Patients at the National Hospital and other major state hospitals are reportedly being asked to buy basic surgical supplies from outside pharmacies because items including crepe bandages are in short supply. After everything Sri Lanka’s health service has been through, this should be the easiest problem to solve. Apparently it isn’t.
There are complicated problems in healthcare and there are problems which ought not to be complicated at all. A shortage of crepe bandages at some of Sri Lanka’s major hospitals falls rather firmly into the second category.
Patients at the National Hospital in Colombo and other major hospitals are reportedly facing shortages of basic surgical supplies used for wound dressing, post-operative care and orthopaedic treatment. In some instances patients are being asked to obtain the required items from outside pharmacies.
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The immediate inconvenience is obvious, but the human consequence deserves rather more thought. A patient who has already reached a government hospital because he or she cannot afford private treatment may suddenly be told that an item needed for that treatment has to be purchased outside. For somebody accompanied by relatives that may mean an irritating trip to a pharmacy; for an elderly or seriously ill patient who has arrived alone, it can become a considerably greater problem.
The shortage has been attributed to delays in the Medical Supplies Division’s procurement process, while mechanisms which allow hospital directors to purchase essential supplies locally are intended to provide a means of dealing with temporary shortages. That makes the question of why shortages are nevertheless reaching patients all the more relevant.
This is not happening because Sri Lanka has suddenly discovered that hospitals require bandages. The machinery for forecasting, purchasing and distributing these extraordinarily basic products plainly exists. The question is why it has apparently failed to ensure uninterrupted availability where the supplies are actually needed.
Nor can the wider procurement problem have come entirely as a surprise. The Government has already acknowledged procurement challenges affecting the uninterrupted supply of essential medicines and surgical consumables and has sought alternative mechanisms for obtaining urgently needed supplies.
That makes the present shortage worth examining beyond the question of whether a particular hospital can find another box of bandages tomorrow. Sri Lanka has spent years discussing pharmaceutical procurement, emergency purchases, regulatory failures, shortages, excess stocks and expired stocks. Somewhere inside that enormous system there must surely be room for the unremarkable achievement of ensuring that a hospital has enough material to dress a wound.
The issue is not that shortages can never occur. Forecasts can be wrong, suppliers can fail, tenders can be delayed and consumption can unexpectedly increase. A functioning supply system is judged by how quickly it identifies such failures and moves stock or purchases replacements before the problem reaches the bedside.
There is a particularly uncomfortable contradiction when a state hospital can provide doctors, nurses, operating theatres and sophisticated equipment but leaves a patient searching outside its gates for something as elementary as a bandage. The cost of the missing item may be relatively small; the message it sends about the management of the system is considerably larger.
Sri Lanka’s public health service remains one of the country’s most valuable institutions precisely because treatment is supposed to be available irrespective of a patient’s ability to pay. Every time patients are sent outside to purchase something necessary for their treatment, however inexpensive, a little piece of that principle is chipped away.
This therefore requires more than another explanation that procurement has been delayed. The Health Ministry should establish exactly which hospitals are short, how much stock is required, why the shortage occurred and how quickly normal supplies can be restored.
We are not talking about some experimental cancer drug costing thousands of dollars a dose.
We are talking about a bandage.Be that as it may.
