A year ago, Children's Hospital 1 in Ho Chi Minh City, as well as several other pediatric and obstetric medical facilities in the city, faced a shortage of Gamma globulin for treating hand, foot, and mouth disease. As a city hospital, but also serving as a tertiary healthcare facility treating pediatric patients from southern provinces, the hospital received many patients transferred from neighboring areas. Most of these cases required referral due to the severity of the illness and the lack of medication at lower-level facilities. Due to the overwhelming number of hand, foot, and mouth disease cases, the hospital's drug reserves were sometimes insufficient to meet treatment needs.
According to Pharmacist Nguyen Thi Bich Nga, Head of the Pharmacy Department at Children's Hospital 1 in Ho Chi Minh City, the shortage of gamma globulin does not stem from a lack of legal regulations in procurement but is mainly due to disruptions in the supply chain caused by delays in importing the drug into Vietnam.
“We have regularly reviewed the drug inventory situation, kept track of the number of drugs purchased under valid contracts, and monitored supply news and disease forecasts to stockpile drugs. However, unforeseen situations have arisen. For example, in 2023, 13 licensed suppliers of Gamma globulin for treating hand, foot, and mouth disease were unable to supply enough. We proactively sought advice from the Department of Health and the Ministry of Health to secure drug supplies for hospitals to combat the epidemic. In reality, Gamma globulin is a rare drug, and the shortage for many years is due to a lack of suppliers, not because the legal regulations for bidding and procurement have not been issued in a timely manner,” Ms. Nga said.
Gamma globulin is a rare drug, and its shortage for many years is due to a lack of suppliers, not because the legal regulations for bidding and procurement have not been issued in a timely manner.
Ms. Nguyen Thi Bich Nga, M.Sc., Pharmacist, Head of Pharmacy Department, Children's Hospital 1, Ho Chi Minh City
Regarding the most critical period of drug shortages, Master's degree holder Nguyen Thi Bich Nga stated that the hospital basically does not lack routine medications. The period of greatest shortage was due to several objective factors, and while waiting for guidance from the Government and the Ministry of Health, the hospital had planned to conduct a bidding process in advance.
Another story, arguably the hottest topic in 2023 in this region in particular, and the whole country in general, especially at central-level hospitals, is the situation where numerous CT scanners are idle due to a lack of replacement parts. Hospitals cannot conduct bidding because regulations require three price quotations.
An official working at the medical equipment procurement unit of the University Medical Center of Ho Chi Minh City cited an example: "A CT scanner bulb costs around 2-4 billion VND. On average, this machine needs a bulb replacement every 1-2 years. The requirement to submit three price quotes before purchasing is a challenge for medical facilities. No unit dares to buy because the specifics of this equipment system require a bulb from the same manufacturer, so only one price quote can be provided."
Some modern equipment has been out of service for periods due to the inability to bid for or procure replacement chemicals and supplies.
Some modern equipment has been out of service for periods due to the inability to bid for or procure replacement chemicals and supplies.
Following the issuance of Decree 24/2024/ND-CP on February 27, 2024, only one quotation is needed to establish the planned price, instead of the previous requirement of three quotations. As a result, hospitals have confidently purchased equipment to ensure timely medical examination and treatment for patients, while simultaneously addressing the issue of wasted unused equipment.
As the medical facility with the highest number of patients in the southern provinces, the University Medical Center of Ho Chi Minh City receives an average of 7,000-8,000 outpatients and over 1,000 inpatients daily. Ensuring an adequate supply of medicines, medical supplies, and equipment for examination and treatment is a very urgent issue.
Sharing the difficulties the unit faced in the past before the new Law, Decree, and Circular were in effect, Associate Professor, Dr. Nguyen Minh Anh, Deputy Director of the Hospital, said that the most difficult aspect of bidding and procurement was obtaining the planned price for the bidding items, with regulations requiring a minimum of three quotations and the lowest bid price. Furthermore, if even one item in the bidding list could not be selected or had a low price, affecting the entire package, the bidding package could not be implemented.
On average, the University Medical Center of Ho Chi Minh City receives 7,000-8,000 outpatients and approximately 2,000 inpatients per day.
On average, the University Medical Center of Ho Chi Minh City receives 7,000-8,000 outpatients and approximately 2,000 inpatients per day.
Regarding medical supplies and equipment, many items can only be quoted on the market because the price depends on the supplier and the specific brand of chemicals used. After numerous legal issues in procurement, many units are hesitant because even obtaining price quotes from contractors is not easy.
However, Mr. Minh Anh asserts that with the regulation allowing for one quotation, and the highest quotation obtained by the hospital being used as the planned price based on professional requirements and the hospital's financial capacity, the hospital has essentially not lacked medicines, supplies, and equipment because the forecasting is done throughout the year and bidding is conducted continuously. The main bottlenecks are minor issues in the bidding process for medical supplies and equipment due to the grouping of items for bidding.
“According to the latest reports, the hospital's procurement and bidding rate has reached 80%. The remaining 10-20% is not due to subjective internal issues but rather objective factors in the supply chain; the winning bids are currently awaiting renewal of drug registration licenses. These are obstacles outside the scope of the hospital and the Ministry of Health. However, these issues do not seriously affect the hospital. We always have alternative solutions with equivalent drugs in terms of therapeutic efficacy, ensuring patients receive relatively stable treatment,” Mr. Minh Anh said.
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According to the latest reports, the hospital's procurement and bidding rate has reached 80%. The remaining 10-20% is not due to subjective internal issues but rather objective factors within the supply chain, outside the scope of the hospital and the Ministry of Health. However, this does not seriously affect the hospital. We always have alternative solutions with equivalent drugs in terms of therapeutic efficacy, ensuring patients receive relatively stable treatment.
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Associate Professor, Dr. Nguyen Minh Anh, Deputy Director of the University Medical Center of Ho Chi Minh City.
At Cho Ray Hospital, an average of 5,000-6,000 outpatients and over 1,000 inpatients are admitted daily. According to Dr. Pham Thanh Viet, Deputy Director of Cho Ray Hospital, the drug shortage is mainly related to disruptions in the global supply chain. Domestic drug manufacturers are also experiencing delays in supply due to a lack of imported raw materials. “The drug shortage actually stems from the source, not from a lack of legal regulations or the hospital’s inability to purchase enough for patients,” Dr. Viet stated.
According to Mr. Viet's analysis, the series of incidents in the healthcare sector related to bidding have made facilities more cautious, especially when the law lacks clear and specific regulations in these cases. There are specific regulations regarding cases where direct contracting is permitted. "However, direct contracting is open to units with shortages, but no one dares to do it because of the accountability issues," Mr. Viet stated.
Dr. Pham Thanh Viet, Specialist Level 2, Deputy Director of Cho Ray Hospital.
Dr. Pham Thanh Viet, Specialist Level 2, Deputy Director of Cho Ray Hospital.
In response to the question of whether the hospital is experiencing drug shortages, an official in charge of pharmaceutical procurement stated that Cho Ray Hospital does face this situation, but it is mainly due to objective factors, such as drug prices being too low to attract bidders; or rare drugs having very few suppliers; or some winning bidders being unable to import drugs and supplies due to supply chain disruptions, extending the delivery time to 4-5 months. In these cases, without alternative drugs, the hospital finds it very difficult to provide sufficient supplies, and the hospital cannot terminate the tender to conduct a new one.
"Our hospital's dental unit is currently unable to bid for anesthetic drugs for dentistry because the number of patients visiting this department is very low. Even with vitamin C, we've held several bidding rounds, but no companies participated, or those that did participate didn't win. Some drugs, like detoxification drugs or BAT, aren't always readily available. The hospital has to spend time searching for suppliers," this person explained.
Source: https://nhandan.vn/thuc-trang-kho-dau-thau-mua-sam-tai-cac-benh-vien-post838371.html
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