Behind the health route
Starting in August, the Ministry of Health recently announced that a distribution system for medicines and medical supplies will be implemented, supplying hospitals and IMSS Bienestar health centers. This will be a small army of 96 three-and-a-half-ton trucks, 38 one-and-a-half-ton trucks, 35 sanitary boxes, and 27 refrigerated trucks that will operate the "Health Routes." The model is inspired by the "Health Trucks" program developed in Veracruz by Governor Rocío Nahle, although unlike the latter, there is still no clarity regarding the bidding process for the federal initiative.
The known information is that the Ministry of Health put the medications out to tender and the fleet of vehicles was acquired, primarily through leasing. However, there are doubts within the industry about the program, led by Eduardo Clark, Undersecretary of Integration and Development of the Health Sector, because the initiative was launched without conducting a market study, without bidding processes (except for medications), and with comprehensive contracts. The perception is that it was another initiative, like those seen during the previous six-year term, without planning and without fully analyzing the logistics.
One of the main problems they see in the industry is distribution logistics. “They said it would cost 146 million pesos, but there's no way,” said one of the industrialists. “There's no warehouse, no storage facilities, and they haven't yet included payroll and operating costs, such as gasoline. They have the truck leases, but the distribution they're planning isn't realistic.”
Among the observations and criticisms they have of the program is the control of the chain of custody of medicines. They argue that not only are refrigerated trucks needed to transport the most delicate medicines, but also refrigeration at distribution points, which they say does not yet exist, nor is there a mechanism to verify the expiration date of medicines. The most recent negative experience was during the administration of Andrés Manuel López Obrador, where logistical deficiencies and bureaucratic slowness, along with poor decisions by coronavirus czar Hugo López-Gatell, caused thousands of COVID-19 doses to expire.
In the private sector, there is a 2% loss of medicines, but the government requires them to replace them. In the case of the government, the average loss is estimated to be 15%, but unlike the private sector, due to the lack of oversight and lack of monitoring of medicine batches, the risk of expiration is enormous. The cold chain has an international certification, which they have not been informed is held by the "Rutas de la Salud" program. This leads to a potential risk in the case of painkillers, particularly fentanyl and morphine, that the requirement in private distribution, which requires that each unit be controlled and supervised, does not exist with the new program.
The federal government will not oversee painkillers, and as far as the industry has been informed, they will transfer the distribution of these medications to the states, where most of them lack the trained personnel or the resources to implement this mechanism. Money is an additional problem that has not been resolved in the program. According to what the sector has been informed, the states will be responsible for operating costs, but they lack the resources to do so because those budgets were transferred to IMSS Bienestar.
The resource problem is more serious than previously seen. Suppliers of medicines, supplies, and equipment to the IMSS, ISSSTE, and the Ministry of Defense have not been paid this entire year. So far this year alone, the IMSS has defaulted on 12 billion pesos in procurement payments. There is also no money for hospitals, some of which the president recently visited, unaware that what she saw was artificially arranged so she wouldn't notice the delays. Other hospitals were placed under the responsibility of the Army—to continue providing public works—but according to experts, the direct awards they are making—as they did for the Maya Train, the AIFA (National Institute of Statistics and Census), and other Obrador administration projects—raise costs by up to 300 percent.
The "Health Routes," they believe, will further dismantle the drug distribution network, deepening the damage caused by López Obrador's health policies. This initiative creates a company or service similar to the Gasolineras del Bienestar (Well-Being Gas Stations), which ended in failure. Created in 2021, it failed to meet its objectives due to operational, commercial, and administrative problems, and its revenues declined, from 254 million pesos in 2022 to 174 million last year, despite Pemex injecting 300 million to boost it.
The purpose of the new program seeks to correct the errors of the model imposed by López Obrador, which saw chronic shortages of medicines, the cancellation of contracts with distributors without functional replacements—which led to higher costs in the emergency acquisition of medicines than previously expected, in some cases with the same suppliers who had been vetoed—and the replacement of these suppliers with Birmex, which not only resulted in a logistical disaster but also in the second-largest corrupt administration of that six-year term.
The initiative involves the Ministry of Health, IMSS Bienestar, and Birmex, and aims to resolve all these deficiencies and inadequacies and ensure that medicines and basic supplies reach 100% of the approximately 12,000 rural medical units and community hospitals. The distribution model that has been communicated to the private sector, however, has raised concerns that it will be used primarily with a political focus, using the National Servants to distribute medicines for propaganda purposes, as has happened with social programs whose ultimate goal has been electoral patronage. This doubt will persist until we see how it works and whether the government manages to overcome the logistics and institutional coordination problems that have so often failed in recent years.
X: @rivapa_oficial
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