The country's hospital system is set to experience shortages of blood, serum and
drugs, including antibiotics, following lengthy delays in the awarding of procurement
contracts.
The lucrative contract to supply the country's drugs had been held by the well-connected
Sokimex group, but was put out to tender following donor pressure on the Ministry
of Health (MoH).
But the lag in approval within the MoH and the Ministry of Economy and Finance (MEF)
has meant delays in supplying drugs are likely in the first quarter of 2003. Health
experts warned the country could face significant problems if there was an outbreak
of dengue fever or cholera.
The MEF has moved to cut some of the expected shortfall by authorizing on December
31 the release of a further half million dollars for emergency procurement of drugs.
Dr Te Kuy Seang, director-general of administration and finance at the MoH, said
the extra funds would be drawn from the health ministry's 'Priority Action Plan'.
Richard Veerman, country head of health NGO Médicins Sans Frontières-Holland
Belgium (MSF), said that supplies of around 30 to 40 drugs, including penicillin
and paracetamol, were set to run out in the first quarter of the year in Sot Nikum
in Siem Reap district. The NGO works there with the referral hospital and 17 health
centers.
"Normally we receive our first quarter supply around this time, but we understand
that the central medical store is quite low," he said of the MoH body that distributes
drugs around the country.
Veerman added that MSF would likely buy in drugs from Europe, but was hopeful the
MoH would solve the problem without the need for external assistance.
Dr Te said the depleted stores would have particularly adverse effects if there was
an outbreak of dengue fever or cholera in the next four to five months.
"The infusions are very important," he said. "If there is an outbreak
of dengue or cholera, then we [will] have a real problem."
The 'infusion sets', which are used to rehydrate patients and deliver intravenous
drugs, are to be supplied from Thailand by Cambodian importer Suoy Chheng Company.
The Cambodian-based importer is one of two companies that won the right to supply
around $8 million worth of drugs and other equipment to the health ministry for 2003.
The award of the contract to the two companies marked the first time competitive
tendering was used, and followed pressure on the MoH from donors to end Sokimex's
monopoly.
"Many donors had been keen to see a change as a principle because open bidding
is supposed to be a better system," said Maurice Hours of UNICEF, which supports
the MoH's Essential Drugs Bureau, the body that determines the country's drugs requirements.
Dr Te said the previous system did have some benefits.
"Under the monopoly system the price was very high, but there were advantages
- they could meet supply very quickly," he said.
Tenders were advertised in May 2002 with bids opened and evaluated by the MoH in
September. Approval by the MEF took another six weeks, and final contracts were signed
on December 5. The contractors have been given up to ten months to deliver the supplies.
Dr Te blamed a lack of experience on the part of both ministries for the delays but
said he was confident the companies could bring forward their deliveries to alleviate
the problems.
"Most of the shortage can be filled by CPE," said Dr Te referring to a
local manufacturer Cambodia Pharmaceutical Enterprise, which is a joint venture between
the MoH and a Chinese company.
"For reagents [essential for testing blood] I have written to the company three
weeks ago and asked them to bring forward their delivery," he said. "If
the supplier has goodwill, then they will provide the supplies".
The MoH had also called on donors, NGOs and international organizations to help.
UNICEF had said it would supply some low dose vitamin A capsules.
UNICEF's Hours said policy at the country's 75 "Operational Districts"
meant they were expected to maintain sufficient supplies.
"Many ODs have three months stock, so where the system is working well they
should be able to mitigate the effects of the shortage," he said.
