Auditor General Sue Winspear has expressed disappointment with the Health Services Authority’s failed procurement exercise for her pharmacy, saying value for money is important when around $ 9 million per year is spent.
The Office of the Auditor General’s HSA Outpatient Pharmacy Services report also highlighted problems with the archaic pharmacy law and the lack of performance checks at government pharmacies.
Winspear raised concerns in a statement on the release of the OAG’s latest report, which reviewed operations and spending processes at the widely used government health facility.
âIt was disappointing that the lessons from the previous procurement exercise did not seem to have been learned. The procurement exercise which started at the end of 2019 was launched much too late and took too long, which led to contracts, which were not profitable, were extended several times. This procurement exercise was finally abandoned in early 2021 and a new one has now started, âWinspear said in the report on the report released Tuesday afternoon.
According to the report, the HSA conducted a procurement exercise in 2017 that resulted in the award of nine contracts for the supply of drugs spanning July 2017 to December 2019, and this exercise posed “some challenges.”
Shopping under the microscope
The Office of the Auditor General said it found a number of shortcomings in contractual arrangements that did not guarantee fixed prices or best value for money. He also highlighted HSA’s model contracts which did not include standard clauses describing the consequences of late or non-delivery of orders.
âThe contracts state that the prices offered in the tendering process must be fixed for the first year, and thereafter, the price change proposals must be submitted in writing; it is not clear whether these provisions have been applied, âthe report said.
A new procurement exercise was launched in December 2019 for drug procurement, but it also had a number of shortcomings and was scrapped in early 2021.
âThe HSA spends around $ 9 million a year on drugs and it’s important that they get what they pay for,â Winspear said.
The report says the new fiscal year “made it impossible” to award new contracts in a timely manner, as contracts for the supply of drugs were due to expire.
This procurement exercise was canceled at the vendor assessment stage and existing contracts were extended until March 2022.
A new tender has been launched and is expected to be completed in January 2022. A business case was initially prepared for the pharmacy procurement, but the OAG said the quality of the options assessed was not sufficient.
In addition, âwe found that two of the options did not comply with public procurement law and that one option had not been adequately explored. The business case established milestones, but these were not met and the procurement process suffered long delays â.
The report adds that the HSA informed the OAG that the emergence of COVID-19 in early 2020 further contributed to delays in completing the procurement process.
“As a result, existing contracts have been extended several times,” he added.
Legal changes needed
The report also stressed that the legislative framework is “outdated and that there is a lack of strategic direction at the national level for health care, and by extension pharmacy services”.
âThis is not the first time that I have to point out that the legislative framework for pharmacy services is considerably outdated and that there is a lack of strategic direction at the national level for health care. The Pharmacy Act, which dates from 1979, does not conform to current good practice and creates risks for the control and regulation of drugs that may be brought into the Cayman Islands. This needs to be rectified as soon as possible, âWinspear said in her statement.
Regarding actual medical supplies, the report noted that the HSA provides good quality pharmacy service, which has improved in recent years, âbut it needs to do more, including measuring and reporting on a regular basis. performance â.
The Auditor General acknowledged that the HSA provides essential pharmaceutical services to a large segment of the population, including many of “our most vulnerable”.
“So it’s nice to be able to report that the HSA provides a good quality pharmacy service and has processes in place to ensure the quality, safety and efficacy of the drugs it uses and dispenses to patients,” said she declared.
âI encourage the HSA to continue to improve the pharmacy service, for example by improving its facilities, and to regularly measure and report on a series of performance indicators. These should include measures that contribute to customer satisfaction, such as wait times, âshe added.
Among the 19 recommendations outlined in the report, the OAG said the government should revise the Pharmacy Act and the Pharmacy Council should finalize, publish and adopt standards of practice for pharmacy technicians as soon as possible.
As for the HSA pharmacy itself, the OAG recommended, among other improvements, training in customer service and ensuring that you have sufficient financial information to monitor and report on the profitability of the entire pharmacy. .
The Department of Health and Wellness did not respond in the report to its recommendations, which the Auditor General called “both very unusual and disappointing.”
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