In a shocking revelation, the controller and auditor general of India has pointed out major inefficiencies in Tamil Nadu's health delivery supply chain. The CAG's audit report has put the blame on late supply of short-shelf-life medicines by Tamil Nadu Medical Services Corporation to the tune of ₹11.12 crore, which remained stocked as expired between 2016 and 2021.

Some of the Key Findings:
Delayed Drug Supplies:
185 manufacturers supplied 1,447 drugs to TNMSC outside of the mandated production window of 30 days before supply.
Replacement of expired drugs has been provided for in the tender conditions. However, replacement of drugs actually took place just 13 times in the five years studied, of which 10 instances occurred post-2020.

Quality Testing Lapses:
TNMSC did not perform a quality analysis for 13,922 cases where drugs lay in warehouses for over six months.

Government Facilities Shortage:
Purchases of essential medicines were either insufficiently made or inadequately stored in such a way that they would become unavailable in government-provided healthcare services.
Inefficiencies in distribution interfered with the supply chain and impacted medicine availability in the sampled hospitals.

Equipment Neglect:
The report shows that essential medical equipment was not maintained properly, despite systems being in place for annual maintenance contracts.

State Government's Response:
In August 2022, the state government quoted "a host of reasons" behind its inability to closely adhere to the conditions prescribed, but assured that closely drawn monitoring processes had been put in place nowadays since 2021.

Impact on Public Healthcare:
A combination of not fixing primary accountability on suppliers with systemic inefficiencies has created a space for both financial bleed and non-availability of adequate healthcare. Non-availability of the essential medicines in the government hospitals has actually deprived the patients of adequate treatment options, alarmingly raising questions on public health.The CAG's findings reveal the dire need to enforce stringent oversight procedures when it comes to drug procurement, warehousing, and quality testing. The improved accountability of suppliers and timely maintenance of medical equipment will go a long way to ensure the robustness of the healthcare systems in Tamil Nadu.

Key points to note:

• Medicines costing ₹11.12 crore expired at the Tamil Nadu Medical Service Corporation warehouses between 2016 and 2021.

• A total of 1,447 drugs supplied by 185 manufacturers violated tender conditions.

• The report mentions over 13,922 instances of stock lying unused for more than six months without quality testing.

The CAG audit report stresses the need for urgent reforms in supply chain management in health care in Tamil Nadu to prevent further losses and to ensure citizens a dignified treatment option.