Kazak Hospitals Suffer Winter Drugs Shortage

The Kazak government’s system for buying medicines is failing patients as new rules mean that fresh purchases can only made in the spring, while supplies run short over the winter, according to doctors.



Kazakstan’s healthcare system purchases pharmaceuticals through competitive tenders, with each regional health department seeking bids from suppliers in February and March. The resulting agreements then run to the end of the calendar year.



However, this leaves a gap in supplies lasting from January until the annual purchases are made in the spring.



Under Kazakstan’s law on public procurement, amended last July, health departments are supposed to cover this period by prolonging existing contracts with suppliers.



But in practice the system does not work, because many pharmaceutical companies refuse to continue delivering drugs at the previous year’s prices.



Hospitals and other medical institutions are being left at the start of the year with no fresh supplies of many drugs that they are supposed to provide free of charge.



Nurlan Kasimov, head doctor at the South Kazakstan regional clinical hospital, says the annual interruption in deliveries has become a problem.



“Supplier firms are refusing to prolong their contacts on the grounds that the prices of pharmaceuticals have gone up,” he explained. “But under the current rules, we are supposed to prolong the contracts at last year’s prices.”



The success with which hospitals get through the early months of then year often depends on the individual head doctor’s qualities as a business manager.



Tatyana Oylarova, acting head of the South Kazakstan region’s cardiological centre, agrees that many hospital heads are being left to themselves to acquire drugs in the interim period.



“Everything depends on the head doctor and on the pharmacist,” she said.



Patients are routinely refuse free medications at some clinics, or are offered alternative drugs that might not be as effective. Some end up travelling hundreds of kilometers in search of health centres that will dispense the medicines they need.



Nasiba Aripova, a diabetic from the city of Turkistan in South Kazakstan region, made the trip to Tashkent, the capital of neighbouring Uzbekistan, to get her tablets after local hospitals ran out.



“I had to go to Tashkent in January to buy my supply of Diabeton because the drug wasn’t available here,” Aripova told IWPR.



Gulaysha Yernazarova, head of Turkistan’s health department, confirmed that the local hospital had run out of Diabeton because the new tender was still pending.



Zhanna Yerseitova, head of medicines in the provincial health department, admitted that fresh consignments of Diabeton only arrived on or after February 18. Before then, doctors and patients relied on remaining stock or made do with substitutes.



“These problems don’t only apply to Diabeton,” she added.



A middle-ranking regional health official, speaking on condition of anonymity, said the problem was made worse by the fact that when clinics were unable to supply medicines to patients, their heads were rarely prepared to say so in public.



One solution now being proposed is to change the schedule for the tenders.



“Holding tenders in November and December so that drugs are delivered by January would be the ideal way out,” said Kulash Ilyasova, chief doctor at the South Kazakstan regional endocrinological drug dispensary.



“The tenders are currently conducted in February and March… and while some suppliers provide the medicines at once, others take up to three months.”



Yerseitova agrees that changes need to be made to the tender system to enable health departments to buy medicines faster.



At the moment, drugs are purchased as part of the wider acquisition of hospital items and equipment, which the government has decreed should happen in spring. But Yerseitova does not see why this could not be uncoupled. “Drugs… should be a separate item and bought separately and more rapidly, because timely treatment depends on it,” she maintained.



In the meantime, hospitals are forced to seek ad hoc solutions to the dilemma posed by the seasonal drugs shortage.



One method is to transfer existing stocks of medicines from one hospital to another. But this is not easy to arrange given the bureaucratic health system.



Until things change, January will continue to be a worrying month for patients who depend on prompt and regular supplies of their medicines.



Zinaida Savina is an IWPR contributor in Shymkent.