Occupied Palestinian territory | News | Gaza: concern over ongoing shortage of essential drugs and disposables, August 2011

Gaza: concern over ongoing shortage of essential drugs and disposables, August 2011

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As of the end of August, approximately one third of the items in the essential drug list (156 out of 480) and 27 percent of the medical disposable items (186 out of 700) were at “zero level” at the Central Drug Store (CDR) in the Gaza Strip. This means that stocks are depleted to less than one month’s supply, whereas a three-month stock at the CDS level is considered necessary to guarantee continued health services. These shortages directly affect the delivery of health services at facilities run by the Ministry of Health (MoH), which provide 40 percent of primary health care (54 clinics) and 80 percent of hospital care services (13 hospitals). Among the main types of drug items currently at zero stock are anti-infective drugs (22 percent) and cancer drugs (12 percent). Shortages in the latter may increase the need for referrals to outside hospitals, resulting in an increase in the MoH’s expenditures for each cancer patient by some 400 percent.

The procurement of drugs and disposables for all MoH facilities in the oPt is carried out centrally in the West Bank; the pharmaceutical suppliers deliver the medications to the CDS in Ramallah, from where they are distributed to other MoH storage or health care facilities, including to the CDS in Gaza. 

While the shortage of drugs is a chronic problem in Gaza, the depth of the seriousness of the shortage has increased over time: in 2006, the average of drugs at zero level was 14 percent of the list, while in 2010 it stood at 23 percent, and, so far, in 2011 it is at 33 percent. 

The MoH in Ramallah cites budgetary restrictions as the main reason for the drug shortages, as pharmaceutical suppliers become more reluctant to deliver when there is a backlog of outstanding payments. The political rift between Fatah in the West Bank and Hamas in Gaza has also affected the operations of the Palestinian Authority in terms of disrupted communication, planning and sharing of resources. However, the fact that drug shortages existed prior to the split between the two authorities points to the existence of deficiencies the supply and logistics chain.14 The shortages may be partially attributed also to the increase in the number of items on the essential drug list,15 at the same time as demand has increased due to a growing population and the opening of new health facilities.

Accessibility and affordability to essential drugs is a key component of the right to health of a person. For poor households, the out-of-pocket purchase of medicines is often their largest health care expense and absorbs a high percentage of household income. While the impact of drug shortages may not be detected immediately, the unavailability of essential medications in government clinics negatively affects personal and community health and well being, despite people’s coping mechanisms. Patients who cannot find their medication in the MoH may try to obtain it, or an alternative to it, from other sources, such as UNRWA clinics or NGOs, or may hoard medicines when they do find them available. UNRWA clinics have noted in 2011 that there has been a noticeable increase in the consumption of specific drugs for hypertension and diabetic patients. Other patients who cannot utilize UNRWA services might skip their drug dose or buy it from the private market.

Monthly expenditures for patients with common chronic diseases can be a substantial financial burden for poor families if they have to buy prescriptions on the private market. A diabetic patient, who requires insulin as their line of treatment, must spend NIS 200 or more every month, while patients who depend on blood sugar lowering agents will pay from NIS 40 to 120 according to the type and the dose of drug. Patients who use lipid lowering agents, usually the elderly, will pay from NIS 50-70 monthly to buy their medications. Asthmatic patients will pay NIS 24 for a common inhaler. In July, medical care in Gaza increased by 2.3 percent, and was the higher major expenditure group for Gaza households, according to the consumer price index for the month.

You can access this text in OCHA Humanitarian Monitor, August 2011, page 6 and 7