GIVE ABSOLUTE PRIORITY TO MEDICATIONS AND MEDICAL SUPPLIES FOR EMERGENCIES
According to feedback from several kidney patients, the Nephrology and Dialysis Department of Viet Duc Friendship Hospital recently informed them that they were running out of dialysis filters and should seek other facilities for dialysis. "We contacted several places in Hanoi , but were all told that they couldn't accept more patients and could only perform dialysis for emergency cases," one patient worriedly stated.
At Viet Duc Hospital, the number of patients seeking treatment has increased, but there has been a shortage of medical supplies at certain times.
Speaking to Thanh Nien newspaper , Dr. Duong Duc Hung, Director of Viet Duc Hospital, said that in response to the situation described by the dialysis patient, the hospital promptly rectified the issue and ensured a sufficient supply of filters, continuing to provide hemodialysis for the patient.
Not only are some supplies for hemodialysis at risk of shortage, but several other items at Viet Duc Hospital are also lacking. Mr. Hung explained that the reason is that "after the Covid-19 pandemic, the number of patients coming for examination and surgery at Viet Duc Hospital increased by about 200% compared to the Covid-19 period, while regulations on procurement and bidding only allow exceeding 130%."
The Director of Viet Duc Hospital also expressed concern that, given the disruptions in the supply of many medicines, medical supplies, and equipment from various suppliers, and the fact that many surgical supplies and instruments for the surgical specialty are only supplied by one or two sources, while the number of patients is increasing, this creates considerable pressure and affects the hospital's procurement planning. To overcome this, the hospital has clearly categorized emergency cases, prioritizing them, while encouraging patients to wait for arrangements, which may result in longer waiting times for surgery.
Regarding the shortage of certain medicines and medical supplies, the Ministry of Health also acknowledged that the current period is a difficult one for the health sector after nearly three years of focusing on combating the epidemic. The severe shortage of medicines, equipment, and supplies in many medical facilities; the numerous violations of the law by medical staff from the central to local levels; the wave of resignations and transfers out of the public health sector; and the remaining policy obstacles... have all created difficulties in the implementation process.
According to the World Health Organization, shortages of medicines, medical equipment, and supplies are a persistent challenge and not a new phenomenon. This is especially true for drugs for the nervous system, cardiovascular system, anti-infective drugs, anti-cancer drugs, digestive drugs, diphtheria antitoxin, emergency yellow fever vaccines, and drugs and biological products derived from human plasma…
This situation arises from several factors, including the scarcity of raw materials and active ingredients worldwide, global price fluctuations, inflation, energy crises, and the impact of military conflicts, all of which significantly increase the input costs of pharmaceutical production. This leads to higher product prices, disrupted supply chains, and a lack of incentives for manufacturers, resulting in the production of less profitable drugs.
In reality, at Viet Duc Hospital, Mr. Hung acknowledged that the Government and the Ministry of Health have issued documents to address difficulties and obstacles in the procurement and bidding of medicines, medical supplies, and equipment. However, there is always a delay in implementation, as even a fast-tracked bidding package takes at least 4 months, usually 5-6 months, and some packages even take 8 months. In many cases, after winning bids for medical supplies, the hospital receives requests from manufacturers to postpone delivery due to disruptions in overseas supply.
"This is something we have to accept. Just last week, the hospital received notices from three winning bidders requesting a delay in delivery and stating that they 'cannot be certain of a specific delivery time'. In this situation, we have to consider alternative procurement methods in special circumstances, finding substitute items to ensure the provision of medical services. Currently, Viet Duc Hospital has relatively sufficient medicines and laboratory chemicals to serve medical examinations and treatments," Mr. Hung said.
PROPOSAL FOR NATIONAL CENTRALIZED BIDDING AND ISSUANCE OF PRICE FRAMEWORK
Regarding addressing the shortage of medicines and medical equipment, the Ministry of Health stated that it has focused on accelerating the process of granting and renewing licenses for medicines, and registering medicines and medical equipment for circulation. Currently, the total number of valid medicines and pharmaceutical raw materials is over 22,000, and the total number of valid medical equipment types is over 100,000.
The Ministry of Health also directed businesses to find sources of supply, especially for rare drugs; implemented comprehensive decentralization of the authority to approve procurement decisions and contractor selection plans for medical units under the ministry; accelerated the progress of drug procurement and national centralized bidding; and strengthened the disclosure of information to support bidding…
According to reports from 1,076 medical facilities nationwide submitted to the Ministry of Health in October 2023, 67.41% reported sufficient supplies for medical examination and treatment activities; 38.59% reported localized shortages. At Bach Mai Hospital, 35 procurement packages for medical supplies, chemicals, and equipment have been completed since the beginning of the year.
"We are currently applying the standard procurement method for specialized supplies and chemicals, which inevitably has drawbacks. For example, there are machines and supplies that are only available from one manufacturer worldwide, and only one distributor in Vietnam. The healthcare sector is a service industry with very specific conditions and characteristics; to purchase machinery, medicines, and supplies, we need procurement regulations that are specific to this particular profession," Mr. Hung stated, and further suggested: "In the future, we should also implement national centralized bidding for essential medical equipment and supplies, or those selected to suit the healthcare network plan and the needs proposed by localities. Instead of 1,400 hospitals forming procurement councils, there will only be one national-level council. And with centralized procurement in large quantities, price negotiations will also be more advantageous."
Concerned about the difficulty in purchasing high-quality products during procurement bidding, the director of a hospital in Hanoi stated that current regulations lack categorization of medical equipment during bidding, while medical equipment from different manufacturers has diverse criteria, making the bidding process very difficult. If only the lowest price is chosen, it often results in lower-quality products. Therefore, appropriate regulations are needed to ensure that units can still purchase medical supplies of good quality at fair prices.
"The biggest challenge right now is that hospital directors can't possibly know all the prices of goods subject to centralized bidding. Currently, state management agencies and the Ministry of Health have issued prices for medical examinations. I think state agencies should also pay attention to issuing prices for medical equipment, publishing specific price ranges, and updating prices annually. From there, hospitals can base their purchases on these prices to ensure they buy appropriate products," suggested Professor Nguyen Duy Anh, Director of Hanoi Obstetrics and Gynecology Hospital.
Hopefully, there will be no disruption to the procurement of medicines and medical supplies.
Following the National Assembly, the Government, and the Ministry of Health's efforts to resolve difficulties for the hospital, from January 2023 to the present, Bach Mai Hospital has won bids for a large quantity of equipment, consumables, and medicines for medical examination and treatment. Recently, we won bids for equipment packages such as: 4 MRI machines; 2 CT machines; procurement of 2 packages of gastrointestinal endoscopy equipment; and bids for ultrasound and X-ray equipment for imaging and examination and treatment. Most recently, the hospital completed the procurement of 7 endoscopic surgical systems. From now until the end of 2023, patients coming to Bach Mai Hospital will no longer have to wait long, especially for imaging.
Alongside the procurement process, with the support of relevant agencies, especially the investigative agency of the Ministry of Public Security, equipment that was previously put on hold due to legal issues will be put back into operation. With a series of synchronized solutions, we anticipate that by 2024, most patients visiting Bach Mai Hospital will receive medical examination and treatment under conditions with adequate basic medical equipment, without the long waiting times experienced in the past.
Currently, the hospital has sufficient essential and basic medicines. However, there are occasional localized shortages of supplies, some medicines are affected by supply chain disruptions, and some domestic medicines cannot be sourced from abroad. We are awaiting the issuance of circulars and decrees guiding the implementation of the recently passed laws, hoping that these documents will be issued and take effect before January 1, 2024. These are the documents we are waiting for to ensure uninterrupted procurement of medicines, chemicals, and medical supplies, providing the most convenient access to healthcare for the public.
Associate Professor Dr. Dao Xuan Co , Director of Bach Mai Hospital
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