Terawan’s Wrong Prescription
Stocks of drugs for conditions not related to Covid-19 are under threat. The government failed to anticipate this.
AT a time when this nation is facing the chaos caused by the coronavirus pandemic, the people should be able to rest their hopes on Minister of Health Terawan Agus Putranto.
However, this has not turned out to be the case. The policies of Minister Terawan give the impression of not prioritizing the most urgent matters—and of seemingly creating new problems.
Since the first Covid-19 case was announced at the beginning of March, Terawan’s style of public communication that underplays the seriousness of the pandemic has caused confusion among the public. His decision to not release information about the number of people under observation and of patients under surveillance turned out to be a serious error because the small number of tests meant that the scale of the coronavirus threat in Indonesia was not accurately portrayed.
Investigations by Tempo over the last month have uncovered another problem caused by a wrong decision taken by the health minister. Supplies of drugs for conditions apart from Covid-19 are under threat of running out. Pharmaceutical companies have expressed concerns that their production will be unable to meet the demand from hospitals and other health care providers. Some lifesaving medicines such as anti-retroviral treatments for people living with HIV/AIDS are now difficult to obtain in many regions.
This problem began with the canceling of the drugs tender process at the ministry of health, the winners of which had been announced at the end of 2019. Claiming that he wanted to eradicate the drugs mafia, Minister Terawan then extended the contracts of the previous tender winners until the end of this year, without making any changes to procurement prices.
This policy has now boomeranged. Supplies have ground to a halt because of delays to tenders. The price of drugs’ raw ingredients, and the fact that the dollar exchange rate continues to increase as a result of the global pandemic, has led to soaring procurement prices. On top of this, the two main suppliers of drugs’ raw ingredients, China and India, have imposed lockdowns as a result of the increasing number of Covid-19 cases there. Around 85 percent of the raw ingredients of drugs produced in this country come from those two nations. It is not clear how Minister Terawan will overcome this problem.
There is more. At the start of this year, the health ministry returned procurement of drugs using the sectoral electronic catalog to the National Procurement Agency/Government Services (LKPP). This is despite the fact that February last year, the Corruption Eradication Commission (KPK), the LKPP and the previous minister of health, Nila Moeloek, agreed that the process would be completed within the health ministry.
The procurement of drugs using the sectoral catalog at the ministry of health was recommended by the KPK to reduce the potential for corruption and delays to tenders. Four years ago, the LKPP was forced to cancel tenders for drug procurement because there were so many discrepancies between the supply of drugs and the actual needs of health care providers.
Now Terawan’s decision has turned back the clock. It has not only lengthened the supply chain, but has also made it much more likely there will be shortages of drugs this year. Clearly the LKPP cannot organize tenders without either the Drug Requirements Plan or the National Formulary from the health ministry. These two documents are the basis for compiling the electronic catalog used as a guideline for pharmaceutical companies participating in tenders. This electronic catalog has yet to be published.
The delays to the tenders have led to the imports of raw materials and production of drugs being four to six months behind schedule. This is not a trivial issue: it is a matter of life or death. The spread of the coronavirus around the world, including Indonesia, means that those with serious conditions or in poor health are at higher risk of infection, or even of losing their lives. If the shortages of drugs worsen, the government could be accused of failing to protect the lives of its citizens.
This dire state of affairs would not have arisen had the government been more careful in calculating the impact of each of its policies. Minister Terawan’s plan to clean up the drugs industry deserves support, but it cannot be done in an arbitrary fashion, yet alone in a way that leads to new problems for the public. Improvements could begin by announcing Minister Terawan’s diagnosis of the current procurement system and the reasons why he feels it needs to be changed. Without transparency, a policy cannot be accountable, yet alone credible.
President Joko Widodo needs to intervene immediately to put right the policies of his aide. At a time when the coronavirus pandemic continues to spread, the government must act quickly to guarantee the supply of drugs. People must not lose their lives due to the government’s inability to do its job.