Laghmanis forced to buy drugs from pharmacies

MEHTHARLAM (Pajhwok): The warehouse of the main hospital in eastern Laghman is full of medicine but hundreds of patients are still forced to buy them from pharmacies, Pajhwok Afghan News’ findings show.

Officials acknowledged that some doctors do so in their personal interest. They warn anyone found with links to pharmacy owners will be dealt with in accordance with the law.

Pajhwok has obtained dozens of prescriptions requiring patients/attendants to buy medicines from the market. Interestingly, these medicines are on the list sent to the provincial hospital by the HealthNet.

HealthNet is an international organisation that supports hospitals and public health.

Provincial hospital

Following public complaints, a team of Pajhwok went to the provincial hospital in Mehtarlam, where many people were seen with prescriptions in their hands and going to private pharmacies outside.

One of the prescriptions contained drugs such as Paracetamol that the patient was asked to buy from a specific pharmacy. The patient was told the drug was not available at other pharmacies.

However, the prescriptions are undated and do not have the names of patients and doctors. Although it is difficult to determine how many people buy medicine from the market on a daily basis, hospital officials and pharmacists say dozens of people are referred to medical stores.

Dr. Mohammad Khalil Qureshi, acting director of the hospital, told Pajhwok on average 800 patients visited the hospital daily and returned home after being administered first medical aid.

Pajhwok reporters found that people seeking medicine from the hospital were referred to specific pharmacies by some doctors. One government pharmacy is located in the hospital compound and two private stores 50 metres from it.

Pajhwok’s findings show at least 60 patients purchase medicine from the pharmacy inside the hospital and more than 40 from the two medical stores outside.

Public complaints

Mohammadullah, a resident of Alingr district, brought a patient with a toothache to the hospital for treatment. He claimed being directed to buy medicine from the pharmacies outside, though the hospital’s own facility was full of medicines.

“Most of the patients are told to buy medicine from the pharmacies outside. But medicine has to be provided free of cost inside the hospital,” he explained.

Mohammad Bashir, who had brought his son for medical treatment, showed Pajhwok a chit from a doctor, asking him to buy medicine from the market.

He said: “The hospital’s own pharmacy is full of medicine, but the doctor instructed me to bring it from pharmacy outside the hospital. If I buy it from another store, he will tell me this medicine is not right and will send me back.”

Javed, a resident of Kaminkhel area, alleged a sordid business was ongoing inside the hospital, where only patients with the right connections were given free medicine.

Wafiullah, who had brought his wife to the hospital for treatment, said he had to wait in a long line in front of the hospital’s pharmacy. When his turn came, he was told the medicine prescribed to his wife had to be purchased from outside.

The Laghman Provincial Council confirmed that a number of doctors at the civil hospital were prescribing medicines from pharmacies outside the hospital.

Mohammad Zahir Hussainkhel, a member of the provincial council, believed after the hospital’s handover to HealthNet, problems in the pharmacy area had increased, sparking complaints.

He charged doctors sent prescriptions to specific pharmacies in return for kickbacks -- to the detriment of patients and their relatives.

Hanifullah Pashaee, a civil society activist in Laghman, said they had shared the issue with the authorities concerned, but their efforts failed to come to fruition.

Pharmacy owners’ views:

Sohaib Halimi, one of the two pharmacy owners in front of the hospital, told Pajhwok on average they receive 30 prescriptions from doctors.

He added most of the patients needed antimicrobial drugs, which could not be found in the hospital’s pharmacy most of the time.

Mohammad Waris, head of the Enterprise National Pharmacy at the provincial hospital, claimed having a national license.

He recalled before quarantines and lockdowns, they received 50-100 prescriptions. But currently they receive about 60 papers on a daily basis.

Violations of law

Under the constitution and Ministry of Public Health principles, all combat victim and ordinary Afghans have to be treated free of cost.

Article 52 of the constitution says the state shall provide free preventative healthcare and treatment of diseases as well as medical facilities to all citizens in accordance with the provisions the law.

The ministry principles also say the health sector is obliged to provide free medical facilities to patients using government resources.

Article 7 of Chapter 3 of the Pharmaceutical Law says: “The trademark name of the drug does not appear in the Afghan National Formulary (Drug List).”

Medical experts say doctors prescribe drugs because they have the same name on their list, though they are sold in the market under another brand name. In this way, they pave the ground for getting kickbacks from pharmaceuticals.

According to experts, doctors should write the trademark of the medicine which is easily available at any pharmacy.

Dr. Shakeel Yousafzai, a medical specialist, said each drug had a generic name and each company gave it its own trade name. The Metodine tablet is known with the Flagyl company name and Paracetamol is the company’s trade name. Its generic names are Calpol and Panadol.

Official version

Dr. Mohammad Khalil Qureshi, director of the hospital, did not deny that some doctors were forcing patients to buy certain medicines from the market. He warned several doctors involved in the practice of legal action.

Qureshi said the 200-bed civil hospital in Laghman received at least 800 OPD patients on a daily basis and the total staff strength was 176.

He added that they provided free medicine to OPD patients, just like those admitted. Even if certain medicines are not available, the hospital has a monthly budget of 75,000 afghanis for the purchase of such drugs from the market.

According to Qureshi, he has warned all doctors against forcing patients and their attendants to purchase drugs in the market. Any doctor still violating the law would be proceeded against, he vowed.

Dr. Ehsanullah Shinwari, director of Health Net, told Pajhwok they sent medicines to the hospital every two weeks in line the health ministry’s instructions and there was no medicine that was not available in the hospital depot.

He also acknowledged that some doctors were doing the illegal practice for personal interest, but if they capture any red-handed they would terminate them from the hospital after consulting with health ministry.

Public Health Director Dr. Samad Ali also admitted that some doctors were given shares by pharmacies in return for sending patients to buy drugs from them.

Asadullah Dawlatzai, the governor’s spokesman, said there was no shortage of medicine in the civil hospital and on receipt of complaints, the doctors concerned would be punished.

sa/mud