The Deputy Nguyen Thi Thuy (Bac Kan) stated that basing on the reflection of hospital pharmacies, there are still difficulties in bidding for drugs. In fact, there are still times when the people cannot buy drugs at hospital pharmacies after examination, affecting their treatment. Can  the Minister explain where this problem comes from and when it will be resolved ?

Responding to the deputies, Minister Dao Hong Lan said that in recent times, the NA and Government have issued various policies to solve the problem of drug shortages. In particular, the 2023 Bidding Law has introduced many policies to solve the problem of drug procurement and bidding at the medical facilities.

Minister of Health Dao Hong Lan speaks at the NA’ s question and answer session.  (Photo quochoi.vn)

The Minister Dao Hong Lan informed that there is only one content related to hospital pharmacies that is stuck. Because, previously, hospital pharmacies were self-managed by hospitals, organizing the purchase of drugs to sell to the people when needed, not funded by the budget, nor by health insurance sources.

However, the 2023 Bidding Law stipulates that hospital pharmacies must also conduct bidding. The needs of patients are very diverse. Therefore, hospital pharmacies face many difficulties. Medical facilities reflect this content in the revised Pharmacy Law. The Pharmacy Law to be approved at this session shall amend the contents related to hospital pharmacies. That is, handing over the initiative to medical facilities, ensuring publicity, transparency, and accountability. On that basis, providing medicine sources for the people.

Participating in question and answer session, the Deputy To Van Tam (Kon Tum) stated that the lack of drugs affects the quality of medical examination and treatment, affecting patients. In the past, there were legal bottlenecks, but recently, the NA and the Government have made many efforts to remove them, and the basic bottlenecks have been resolved. However, the shortage of drugs still exists. So is there a lack of responsibility among those responsible people for bidding at these medical facilities? If so, how will the Minister of Health resolve it?

Minister Dao Hong Lan answered: There are currently three levels of drug bidding: Centralized procurement at the Ministry of Health; procurement at the provincial level and assigned to localities to direct implementation; procurement at medical facilities.

With the difficulties in the recent past, the NA and the Government have removed many of them and the Bidding Law has taken effect since January 1st, 2024. However, this is the first year of implementing the new regulations. Therefore, the Ministry of Health has worked with localities, regularly conducting online conferences to deploy instructions for implementing the Law on Bidding in 63 provinces and cities. The  difficulties are caused by new regulations, so, researching, studying, and arranging human resources for implementation is still difficult...

Therefore, in addition to training all localities to solve difficulties, the Ministry of Health is developing a handbook on drug bidding, providing specific, step-by-step instructions so that localities have enough capacity to implement.

In addition, in practice, at some units, there are still cadres who do not dare to think, dare to do and are afraid of making mistakes, so the implementation process is entangled. The Ministry of Health has also issued the Directive No. 24 stipulating the responsibilities of the heads of all medical examination and treatment facilities to fully perform their responsibilities related to ensuring adequate medicines, equipment, and medical supplies.

This content has also been stipulated at the Law on Medical Examination and Treatment (amended) and this is a mandatory responsibility. At the same time, the Ministry of Health shall continue to support the leaders in the implementation process and any remaining problems shall continue to be resolved.

***According to WHO, A good health system must ensure equitable access to medicines, vaccines, medical supplies and health technologies at affordable prices. It must also implement a robust system of regulation and control of these products to ensure their quality, safety and efficacy. All this is necessary, not only for the good performance and equity of the system, but also to achieve universal health coverage. However, in practice, more than two billion people do not have access to the medical products they need, especially in middle- and low-income countries.

When there is also a humanitarian crisis, health sector actors face additional challenges to ensure the availability of quality medicines. In these contexts, local market regulation is often deficient and importation is fraught with administrative, logistical and technical obstacles. Even when medicines are made available, it is difficult to ensure proper use.

In low- and middle-income countries, even after overcoming barriers to accessing health services, people encounter numerous problems in obtaining the medicines they need.It is estimated that more than half of the drugs prescribed to them are not available at public health facilities. As a result, patients must go with their prescription to buy them out of pocket at prohibitive cost, in environments where around 15% of the drugs on the market are of poor quality or counterfeit. This particularly penalizes those with the least resources. This problem is further exacerbated when there is a high proportion of inappropriate prescriptions. The WHO estimates that 9.5% of all spending by the poorest families in middle- and low-income countries goes on medicines.

Public investment in essential medicines is needed. It is recommended that countries determine a national list of essential drugs. 
The public financing (and with international collaboration in some cases) of these drugs allows them to be included in the benefit packages and the different prepayment and health insurance schemes available in the country. This also contributes to reducing the population's out-of-pocket expenses as much as possible.
WHO is collaborating with other partners to develop solutions for shortages and stock outs of medicines. 
Efficient medicines supply systems are integrally linked to strong health care systems. Adequate human resources, sustainable financing, comprehensive information systems, and coordinated healthcare partners and institutions are key components to ensure uninterrupted availability and accessibility of essential medicines. Long term supply strategies are absent in many countries, especially in sub-Saharan Africa.

WHO has developed tools to assess the medicines supply management systems in countries in a drive to identify strengths of the system on which to build, and weaknesses to be addressed to improve the system. WHO provides guidance and advocates for secure and efficient medicines supply systems to improve availability of and access to essential medicines.
The Medicines Management Cycle illustrates the main steps of effective management of medicines supply: selection, quantification and forecasting, procurement, storage, and distribution. Improved access to medicines can occur when rational selection, affordable prices, reliable health and supply systems, and sustainable financing are present.

A reliable health supply system will:

Integrate supply management into health system development;
Develop an efficient mix of public-private partnerships;
Maintain medicines quality in distribution channels; and
Ultimately increase access to essential drugs.