Important questions have been raised regarding the financial performance, price differences and quality monitoring of the existing procedure for purchasing medicines, medical equipment and other essential medical supplies under the Sehat Card Plus programme in Khyber Pakhtunkhwa.
A report on the procurement system of the programme has revealed that hospitals affiliated with Sehat Card Plus purchase medicines and medical supplies used in large quantities independently, due to which the potential savings available through the government’s centrally established procurement system are not being utilised.
The report has recommended linking the procurement of medicines, medical consumables and medical equipment under the Sehat Card Plus programme with the Khyber Pakhtunkhwa government’s central procurement system to ensure the provision of quality supplies at lower prices, effective use of public resources and transparency in the procurement process.
According to the report, medicines, medical consumables and equipment account for approximately 40 to 45 per cent of the total healthcare expenditure of the Sehat Card Plus programme. Despite the expenditure of a large amount on this category, the adoption of separate procurement procedures by different hospitals may create difficulties in maintaining uniformity in prices, quality and availability.
The report stated that hospitals affiliated with Sehat Card Plus generally obtain medicines and medical supplies from nearby medical stores, pharmacies and local suppliers. Discounts are mostly given importance when selecting suppliers.
However, according to the report, these discounts are often no more than 15 per cent compared to the listed market price. In contrast, the Khyber Pakhtunkhwa government’s central procurement system provides the facility to purchase medicines, medical equipment and other medical supplies in bulk directly from manufacturers and importers.
The report claimed that under this procedure, discounts of up to 70 per cent compared to the listed market price can be obtained on certain items. Meanwhile, the procurement process also gives importance to quality testing and compliance with relevant national and international standards. The report maintained that if procurement under the Sehat Card Plus programme is integrated with the existing government system, the cost of medicines and medical supplies can be significantly reduced. The money saved in this way can be used to provide facilities to more patients, introduce new medical services and improve hospital infrastructure.
The report recommended that formal agreements be signed between the administrative unit of the Sehat Card Plus programme, the Khyber Pakhtunkhwa Health Department and the insurance company to make the implementation of a central procurement policy possible for hospitals affiliated with the programme. For this purpose, it also recommended introducing an automated system through which hospitals could place orders for medicines and medical supplies according to their requirements, while ensuring their coordinated delivery.
According to the report, implementing a uniform procurement policy for all hospitals could help reduce differences in prices and discount rates among various institutions. In addition, uniform rules could be established regarding procurement standards, supplier selection and the availability of medicines.
The report also recommended amendments to the agreements signed with hospitals under the Sehat Card Plus programme. According to the report, conditions should be included requiring hospitals to benefit from sources that guarantee low costs and quality when purchasing medicines and medical consumables. Similarly, it proposed reviewing the agreement with the insurance company and introducing clear conditions to control procurement costs, so that programme funds could be utilised more effectively and unnecessary expenditure could be avoided.
The report also recommended establishing clear benchmarks for evaluating hospital performance. These benchmarks could include medicine prices, procurement sources, compliance with quality standards and financial savings targets. This is expected to help improve the accountability of hospital administrations and assess the efficiency of the procurement process.
The report also recommended introducing a digital audit system to monitor all stages of procurement. Through the proposed system, records of procurement transactions, supplier selection and prices could be maintained. It would also be possible to assess whether hospitals had selected suppliers offering low-cost and quality supplies from among the available options. Alongside this, the report proposed conducting independent audits through a third party to maintain transparency in the procurement process and ensure the timely identification of any possible irregularities or unnecessary expenditure.
The report also stressed the need to simplify procurement rules and approval procedures. The stated objective is to ensure that hospitals do not face unnecessary administrative delays in obtaining the benefits of central procurement and that essential medicines and medical supplies remain available on time.
The report estimated that the effective use of the central procurement system could potentially reduce procurement costs by up to 50 per cent. However, this is an estimate of the savings expected as a result of the proposed reforms, and the report has not described it as financial savings already achieved.
According to the report, linking with the central procurement system could help improve the supply of quality-assured and verified medicines, reduce risks associated with substandard products and improve the utilisation of public resources. As a result, the possibilities of providing medical facilities to more patients under the Sehat Card Plus programme could also increase. The report recommended that the Khyber Pakhtunkhwa government issue clear policy guidelines for the procurement of medicines and medical supplies under the Sehat Card Plus programme.
Under this, uniform rules should be established for all affiliated hospitals, while price, quality and transparency should be given primary importance in the procurement process. The report also considered coordination and consultation among the relevant stakeholders necessary so that responsibilities could be defined among the Health Department, programme administration, insurance company and hospitals, and the proposed reforms could be implemented effectively.
At the conclusion of the report, it was stated that reforms to the existing procurement system of the Sehat Card Plus programme are necessary to improve financial sustainability and the quality of medical services. Integration with the central procurement system, uniform rules, digital monitoring and independent audits could create opportunities for better utilisation of public resources and the provision of more effective medical facilities to patients.
