HSA’s pharmacy services under the microscope in accounts committee hearing

The content originally appeared on: Cayman Compass

The Public Accounts Committee will hear testimony in relation to an auditor general’s report on the Health Services Authority’s outpatient pharmacy services, on Wednesday and Thursday.

The report released in November 2021 was critical of government’s procurement work, given nearly $9 million is spent per year on medicines.

The Office of the Auditor General “found significant deficiencies” in the contract provisions for suppliers, which did not ensure fixed prices or best value for money. Some of these challenges already existed in a previous procurement exercise in 2017, “but HSA did not appear to have learned lessons from that”, Auditor General Sue Winspear said in the report.

According to the findings, the process was started far too late in 2019, at a time when contracts with suppliers were due to expire. The business case for the procurement was equally late, did not appraise the available options well and the evaluation of the tenders took too long.

By the time the tenders were received, Cayman found itself in the middle of the COVID-19 pandemic. This in turn affected supply chains and prices that suppliers were able to commit to, the auditor general said.

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Although the procurement was cancelled at the vendor evaluation stage and relaunched in 2021, Winspear said existing contracts that do not ensure value for money have been extended multiple times until March 2022.

The prices of pharmaceuticals in Cayman have been rising faster than the average pace of inflation. In the third quarter of the 2021, pharmaceuticals were 7.2% more expensive than in the previous year, after prices had already increased by 6% in the previous 12 months, according to the Economics and Statistics Office’s consumer price index.

In addition to the procurement issues, the report noted that the underlying legal framework, the Pharmacy Act, has not been updated since 1979 and is outdated.

There is no government strategy or plan for pharmacy services or a formal performance management framework in place to monitor how services are provided.

Despite these gaps, the report said, the HSA has managed to establish standards for the selection of medicine to ensure the safety and high quality of medicines.

The pharmacy’s inventory systems have also improved and resulted in falling rates of expired or out-of-stock medicines.

While the report highlighted that the HSA provides good quality pharmacy services, it said more can be done to regularly measure and report on performance, including customer waiting times and general customer satisfaction.

On Wednesday, the PAC will hear from the chair of the Pharmacy Council Dr. Marla Barnes, Chief Officer in the Ministry of Health and Wellness Nellie Pouchie and Deputy Governor Franz Manderson.

On Thursday, the committee will direct questions to HSA officials, including Acting Medical Director Dr. Courtney Cummings, Chief Pharmacist Colin Medford, former chief financial officer Dawn Cummings, interim CFO Ronnie Dunn and CEO Lizzette Howell.

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