Moi Teaching and Referral Hospital are feeling the pressure of having to go without basic supplies since they do not have petty cash to pay providers.

“The hospital is running without drugs. When we want to buy anything we request the Treasury to release money and that takes time. Many patients are going without drugs and even our suppliers of food will soon stop supplying us. A number of them have not been paid for their previous supplies.

A spot check at the Moi Teaching and Referral Hospital (MTRH) showed that some patients seeking outpatient services settled their medical bills using the eCitizen platform.

When the Nation visited the facility on Thursday evening, there was a queue of patients waiting to be attended by a medical doctor.

“My wife has had stomach pains, we visited other facilities but the pain persisted. We did lab tests here for which we paid Sh3,000 via eCitizen. We were informed that NHIF services for outpatients were not working,” said James, requesting that we do not reveal his full names for fear of victimisation.

Some patients using the National Health Insurance Fund card are unable to access health services, claiming their payments were taking time to reflect on the hospitals’ records.

“When I went to the hospital, I was told that I had not paid Sh500 (the monthly premium) for last month, yet on December 2, I made payment. I was told that it could be the online payment system, said Ms Joyce Aturo.

The e-citizen Director General, Ambassador Isaac Ochieng, said he was not aware of the challenges reported by health facilities.

“If there is a problem why are they reporting to you,” he paused.

Additional reporting Stanley Kimuge, Angeline Anyango, Winnie Atieno

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