[e-drug] Sri Lanka - Most tsunami drug donations were useless & dangerous

[e-drug@healthnet.org]

E-DRUG: Sri Lanka - Most tsunami drug donations were useless & dangerous
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[This report from Sri Lanka concurs with the analysis of the Aceh situation after the tsunami (e-drug December 5 2005) As in the Aceh situation, it was the local donations that were most appropriate.  
The synthesis of the study on drug donations in the Province of Aceh in Indonesia is on the web site of PSF-CI, link :
http://www.psfci.org/new/uk/Medias/synthesis.pdf
There are clear recommendation towards the end of this message. Advocacy is still needed. BS]

Sunday Times (Sri Lanka) online
http://sundaytimes.lk/070225/News/106news.html
 
Sunday, February 25, 2007 Vol. 41 - No 39 

Most tsunami drug donations were useless and dangerous 

An in-depth study by the Health Ministry on the donation of drugs to the
country after the 2004 December tsunami has revealed that despite the great
expectations of the government that the country would benefit financially
and materially from such donations, they were more of a burden than a
benefit to the country .

The report said donations largely did not adhere to the internationally
accepted recommendations for improving the quality and efficiency of
drug/medicine donations in emergency situations and were in violation of
World Health Organization's (WHO) guidelines.

Research conducted by the Health Ministry's Medical Supplies Division
revealed that 43% drugs for tsunami victims belonged to the "non list"
category and 38% of drugs were never registered for use in the country while
50.5% of the total donations did not have expiry dates.

According to WHO guidelines, after arrival in a recipient country, all
donated drugs should have a remaining shelf life of at least one year. But
in this case, more than half (28 metric tons) did not have the expiry dates
while shelf life of (5%) of the products had expired or expired within a few
days of arrival. The balance had a year or more prior to expiry from the
date of arrival. Hence nearly 57 % were unusable from the date of their
arrival.

Contrary to this, donations purchased by local residents and organizations
after consulting with the Director Medical Supplies Division (MSD) though
small in quantity, had the required shelf-life, were appropriate to the
needs of the time the entirety of drugs were utilized. 

In addition over 90% of the donations that were sent directly on a
government to government basis were on the Health Ministry expressed list
and had the required shelf life.

Another violation of the WHO guidelines was regarding costs. It is accepted
procedure that costs of international and local transport, warehousing, port
clearing and appropriate storage and handling should be paid by the donor
agency but in this instance all local costs for handling, transport storage
were borne by Sri Lanka.

The costs incurred by international organizations to transport medicines at
collection centres overseas is also considered a total waste as 90% of these
donations were in the unusable category, the report states.

The cost incurred by the Ministry of Health to destroy the unusable drugs
-approximately 150 metric tons- amounted to approximately Rs. 2.6 million.

The report also criticised the behaviour of some of the donors stating that
many of them requested publicity for their donations and sought to be
photographed when handing over the donations claiming that this could be
beneficial to seek more aid from the country of origin.

The Report cites an incident where a Director of Health having provided
transport and refreshments to a particular donor, in addition to having to
pose for photographs, found to his dismay the expiry date of the
pharmaceuticals had passed and the entire consignment was useless. 

The survey was carried out between March 2005 to July 2005 and included
donations received and handled by the Ministry's Medical Supplies Division. 

Products having the same drug substance, in the same dosage form and in the
same strength irrespective of brand name and package size are classified as
a 'Unique Drug Product' (UDP). To determine compliance with the World Health
Organisation (WHO) Good Donation Practices Guideline the 2003 version of the
WHO Essential Medicines List, (WHO-EML) the Ministry of Health published a
list of needed drugs (MHO List) and the Sri Lanka Hospital Formulary List of
Medicines (HFL). 

Unfortunately a majority of the UDPs -over 80%- were unsolicited, came
unannounced and in unsorted boxes. Around 50% of the donations were
non-discriminatory collections of unused pharmaceuticals of private
individuals collected at various centres and transported via international
relief organisations. 

The stockpiling of unnecessary or expired drugs cluttered up storage depots,
resulting in a shortage of space for essential medicines. It is estimated
that approximately 20-30 metric tons of drugs were not appropriately stored.

The report also come out with recommendations to be made at three levels,
namely international, national and at the advocacy and information level in
order to avoid such a situation in the future.

The lack of initiative and courage by the government to refuse unsolicited
donations in spite of the growing knowledge that most of the donations were
inappropriate, is also seen as one reason for the flood of unnecessary items
to the country in the aftermath of the tsunami.

It is possible that unwanted donations may have been curbed if the media
also showed the international community some positive aspects of Sri Lanka
such as the good health care infrastructure thus guiding them on good
donation practices.

The report adds at least in the future, a policy for the receiving of
donations of pharmaceutical should be instituted.
The report ends with the words: ".given the bitter lessons learnt, our hope
is we will be as courageous as India and Thailand who rejected unsolicited
international help following the tsunami."

Suggestions to improve the situation 

Recommendations for improving the quality and efficiency of drug medicine
donations in emergency situations are detailed at three levels:

* International level: Implementation of the International guidelines and
regulations on Good Donation Practices, for international monitoring of drug
donations by WHO, NGOs and donor countries and to prohibit dumping
practices.

* Local level: MOH to include a national policy on pharmaceutical donations
in the National Drug Policy and have operational guidelines on handling such
donations.

* Advocacy and Information level: dissemination of the study results, and
organisation of awareness raising and campaigning activities for good
donation practices. 

* The majority of the UDPs (80%) were unsolicited, came unannounced and in
unsorted boxes. 

Around 50% of the donations were a non-discriminatory collection of unused
medicines of individuals collected on an ad hoc basis and transported via
international relief organizations including the International Red Cross
Federation. These donations were a mixture of many different brands mixed up
with other relief items.

43% of the UDPs belonged to the "non list" category (not listed in the MOH
list, WHO-ML)  HFL, Emergency Medicines Lists and 38% of the drug substances were never
registered for use in the country. Hence they could be considered totally
irrelevant, useless and at times dangerous. 

A large proportion of non essential medicines (80%) were irrelevant to the
emergency situation. 

62% of the pharmaceutical products were labelled in languages not understood
locally, 81% were without package inserts and 15% were without generic
names. 

Stockpiling of unusable and useless medicines cluttered up storage areas,
resulting in a shortage of space for storage of essential medicines. 

The monetary value of one donation as claimed by donors was equivalent to
approximately 50% of the public health drug budget and should have had the
purchasing power to supply 50% of the medicines on the Sri Lanka hospital
formulary. However total tsunami donations reduced the total drug budget for
the year 2005 by a mere 4%