A bit of policy humor (or why I wont use government drugs)

Dispensing with those ghastly p and R-squared values, and other such professional writing etiquettes and verisimilitudes, I am going to write about my learning from my work related to public drug procurement in this post.

Just for laughs, I am going to put my thoughts in a way that I usually would in an academic journal/ policy brief but will also include what I am actually thinking (italicized).

Learnings:

1. Autonomous administrative structures may accord for faster decision making, faster vendor payments, merit-based staff recruitment and perceptibly improved outcomes

(If you free up people who sometimes try to work (bureaucrats) from the people who pretend to think about trying (politicians), then things get done faster and better)

2. Length of payment cycles has an inverse correlation with the (positive) variance of procurement price compared to national and international reference prices

(Pay your bills on time to get your stuff at cheaper rates!)

3. The political structure of a state has some pronounced effects on procurement. Contexts of the states need to be well evaluated before embarking on a particular procurement model/ changing the existing practices

(Red tape is NOT the tape that holds a nation together. If a Health Minister insists that his wife’s brother-in-law should be awarded majority of the supply contracts then setting-up an autonomous agency would probably help the public interest. )

4. Eliminating wastage of drugs, caused by mishandling or expiry, is necessary to optimize expenditure and ensure availability. The current investment in storage infrastructure is negligible. Regional warehouses/ drug depots and drug stores in the hospitals need to comply with storage norms

(Medicines should NOT be stored in unused lavatories, assorted fungi should NOT be growing inside IV bags, employees should NOT store their lunch with ELISA Kits & high-value antibiotics in the refrigerators)

5. Real-time stock monitoring and scientific methods of demand estimation and forecasting are critical to minimize wastage, optimize expenditure and ensure availability

(Adding 10% to previous year’s demand is not estimation, its mental retardation)

6. Analysis of time series data of L1 – L6 bidders for all the drugs in a state’s essential drug list data indicates formation of supplier cartels.

(If you notice that most of supply contracts are going to the health minister’s wife’s brother or transport minister’s son-in-law or cabinet secretary’s nephew, you need to wake up)

7. The procurement agencies should mandate external quality testing protocols, preferably double-blinded, and ensure that material dispatches occur post quality testing.

(How much of weed must one smoke to accept an internal quality certificate provided by the manufacturer as the quality standard? In case you are wondering, there are some weird states that only do quality testing on those batches only if adverse drug reactions are reported – Essentially, the first response and the last option are the same! )

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