The essential drug list and health service outlets

Tuesday, February 12, 2008

We understand that with the assistance of WHO, senior level health service providers in the Maldives drew up and occasionally update a list of medications and consumables under the broad heading of Essential Drug List. Its been several years since the list was first created and the list has not been updated for a few years now.

The Essential Drug List names medications and consumables that are to be made available, as a prime responsibility of the Ministry of Health, at all health service outlets across the country at all times. These are basic requirements that need to be in place at all centers regardless of the geographical location within the archipelago. Recently we read about several hospitals and health centers running out of medical oxygen. When we were investigating the story we found out that many of the health posts and health centers that we were able to contact, also had some of the essential drugs missing.

Haa Dhaal Maavaidhoo has a health post but no doctor and no medications. The community health worker is unable to manage anything, even under the advice of properly trained doctors who he reaches by phone for assistance. Maavaidhoo health post is left decapitated because of lack of proper health service personnel. The island recently made the news in Maldives when few of its residents protested against the health conditions on the island.

Haa Alif Ihavandhoo has a health center and 2 small pharmacies managed by local businessmen. Recently, patients had to be transfered to Haa Dhaal Kulhudhufushi and Haa Alif Dhihdhoo because the doctor in the island said that he was unable to treat the cases because he had nothing more than Penicillin injections and some over the counter pain medications available for use. One case of epilepsy was transfered because they ran out of Diazepam. No routine anticonvulsant therapy was available.

We can also confirm that in moth Raa Alifushi and Rasgatheemu the health posts were until recently running on very little amount of medications. An asthmatic in Alifushi was referred to Ungoofaaru regional hospital because there was no ventolin in the island. The elderly patient had been keeping a stock of his own medications but ran out just at the time when his asthma had worsened. He survived the attack and has brought back a good stock of ventolin with him to Alifushi. Ventolin is listed on the Essential Drug List.

One young doctors from Alif Alif Rasdhoo atoll hospital reported to us that he and his colleagues receive calls from nearby islands when they are requested to take charge of cases because the doctors in the health centers don't have simple antibiotics to manage infections. The doctor fears that even mentioning his gender endangers him being identified as there are only four doctors working there including a gynecologist.

In Thaa Atoll Burunee the recently upgraded health center also reported a dire lack of medications and IV fluids. Sporadic cases of Dengue fever are seen in the island, especially among the Tsunami refugees. Not having IV fluids of the type needed in Dengue, the station doctor was unable to manage cases as best as possible.

These are some cases where we were able to identify issues of availability of even the essential drugs for basic health services. We wonder how many other islands and health centers would have similar problems. Even maintaining a supply of medications that MoH itself has declared as basic necessities for health service provision is not guaranteed.

We are also concerned about the lack of health service providers in a large number of islands. We do understand that MoH has made a renewed commitment to ensure that doctors are placed in many of these previously neglected island. This is promising, however, it comes to us as no surprise that many of the doctors currently working in the islands are mere novices who graduated from basic medical training less than 6 months before joining the Maldivian health sector! Their ability to work exclusively on their own in the very demanding conditions is highly questionable. This compounded with lack of medications and investigative capabilities leaves them and the public exposed to sad outcomes that we often hear about.

We ask the public to pressure the authorities to ensure that a basic health service guideline be established and minimal standard of health services to be provided to the islands be established. The Essential Drug List needs to be updated and provisions kept in place to ensure that all health facilities including the very basic ones have a ready supply of these medications.

108 comments:

Anonymous said...

congratulations MMW!
Finally an article that deserves it!
After a series of tabloid stories at IGMH and biased articles i read this article with interest and sympathy.
It is true that most of the islands dont get Diazepam inj, streptokinase inj and recent i/v antibiotics.
leave the defibrillators but simple devices like Pulsioxymeter are not even available to the people living in islands with health centers.IGMH of course gettin all this resources hand staff have not fulfilled our peoples needs...
Take a minute People!!..think about the people in the islands...how much they suffer??and for how long becos of transport difficulties to the mainland...
Mind you it is the Ministry of Health, Dept of Medical Services that has decided that all the doctors coming back from MBBS not spend even 3 months here in Male' be sent to an island..They decide the essential drug list.So dont blame the doctors or nurses.
The population is gettin more civilised. Our goverment needs to broaden the facilities and services to these islands not just merely by puttin a "health center" name board instead of a "health post"...this is a very crucial issue..i am glad MMW took it into account..cos if you were livin in an island and you get sick,Believe me..you'd say "oh god, i wish i was in Male' at least i'll get my basic labs done!"

virionx said...

I agree island health facilities leave a lot to be desired. Atleast compulsory service in islands for new doctors is a positive step, even though the duration and exactly how this is to be done is debatable. I can think of a few influential people who had intervened to avoid or make their son or daughters' tenure at the islands shorter.

It is sad that doctors crib the most about health facilities in islands and they try their best to avoid them.

Apart from providing islands with doctors this also helps boost the confidence of the new doctors after internship in which they are under constant supervision. I feel after one year of internship they should be able to tackle problems in the islands atleast at the initial phase and they would have constant advice form doctors in IGMH.

Isnt it amazing that compared to islands the service we kept on criticizing in IGMH suddenly seems like heaven? Like I said the grass is greener on the other side.

Talking about essential drugs what exactly is the pharmaceutical board doing? Whats their role in this? I wonder...... We certainly are not seeing any guidelines or policies.

Anonymous said...

I think we should consider here that it will be difficult to establish good quality health services to all the islands because of scattered nature of Maldivian islands.
Its nice that you brought the topic of essential drug here. I think WHO has formulated this concept as a tool for providing health services to the most rural outreach areas. Its a shame the doctors in the islands do not have the access to this minimal basic drugs in the essential drug list. Even if the doctors are trained enough to practice independently if there are no adequate supplies I don't think it'll do much good.

Any way I don't think that health of islanders is in the top priority list of our government today.

Anonymous said...

last anony..ure right!!the docs here are trained abroad in hospitals to manage cases with a team well equipped and even after the best education n training u cant expect these people to "perform their duties without much problems"..after all they are sent to an "HEALTH ICE AGE" not "JOHN HOPKINS Hospital"...its time they think about sending consultants rather than MBBS...then only they will know the difficulties they face..becos rather than Medical Officers the islanders also prefer to have a consultant when they have a heart attack!!..

Anonymous said...

Are u saying that MOs cant manage a hart attack? shame shame.

Anonymous said...

In the best of the countries the resources are limited and thus distinction between primary care and tertiary care is maintained.

So should we send the few consultatnts we have to the islands and left our tertiary centre dry?

virionx@hotmail.com

Anonymous said...

oh leave the streptokinase apart, i had severe gastritis in one of my island trips, and i couldnt get a tablet of rantac, waited all night, for morning to come, so can sent someone to another island to get it.

Anonymous said...

DID not say "cannot manage"...but said they would PREFER...who wouldnt???especially since the immediate drugs/services are not even available!!
and of course didnt mention about sending the existing consultants to islands...but notified that there is an increase in the demand..even if we have to bring them from India/US/Nepal its time they should!!

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