KUALA LUMPUR, June 17 – The Ministry of Health (MOH) yesterday released a guideline to streamline the process for government health care facilities to loan medicine supplies to private clinics or hospitals, three days after Health Minister Khairy Jamaluddin announced the policy.
According to the 10-page circular sighted by CodeBlue, the guideline aims to clarify and standardise the procedures for managing the supply of medicines requested by private health care facilities from health care facilities run by the MOH during an emergency, crisis, or disaster, following the minister’s June 13 statement on the issue of drug supply disruption in Malaysia.
The June 16 circular by Rohana Hassan – deputy director of the pharmaceutical management branch of MOH’s pharmacy practice & development division – cited remarks from local pharmaceutical suppliers, as published in CodeBlue’s June 2 report, that attributed the current reported medicine shortages in private clinics, hospitals, and pharmacies to global factors outside Malaysia’s control.
MOH’s standard operating procedure (SOP) on medicine stock loans will be automatically revoked if a new federal order is issued to cancel the drug supply order to private health care facilities.
“Medicines” in the MOH guideline refer to medicines listed in the MOH Medicines Formulary (FUKKM) and those not listed in the FUKKM. These medicines include both registered and non-registered items under the Drug Control Authority (DCA) that are kept as stock to treat emergency cases.
The FUKKM is the main reference list of medicines provided in MOH clinics, hospitals, and institutions. FUKKM is used to control and promote the rational and quality use of medicines in all MOH hospitals, clinics, and institutions to avoid any wastage in drug procurement.
MOH’s medicine loan guideline also defines an “emergency” as a dangerous or serious situation that occurs suddenly or unexpectedly and requires immediate action to avoid dangerous consequences such as death.
“Crisis” is defined in the MOH guideline as unexpected situations with life-threatening effects on patients, while a “disaster” is a sudden event such as an accident or natural disaster that causes great damage or loss of life.
“Head of department” refers to the head of department or district health officer who has been delegated by the controlling officer.
“Chief pharmacy officer” refers to the deputy director of Kuala Lumpur Hospital (TPHKL), chief pharmacist (KPF), or pharmacy officer (PEK).
Work Process For Lending Medicines To Private Facilities For Use During Emergencies, Crises, and Disasters
To initiate the loaning process, the head of department must first receive a written application for a medicine loan from the applicant (private facility) and submit it to the logistics pharmacy unit (UFL).
A pharmacy officer will then examine the application and submit a proposal to the head of department for approval, taking into account the situation of the application submitted by the applicant, availability of stock at government facilities, that the remaining stock of medicines is sufficient for use of daily activities at government health facilities, that the medicine is returned according to the same quantity and brand (although other brands may be considered), and the agreed return period.
Upon receiving the proposal, the head of department will consider approving the lending of requested drugs to the applicant (private facility).
If the loan application is not approved, the pharmacy officer will inform the applicant.
If the loan application is approved by the head of department, the pharmacy officer is required to update the production record on KEW.PS-7 and stock registration card (KEW.PS-3) before supplying the stock to the applicant.
The applicant can then proceed to receive the medication stock and the KEW.PS-7 confirmation receipt.
The pharmacy officer is responsible for monitoring and ensuring that the loaned stock is replaced by the applicant.
Work Process For Return Of Medicines From Private Facilities
For the return transaction, the head of department must first receive written notification of medicine stock return from the borrower (private facility) which will be submitted to the UFL.
The issuing unit or pharmacy officer will then receive a letter or delivery note from the borrower (private facility).
Upon receipt of the returned items, the pharmacy officer will inspect and identify the goods received, ensuring the items are in accordance with the delivery note and the agreed product specifications.
If the returned goods comply with specifications, the borrower (private facility) will receive a confirmatory receipt on the letter or delivery note from the pharmacy officer. The “Lengkapkan Borang Terimaan Barang-Barang” KEW.PS-1 form should be filled.
If the returned medications do not comply with specifications, the pharmacy officer can reject the returned items and inform the private facility. The “Lengkapkan Borang Penolakan Barang-Barang” KEW.PS-2 form should be filled.
No further instructions were given in the MOH guideline about returned drugs that are rejected for not meeting specifications.
Private hospitals and clinics in Malaysia typically have their own pharmacies, separate from community pharmacies. University hospitals under the Ministry of Higher Education also run individual pharmacies separate from the MOH.
MOH’s pharmacy practice & development division noted in its circular to the deputy director (pharmacy) at HKL, the head of the pharmacy department at the National Cancer Institute, and to deputy state health directors (pharmacy) across the country that this was not the first time that private health care facilities have requested to borrow medicines from MOH.
“Previously, private hospitals have made requests to borrow medicine stocks,” said Rohana.
She cited incidents in the past like life-threatening emergencies involving the need for life-saving medications such as antidotes, antitoxins, antivenoms, and intravenous immunoglobulin (IVIg), among others.
Other incidents when private hospitals asked to borrow medications from MOH include flood disasters that disrupted drug supply, a crisis in supply during extraordinary infectious disease outbreaks, and medicines that are not registered by the DCA and require special medicine import approval from the Health director-general.
A private children’s clinic in Miri, Sarawak, pleaded last week for assistance to borrow medicine supplies from Miri Hospital, after most of its paediatric medications ran out, including salbutamol syrups to treat asthma attacks.
CodeBlue reported Tuesday an anonymous account from a procurement pharmacist working in a private hospital outside the Klang Valley about the dire medicine shortage at her facility, affecting not just respiratory-related and paediatric medications, but also crucial drugs to treat psychiatric or neurological conditions like epilepsy and anxiety.