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Minister of Health blames delay in budget approval

By Aurea Gerundio-Dizon

KOROR, Palau (Island Times, Dec. 30, 2011) – Health Min. Stevenson Kuartei yesterday disclosed that the national hospital will be running out of essential drugs because of the delay in approving the budget for Fiscal Year 2012.

Kuartei told the media that because of the limited budget, the ministry was unable to procure all the essential drugs, medical supplies and lab reagents that were supposedly procured in the first quarter of the fiscal year.

Because the continuing budget authority only lasts until December 31, Kuartei said the ministry was able to procure only 50 percent of the minimal essential drugs, medical supplies and lab reagents in the first quarter.

Kuartei said the ministry already submitted all the required paper works to the Ministry of Finance, but the latter is unable to proceed because there is no budget yet. "Because of that, we will begin to run out of drugs in the middle of January 2012 which can lead to severe consequences including the loss of lives," Kuartei said.

Kuartei said there are 109 minimal essential drugs. He said that no matter what, the ministry must have these essential drugs in stock. In the past years, Kuartei said, the ministry always had the essential drugs in stock. He added that procurement of these essential drugs is done before the quarter begins.

But beginning FY 2012, because of the continuing resolution, the ministry is limited to using the budget for first quarter only (until December 31). Kuartei explained that in procuring the essential drugs for instance, the ministry procures all drugs needed during the first quarter. Orders for drugs in the subsequent quarters get smaller, depending on what is lacking in the previous orders or when an outbreak occurs.

"The delay in adopting a unified budget will also put the second quarter minimal essentials at risk because the order needs to be placed by the end of January 2012," Kuartei said.

Kuartei said that although the MOH has projected to collect $2 million this year for the Trust Fund, they cannot even use the money in case the budget will not be in place yet. The minister said that the way the continuing resolution was written, and as explained to them by the minister of Finance, they only have authority to spend up to December 31. The continuing resolution, Kuartei said, does not clearly include the language authorizing them to use the trust fund.

Kuartei is seeking the assistance from the Office of the President on this matter to assure that there is continuation of drugs and medical supplies for the people.

"Further delay is not only counterproductive, it is not cost effective and will have dire consequences including possible loss of lives," Kuartei said.

Kuartei said there are four emergencies simultaneously happening at the hospital that need to be addressed. These emergencies include tuberculosis, diarrhea, dengue and non-communicable diseases (heart attack, stroke, diabetes, obesity, etc.).

Without the financial resources, Kuartei said that these emergencies have the potential to become disasters.

"Palau has just diagnosed its first multi-drug resistant tuberculosis. We have few cases of diarrhea and dengue fever. Even though we have contained them, if we let down our efforts, stopped visiting communities to spray because there is no money to buy fuel, this can become an epidemic. Every day the emergency room is becoming busier and busier as the burden of NCDs continues to rise. These emergencies can’t be managed appropriately under the current budgetary conditions," Kuartei said.

Kuartei expressed hopes that as the Olbiil Era Kelulau continue to debate on the budget, they also take into consideration the impact of the delay to the Ministry of Health.

Kuartei also said that beginning January, the ministry will be closing the recompression chamber services for divers.

"We have requested repeatedly and have suggested ways to financially support this service but at this time, we can no longer require our employees who have full time jobs to be on call for this service without compensation. As you know, we have closed the hyperbaric treatment which is greatly needed for wound healing because we just lack the financial support. Closing the recompression chamber services will have a great effect on the tourism industry who most come to dive in Palau," Kuartei said.

As to the medical referral program, Kuartei said that the ministry will no longer be sending anyone who is not covered by the National Health Insurance for medical referral off island because there is no funding provided for them.

"This is for those who are unemployed and have not paid their NHI premiums. The Ministry of Health will also no longer pay any medical bills in Manila (Philippines) that go over the NHI coverage limit of $25,000 also because we do not have the funding," the minister said.

Kuartei said that even if the Office of the President and the OEK recommended that the MOH establish medical referral services with the Republic of China, the ministry will not proceed any further without financial support to do so.

On the ministry’s human resource, Kuartei said that the Pharmacy Department reportedly reduced its hours of operation due to minimal staffing. The minister said this will soon be followed by the Radiology and other departments (including doctors and nurses) that are having attrition due to retirement but no new hires.

Kuartei appealed to the president as well as the senators and delegates to consider the issues of the Ministry of Health. "These health issues are not political issues. They are social issues that can truly have long effects on the quality of lives of the people of Palau and the trust that they have for the Ministry of Health," Kuartei said.

Kuartei said that politics seem to begin dictating the health status in the community, which he finds to be quite unsettling.

Kuartei said that as minister of Health, he is ready to implement any austerity measures to assure continued quality of health care services, even if it means reducing his own salary.

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