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an obstacle to access to health care

Author: Luz Alarcón C.

Mautino Bonifacio, 70, leaves his home in San Juan de Lurigancho for Archbishop Loayza Hospital in search of the relief of his respiratory illness.

In a medical center he is diagnosed with chronic bronchitis and prescribed three drugs. More well, Mautino goes to the SIS pharmacy and while waiting for his order, the pharmaceutical technique confirms the remedies "so they do not come in line for clean", according to RepublicHowever, his surprise was great when his SIS pharmacy gave only one of three prescription drugs. "All life is the same. They always say they do not have them, and if they do, they only give you the cheapest pill," he said in a dialogue with this newspaper.

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Obviously it was so. Republic He found that the only drug given to Mautin was amoxicillin 500 mg, which costs S / 1.00 in pharmacies near the hospital. However, the cost of the medications not delivered is even higher. A 75 mg tablet of diclofenac costs S / 5 each, which is S / 55 for the treatment of 11 tablets. In addition, the third drug, Hedilar in the syrup, costs S / 22.50.

Taking the bills, the costs of treating Mautino S / 89.50, of which the insurance pharmacy covered only 13%.

Mautino is not the only case. Everyday, many patients decide not to come back because their doctor sets up a diagnosis, but when they do not get access to medication and can not afford it in private pharmacies due to lack of money, they are still not recovering.

Others even consider it unnecessary to relocate from their homes to the hospital and rather go directly to the nearest pharmacy, but there is another problem: the pharmacies and drugstores offer drugs up to 10 times more expensive than generic medicines, as demonstrated by a recent study on Manipulation in Supply drugs "that Oxfam, AIS and RedGE did.

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Given the lack of knowledge of the effects of medicines in healthcare treatments, it is easy to encourage a branded drug to be consumed, with the excuse that "others do not affect you".

There is already a blueprint promoted executive that private pharmacies and pharmacies offer generic medicines. But the foundation of the problem, as many experts say, is the lack of public hospitals.

José Silva, President Association of National Pharmaceutical Industries (Adifan) said the lack of hospitals was associated with a low budget execution in medicines. "This execution only reaches 16.5% in the middle of this year, when it should have been at least 50%," he said.

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On the other hand, Hernán Malpartida, director of corporate affairs InRetail Pharme, noted that the problem of access to health in Peru has structural sources that, in order to resolve, require important reforms to strengthen the government.

"Only joint and coordinated work between the state and the private sector will enable us to improve and develop the health system in the country. As we all know, it faces great challenges, especially for the attention of the sector with lower resources," he added.

Why is there a shortage? Dean of Pharmaceutical Chemistry College in Peru, Marcial Torres, explained that since 2008 executives of the state as a whole have performed an annual request based on a list of medicines they have made Main Directorate for Medicines, Inventories and Medicines (Digemid).

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This list is sent to the National Center for Supply of Strategic Resources in Health (Cenares), which combines call forwarding information.

"In June 2019, entities are in the process of programming for 2020, which consists of defining items and quantities. Digemid provides a list of necessary medicines. Cenares unites and announces the contest in December. Then, in February, she gets a good job-seeker. And that is from May to June when the first deliveries were made, Torres explained.

In this waiting process, approximately four months of shortage is generated and this first call does not guarantee total purchase, only 70%.

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"To provide the other 30%, before Cenares makes the second call, now no longer, as this means opening a new file and a delay of four months. At present, this process is the responsibility of each Directorate of Integrated Health Network (Diris) or the Regional Health Administration Diresa.) And if there is still a deficiency, in the third case, that is the answer to each hospital", Torres detailed.

He added that the state has an annual program drug system that does not allow timely decisions. While private pharmacies, and even public in other countries, make a real-time replacement.

"The state envisions spending from one year to the other, we need to look at the fluid system, a new drug procurement framework. The public tender is very complex and takes a lot of time to buy," he said.

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Torres pointed it out Pharmaceutical Chemistry College They have proposed a special drug purchase law that allows the use of several procurement methodologies.

The proposal consisted of a framework agreement similar to that currently in force for the purchase of office materials, which, in contrast to a public bid requiring a single-supplier purchase, selects more than two vendors to purchase directly, different times and with fixed expenses.

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This would avoid annual programming and each executive agency would deliver different suppliers according to each spending history. In addition, several vendor options will be available.

Torres recalled that since 2014, the Ministry of the Economy and Finance has ordered all sector revenues to be in one account. However, many hospitals use resources for other contracts with service providers or other aspects, not for drug procurement.

As for the Inclusive Medicine Act, the measure proposed by some laboratories, he said it was approved in 2014, but only the private sector allocates what can not be met in the state.

Lack due to lack of public execution
Lack due to lack of public execution

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