São Paulo Health Department advises employee to omit lack of medication delivery forecast

The Municipal Health Department of São Paulo determined that pharmacy employees can no longer tell patients from the public health network in the capital that there is no forecast of the arrival of medicines that are in shortage in the units.

An email with this determination was sent on February 15, at 7:05 pm, as a matter of urgency, signed by a manager of the folder. The message says that the objective is to prevent this type of information from appearing in the press.

“To guide all professionals from the pharmacies in the municipality who do not respond to users that there is no forecast for us to receive a certain medication. All items are either in the CDMEC [Centro de Distribuição de Medicamentos e Correlatos] or in purchasing processes in progress. We no longer want this information to be reported by the press,” the report says.

The new rule comes amid a series of complaints of shortages in pharmacies in the public health network.

THE sheet had access to a copy of the email and confirmed receipt at five public pharmacies in the east, south and north of São Paulo.

Sought, the Municipal Health Department said that the guidance is to show that there is no shortage of medicines without delivery forecast.

“All medicines supplied by the municipal network are in the distribution phase, stock relocation or in the purchase process, therefore already provisioned or in the replacement phase”, says an excerpt from the note sent to the report.

In the country, the purchase of medicines is divided between the governmental spheres. In the case of basics, the responsibility lies with the municipalities.​

When accessing the system, pharmacists who dispense the drug to the patient can only obtain information about the stock, according to a pharmacy employee at a health unit in the east of the city, told the report.

The employee stated that she did not have access to information such as arrival forecast or status of drug acquisition.

Through a note, the Municipal Health Department explained that, in addition to the stock data, the local pharmacy team is also able to know the consumption of medicines in their unit.

According to the agency, the citizen can also check the availability of stock in pharmacies through the Aqui tem medicine app.

For public health doctor Adriano Massuda, a professor at the Fundação Getulio Vargas School of Administration of the State of São Paulo, the practice can be configured as administrative impropriety.

“To the extent that you advise servers to withhold information from the population, this is administrative improbity subject to some type of punishment. Control agencies, such as the Public Ministry, should be on top of this. The manager must inform the population about to the real situation of the public administration”, he says.

“It is absurd to send a circular to hide the problem under the rug. It is better for the city to act transparently and inform the situation of purchase and supply”, he also says.

There are situations in the drug procurement process that can prevent management from predicting delivery and dispensing. Among them are problems with the bidding or the supplier, such as failure to meet the delivery deadline.

There may also be bids that are deserted (without any proposal) or that do not comply with the requirements of the public notice, among other problems.

missing medicines

THE sheet questioned the Municipal Health Department about some medicines that were lacking in the network at the time of the production of the report, such as folic acid (in drops or tablets), AAS (acetylsalicylic acid), gliclazide, sertraline and rifabutin.

Specifically at AMA/UBS Integrada Água Rasa, the report saw patients not finding amoxicillin, ivermectin, omeprazole and levothyroxine.

The secretariat stated, in a note, that acetylsalicylic acid 100 mg is in stock at the network, as are gliclazide and sertraline — at the aforementioned health unit, the report witnessed the pharmacist tell a user that the medication was still in lack.

The folder also said that amoxicillin 500 mg and ivermectin 6 mg are in stock, both in tablet presentations.

Regarding omeprazole 20 mg (capsule), the Southeast Regional Health Coordination requested the relocation of the drug among the UBSs in the region to meet the demand of the unit in question.

Folic acid in drops, according to the folder, is scheduled to be delivered on February 24 and in the presentation of tablets it should be made available in the next few days, as well as levothyroxine —​​in the last two cases, the secretariat did not give a date.

The agency also says that it received, in December 2021, more than 867.5 million units of medicines and supplies, with a total investment of R$ 116 million.

Regarding rifabutin, the secretary told sheetin a note, which “awaiting transfer from the Ministry of Health”.

When questioned, the ministry explained that the medication is not registered in Brazil and is acquired via PAHO (Pan American Health Organization).

At the end of 2020, PAHO announced that the only world producer would undergo new prequalification by the World Health Organization and its supply would be suspended until regularization. Since then, state and municipal health departments have been instructed to use levofloxacin 500 mg instead of rifabutin.

According to the ministry, on January 24, 5,460 tablets of levofloxacin 500 mg were delivered to the State Health Department of São Paulo, with coverage until April 2022.

“It should be clarified that the Municipal Health Department of São Paulo must request levofloxacin 500 mg directly from the SES [Secretaria de Saúde]”, says part of the note.