Manuel Vera, 44, was declared as insulin dependent, so since 2015 he has required this medication to control blood glucose levels. The option is to buy it with what he gets from his work as an external accountant, since it is scarce in the public health network, but in June of this year he did not find what he required in the distributors or pharmacies in Guayaquil that he visited.
Since he does not have his right foot, amputated in October 2019 from above the knee due to complications from diabetes, his neighbor is the one who helped him buy insulin. “There was no Novolin (one of the types) anywhere, I was already desperate because it has been four consecutive months that the IESS (Ecuadorian Social Security Institute of which Manuel has been a voluntary member since June 2019) has not delivered me,” he says.
In his case, they told him about a municipal program for diabetics that delivers medicines for free, which is why he has obtained them since July of this year. “Otherwise, my condition would have worsened,” he adds.
Complaints about the shortage of various types of insulin -a hormone produced by the pancreas and used by the body to allow sugar to enter cells and produce energy- also reach Fuvida, an organization that donates or sells supplies at low cost to families with a child with type 1 diabetes.
There are cases of patients who travel abroad to acquire it, such as Colombia. Aracely Bazurto, pharmaceutical chemist and president of Fuvida, reports on this and assures that the shortage in the private network is more noticeable as of May of this year. “It must be taken into account that insulin-dependents need two types of insulin, since they cannot maintain themselves with one, regardless of whether they are children, young people or more adults. They are three to four daily doses at least. Insulin is not Tempra or paracetamol, if you did not find them you can wait for the symptoms to pass, here it is life or death ”, she refers.
The shortage in the private network includes other types of drugs such as to treat hypertension, cancer cases and injectable Dolo-Neurobion.
Bazurto indicates that in the case of insulin there are three pharmaceutical companies that distribute it in Ecuador. “In the answers they have given me they tell me that they do not have stock. People with diabetes without treatment get complicated, go blind, have a leg amputated or go on dialysis, which costs $300 and they need three a week, that’s $3,600 a month, so not having insulin available generates a higher cost to the State ”, he manifests.
Demand is variable, since there are times when those with type 2 diabetes need to inject insulin because they cannot stabilize their glucose levels with oral antidiabetics, so this use is added to those with type 1 diabetes who, being insulin dependent, take them they always need to live.
Diabetes is the third cause of death in Ecuador with 5,564 deaths in 2021, a number only surpassed by deaths from COVID-19 and ischemic heart disease.
A pharmaceutical businessman, who prefers to remain anonymous, affirms that the problem in the public health network with some products is that they have not been tendered correctly or the reference prices are very low and the suppliers do not participate and do not dispatch them.
There are medicines that are required in certain treatments for diseases such as cancer. The liver and stomach are those that register the highest number of deaths in the country.
The Ecuadorian Ombudsman’s Office (DPE) began an analysis of the bottlenecks in the purchase of medicines in the public health network in which delegates from all those involved in the processes participated. This was about the protection action in favor of people who require these medicines in their treatments because they have diseases considered catastrophic, rare and complex.
Francisco del Pozo, provincial delegate in Guayas and member of the Commission that set up the DPE for the dialogue and technical tables, explains that many of the tenders for the acquisition are declared void because the bidders do not present their proposals. “They argue that they do not have stock enough or that the prices are not attractive enough, but they were not adequate to the deadlines either and one of the critical knots are the times due to the rigor of these public contracting processes”.
There is no difference in the purchase mechanisms for office furniture or materials such as desks or televisions, the same applies to the purchase of urgent medications. “That is not very sensible, it cannot be that medicine that is urgent because catastrophic illnesses do not wait, has the same contracting regime as movable property, they are processes that in the best of cases can last up to 45 days, but if there are challenges, it can be extended up to three more months.”
The analysis will conclude in a report to be presented by the DPE in which it will be determined that the pre-contractual phrase should not take more than 15 days and the contractual one no more than 30, in the acquisition of medicines, which can be achieved with a reform of the normative.
“The staff of the State Comptroller General’s Office must be reinforced so that their inspection task is in the same year as when the contract is awarded and that the challenge phase of the processes does not last more than fifteen days, which requires more personnel in the National Public Contracting Service (Sercop), that is the proposal”, says Del Pozo.
The acquisition is progressing so slowly that in the ninth month of the year (last September) the Ministry of Finance reported that 43% of the budget allocated for medicines in the public health network had been executed, according to information in one of the technical roundtables undertaken by the DPE.
Robson Castro, regulatory coordinator of the National Agency for Sanitary Regulation, Control and Surveillance (Arcsa), affirms that there are two mechanisms for importing medicines as natural or legal persons. The first is obtaining a sanitary registration of the product, according to Ministerial Agreement 385 of July 2019, which is the regulation for obtaining the sanitary registration of biological medicines.
The second is the one brought by exception established in Arcsa resolution 016 of July 2020, through which one that is not in the national market can be imported.
The natural or legal person who needs or requires to import a medicine must meet all the requirements, Castro clarifies, starting with having an operating permit as such. “In this case, there would be no inconvenience that a pharmacy, a company or a person could do the importation.”
The second import mechanism by exception was created with the purpose of complying with art. 144 of the Organic Health Law, which allows the availability of medicines for diseases considered catastrophic, orphan or rare. “These patients can have access whether they do it through a public health institution or in person with justified documents from their treating doctors, they present the request to Arcsa to bring it to the country, without it being registered (sanitaryly) in Ecuador yet ”, Castro maintains.
The authorization for the importation of a medicine by Arcsa can take up to five days, according to Castro, counted from the moment the request is submitted. “Everything also depends on the users presenting the complete and correct documentation. One of the mandatory requirements is that this medication has a health registry in its country of origin from where it is going to be imported with documents of good manufacturing practices, a medical prescription is also requested if it is for a specific patient and a report that the person has the specific disease in which it will be used.
If the medicine already has a health registry but there is no stock, the import process demands fewer requirements, since the product information can be verified in the national database. “In this case, they must present the complementary documents, such as the documented justification that the stock. This mechanism is appropriate for hospitals, in fact, when they do not have certain medicines they apply it to import”.
In the case of insulins, Castro refers to the global tension due to the war between Russia and Ukraine, which has impacted the flow of raw materials and medicines. “Then there is a lack in Ecuador of certain medicines due to the absence of raw materials. Interested parties can notify us to see if the applicants (for imports) have or do not have stock in their private facilities in the country, that is how we provide help.”
People can use a query mechanism by sending a e-mail to find out if the medicine is available or not within the country to the email atencionalusuario@controlsanitario.gob.ec. In this case, they will know if those who request the importation have stock, since other marketing channels are used to the public. (YO)
Source: Eluniverso
Paul is a talented author and journalist with a passion for entertainment and general news. He currently works as a writer at the 247 News Agency, where he has established herself as a respected voice in the industry.
