Op-Ed: Despite yearly budgetary increases for health, chronic medicine shortages remain

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Below is an opinion editorial done by former Health Minister Dr Leslie Ramsammy:

Dr Leslie Ramsammy

Even as the Minister of Finance boasts about the largest budget ever ($300.9B) and the Minister of Public Health gleefully bragging about the $35B Ministry of Public Health budget for 2019, chronic medicine shortages continue to impact the lives of people in Guyana.

The chronic stock-outs of medicines that have plagued the health sector since 2015 have occurred in spite of increasing budgetary allocations. Each year, there is another record-breaking allocation for medicines and medical supplies. In 2019, the allocation for medicines and medical supplies is about $8B. Each year, the Ministers of Finance and Public Health promise that medicine shortages will be part of the past. But so far, we have only experienced a worsening situation.

Last week the Ministry of Public Health admitted that there is a serious shortage of medicines to treat MDR-TB (Multi-Drug Resistant Tuberculosis). At least up to two weeks ago, there was also a shortage of Efavirenz, a medicine used to treat HIV-positive persons.

Unfortunately, these serious stock-out situations occur too frequently in Guyana over the last almost four years. Multiple stock-outs like these  occurred in 2016, 2017 and now in 2018. Stock-outs of TB and HIV medicines have serious implications for persons living with TB and with HIV, but also increase the risks of transmission for the population at large. Such stock-outs, therefore, represent a public health risk, endangering the lives of thousands of people.

MDR-TB is a growing problem in Guyana. MDR-TB is a type of TB that is resistant to the normal medicines that are used to treat TB. It is critical that early diagnosis for MDR-TB is available and that the specialized medicines for MDR-TB are readily available to begin and sustain treatment for all persons with MDR-TB. Continued, uninterrupted treatment for MDR-TB is of life-and-death importance for the patient.

But it is also an important public health emergency since treatment interruptions place more people at risk for MDR-TB and life-threatening transmissions of a virulent form of TB. Guyana has committed to the global goal of a minimum of 80% cure rate for MDR-Treatment. With stock-outs like these, the goal is not achievable. Already, we have seen Guyana missing its global commitment of a minimum of 80% treatment success for MDR-TB in 2017. Treatment interruptions due to stock-outs represent an important factor in MDR-TB treatment failures.

Efavirenz is one of the anti-retroviral treatment (ART) medicines that constitute the HIV treatment cocktail in Guyana and in countries around the world. Stock-outs of Efavirenz mean that there is treatment interruptions. Like MDR-TB medicine stock-outs, stock-outs of efavirenz leave people living with HIV in life-threatening situations and also increase the risk of transmissions of HIV to other people. The present Efavirenz stock-out is just the latest of a consistent stock-out of one or more of the HIV medicines.

This seriously impact on Guyana’s stellar universal treatment successes for HIV and has major implications for Guyana’s commitment to reach the 90-90-90 goals by 2020. The 90-90-90 UNAIDS goals for HIV and AIDS refer to the national commitment to ensure that 90% of all persons living with HIV know their HIV status, 90% of persons living with HIV are receiving sustained anti-retroviral treatment and 90% of persons on ART have HIV suppression by 2020.

Budget 2019 provides almost $8B for medicines and medical supplies. This should be good news. But 2018 was also a year where more than $7B was expended on medicines and medical supplies, yet there were major shortages of medicines and medical supplies. The latest shortages of MDR-TB and HIV medicines represent just a tip of the iceberg.

Guyana has experienced stock-outs too often and these stock-outs are not limited to TB and HIV medicines. Since 2015, Guyana has also experienced stock-outs regularly of medicines for malaria, diabetes, blood pressure etc. Guyana has even experienced stock-outs for vaccines. Boasting of large allocations will not solve the problem as long as corrupt, single-sourced procurements continue. Boasting of capital allocations for more warehouse development will not solve the problem.

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