The managememt of drugs, food and white materials in
“Mother Teresa” Hospital
 Background.
National Hospital “MT” is the biggest hospital in my country. It was built in 1930 by
the Monarchic Regime. In 1939 when Albania was invaded by Italian troops, it was
expanded. After the Second World War it become the main hospital in Albania and
considerably expanded for two reasons. First because in the first ten years the
number of population increased three times. Second it was the only tertiary care
facility in the country.
Even today is full of patients because it still remains the main hospital and the
population in this last ten years is still increased 200 %. The equipment is obsolete,
but even update ecquipments are present as a result of grants or state investments.
National Hospital “MT” is government property and is functioning as monopoly
because there is no competition. Only a few small private clinics are operating and
two hospitals are being build invested by Catholic and Orthodox groups. National
Hospital “MT” is composed of six main clinics such as: internal diseases, surgery
and plastics, pediatrics, neuro – psychiatry, oncology as well as Injectable Solutions
and a laboratory complex service. It has in total 1350 beds, 280 physicians, 350
specially physicians, 986 nurses, 529 aid nurses. The administration is composed of
60 members.
This presentation will focus on the issue of materials management. Materials
management is the responsibility of two offices, within the hospital administration:
Department of Pharmaceuticals and Department of Food and White Materials.
The Pharmaceutical Department has a staff of three people: a financial officer, a
distribution officer and an information officer. This office is responsible for
purchasing the necessary pharmaceutical supplies, receiving them from different
donors (humanitarian aids) and than distributing them to the clinic’s pharmacies
(each clinic has two pharmacies).
The Department of White Materials and Food is responsible for all problems dealing
with food, laundromat, and white materials (bad sheet, gowns ..etc). Even here the
delivery is done according to requests but decisions are based on the normatives
(white materials normatives have been established in 1980 and have not been revised
updated since).
 Description of the Problem or Situation.
 Description of Situation.
Although at first sight it seems that this hospital has the necessary mechanisms
that handle the management of the materials used at the hospital, the situation is
more complicated. The hospital has been suffering for years from a chronic lack
of materials which is not always the result of limited financial resources. Very
often different clinics lack the most necessary supplies because of incorrect
estimation of needs and inefficient use of certain supplies.

The information system is very weak. The clinics make their requests for
pharmaceutical supplies every two weeks. These requests are based on the current
number of patients and not on the expected flow. Because of this system the clinics
often do not have several kinds of drugs and face an overflow of certain others. In this
situation there is a lot of space for abuse. Very often nurses sell under the table highly
demanded drugs. Sometimes if the medicine is rare or expensive patients are asked to
buy it from the pharmacy outside the hospital.

The Public Procurement Law is very strict and does not allow flexibility. The
hospital budged is proposed by the Hospital Board in detail and approved by the
Ministry of Health. The hospital managers don’t have the authority to make decisions
about the type of expenses at their organizations. In case of unexpected expenses (due
to an increase in the flow of patients or unexpected need for equipment) they must
seek the approval of the Ministry of Health. This is very time consuming and does not
always have positive results.

The hospital has one big Laundromat, but unfortunately this unit is poorly managed.
Here white materials are not treated accurately and consequently. They are often
damaged. As a result of this, the lifetime is reduced.

The group efforts purchases have not been very successful so far in Albania. In this
situation the “MT” Hospital purchases its supplies individually. As a result drugs and
other supplies are purchased at higher prices, consequently the expenses are higher.
This affects the quantity of supplies that have to be purchased with a limited amount
of money.

The personnel who works during the nights in different clinics, is not included in the
“old” normatives. In fact they use these materials (food and white materials) from
patient list – so some of them have to pay this “lacking” materials.
 Who is primary responsible for handling this situation?
 Who else is involved?
In the first level head-nurse is responsible for medicines and white materials. She
nominates two other nurses, (one for pharmaceuticals and the other for white
materials) to make the requests and to deliver them to patients.
Second level. Each clinic has the supply unit and two pharmacies. These units
transmit the requests to the Pharmaceutical and White Materials & Food
Departments. Also they are responsible for delivering the supplies to each service
head-nurse.
In the third level two Departments (Pharmacy and White Materials & Food) in
cooperation with the Procurement Department do the necessary purchases
according to their needs and their budged by purchasing or from different
donations.
 What are some possible solutions?


The hospitals must have certain independence in their financial management and at
the same time they must apply new payment systems, which will affect positively the
employees motivation as well as their responsibility. So changes in Public
Procurement Law have to be done just to leave more space for the managers.


Regarding the first item the directors of clinics have moral responsibility
while the Ministry of Health have legal responsibilities. It has to identify
clearly the diagnosis of inpatients as well as their categories. So each
diagnosis have to be classified in categories based on illness degree and to be
clearly defined how long the inpatient is going to stay in hospital. Only in this
situation the requested drugs would be real and convinctiv and the
pharmaceutical Department would be able to keep under control the
abusements calculating each month how much drugs have been delivered
(according requests) and how much have to be delivered (according total days
per hospital degrees of diagnoses). And the difference would be important
information for us. To realize this a computers network is a basic need.
Establishing the central drugs and equipments store to provide them for
hospitals all around country will be very efficient. This will decrease
considerably the cost of drugs and equipments because they will be delivered
with the cost of the fist hand plus expenses, while in the tender are in
competition the prices of third and fourth hand.
As the supplies today differ in their content, the normatives (established in 1980)
have to be changed.
Some decisions that have to be taken by Ministry of Health in order to increase
the efficiency and the effectivity:


As all the directors of hospitals and clinics are physicians, a conceptual
reformation has to be done and of course, ideal would be their substitution
with economists and managers.
The application of fees for different services like; echo, analysis,
radiogaphy..etc must be be followed by other forms of payments just to
increase the hospital incomes.
Prepared by:
Rudolf ZAHARIA
Tirana University
Faculty of Medicine / Dep. Of Public Health
Tirana, ALBANIA
HOSPITAL BOARD
GENERAL DIRECTOR
VICE DIRECTOR,
FINANCE AFFAIRS
CLINIC OF
IMTERNAL
DISEASE
Dep. of Finance
and Accounting
Dep. of Human
Resources
Dep. of White
Materials &
Food
Dep. of
Investments
Dep. of
Pharmaceutics
Dep. of
Procurement
Complex
Laboratory
Injectable
Solutions
VICE DIRECTOR,
MEDICAL AFFAIRS
CLINIC OF
SURGERY
& PLASTICS
CLINIC OF
PEDRIATICS
VICE DIRECTOR,
MEDICAL AFFAIRS
CLINIC OF
NEURO PSICHIATRY
CLINIC OF
ONCOLOGY