NEENA RAMDENEE

Pharmacist

Docteur en pharmacie de l’université de Strasbourg

MBA International des Universités Sorbonne et Dauphine.

Dear Sir,

Re: The Commission of Inquiry Drug Trafficking Report: July 2018 (pages 100-110)

As a citizen of Mauritius and as a health professional who has worked abroad for 25 years and having returned permanently since 2006, I would like to make certain observations and recommendations.

The Report of the Commission of Inquiry on Drug Trafficking (the Lam Shang Leen Report) has, in no uncertain words, issued an incompetence certificate to the Pharmacy Board, its Registrar and to the office of the Director of Pharmaceutical Services. The Pharmacy Board (the Board) according to section 4 (b) of the Pharmacy Act is called to “exercise control over the manufacture, importation, distribution, sale and possession of any drug, poison, dangerous drug and psychotropic substance

  1. Concerning the grant of licences for the Operation of Pharmacies :

Please note that for decades now, all decisions of the Board are implemented by the office of Director of Pharmaceutical Services and the Registrar.

I am stupefied to read in the Lam Shang Leen Report at section 10.3.5 regarding the need to regulate the number of retail pharmacies in an area «With the coming into force of the Business Facilitation Act 2006, the Pharmacy Board, although it felt there was a need for restriction could not proceed because of different divergent views »

This is inexcusable! The Board, a regulatory body, which is called by law to regulate the pharmaceutical trade has according to the admission of the Director of Pharmaceutical Services, been acting as a business facilitator i.e. outside its mandate when granting licences for the operation of pharmacies. *Refer to annex 1.

  1. Concerning the import of Pharmaceutical Products (drugs)

The Lam Shang Leen Report has, however, missed one crucial point : the immense power given to the Registrar of the Pharmacy Board in the clearance of pharmaceutical products from customs according to section 44 of the Pharmacy Act which stipulates that at sub-section (1) «The Comptroller shall not allow the removal of any imported pharmaceutical product from the place where it is stored unless the relevant invoice has been endorsed by the Registrar to show that the importation of the article is authorised under this Act.»

This section leaves it to the sole discretion of the Registrar to allow or not, the clearance of pharmaceutical products (and therefore psychotropic drugs). If one takes into account that no audit has ever been carried on the Pharmacy Board or the actions of the Registrar, one can easily understand that the import of psychotropic drugs has been depending exclusively on the probity of the Registrar (a Government Pharmacist nominated for the job by the Minister of Health). This results in a lack of accountability and transparency.

  1. Concerning inspections of Pharmacies

The Lam Shang Leen Report has this to say on inspection of pharmacies at 10.3.7 “it seems that only when the Pharmacy Board is approached by the ADSU that there is a reason to believe that a pharmacy is in breach and that the Board wakes up”.

Inspections are carried out by Government Pharmacists who work directly under supervision of the Director of Pharmaceutical services. I read that there are 37 pharmacists employed in the Public Sector. Apart from the Director of Pharmaceutical Services, every single one of them is called to carry inspections according to their scheme of service. And, they have been routinely doing so against payment of a fee as provided in the PRB report. If there are 340 retail pharmacies for 36 inspectors, this results in one inspector responsible for 9 retail pharmacies and I fail to see how inspections were carried out only twice yearly! In addition had these inspectors been given the proper training, the president of the Pharmaceutical Association would not have qualified the inspections as “perfunctory, futile and a waste of time”.

This further demonstrates how there is a waste of human resources at the Pharmacy Department. *refer to annex 2.

In view of the above, and taking into account the incompetence with which the Pharmacy Board, the office of the Director of Pharmaceutical Services and the Registrar of the Board have been regulating the Pharmaceutical Trade for decades, I propose that:

  1. All regulatory activities concerning the Pharmaceutical Trade be removed from the office of the Director of Pharmaceutical Services.
  2. An urgent and complete revision of the legal framework to provide for the creation of two more Acts which will provide for:

(a)The creation of the National Medicine Regulatory Agency (NMRA) to look into the import, storage and distribution of drugs. The NMRA will be headed by a Director recruited by the PSC and who will work under the direction of a Board whose members are nominated by the Supreme Court. The Board of the NMRA will consist of Medical Practitioners, Pharmacists, Representatives from Customs, from the Tax Payer Department of the MRA, from the State Law Office and a Representative from the Consumers Association. The Agency will have to be audited at least twice a year and audit reports made public. This Act will provide for a corps of inspectors who will work in the agency.

(b)A Pharmacy Operation Act with the creation of a regulatory body to be responsible for the grant of licences to Retail and Wholesale pharmacies. This body will, inter alia, investigate the source of funds being used for the creation of a new pharmacy, the trustworthiness of its owners, the number of pharmacies that can operate in a region, the opening hours etc.

  1. To avoid mismanagement, pharmacists should be owners or hold a majority of shares of retail pharmacies. I propose that a scheme be put in place for the Development Bank of Mauritius to provide loans for the opening and operation of a Pharmacy to licenced Pharmacists only. *refer to annex 3.

 

Thanking you in anticipation and hoping that due attention will be given to my propositions.

 

Yours Sincerely.

 

Copy to:-

The Minister Mentor, Minister of Defence and Rodrigues, Anerood Jugnauth.

The Leader of the Opposition, Xavier-Luc Duval.

The Leader of the Mouvement Militant Mauricien, Paul Raymond Bérenger.

The Leader of the Labour Party, Dr Navin Ramgoolam.

The President of Mouvement Patriotique, Alan Ganoo.

The President of the Task Force, Navin Beekarry 

Annexes

Annex 1

Considering that half the population of Mauritius goes to hospitals, it can be calculated that there is a pharmacy for 1800 inhabitants. Our neighbour la Reunion has 2500 inhabitants for one pharmacy and in England 4000 inhabitants/pharmacy … Farmasi ouver dan tou koin lari kom bann snak vann boulet. How can they healthily survive?

For the opening of an account in a bank KYC (know your client) is applied and why not for pharmacies? The board cannot tell you precisely who are the owners or shareholders of a pharmacy because the renewing of a licence by the Board is done on the original name which exists since 30, 40 or 50 years. No transparency.

Annex 2

In other countries, the delivery with the necessary advice to patients is done by Pharmacists and trained dispensers. Unfortunately there is no school for the training of dispensers. Errors can happen and even drug traffic may prevail at this level. No deontology.

To follow the delivery chain and help inspection, all pharmacies should be computerized. This will help to avoid drug traffic at this level.

This should be compulsory.

Annex 3

The pharmacist working for businessmen cannot manage  according to the deontology.

Is the businessman supposed to assure the whole purchase and delivery chain?