CDAP Medicine Availability: Understanding the Procurement Process

The Pharmaceutical Society of Trinidad and Tobago (TPSTT) is aware of recent media reports concerning the availability of medicines under the Chronic Disease Assistance Programme (CDAP). We recognize the concern and anxiety experienced by patients who depend on these medicines for the management of chronic illnesses, and we reaffirm that uninterrupted access to essential medicines must remain a national priority.

CDAP is one of Trinidad and Tobago's most significant public health initiatives. It allows citizens to obtain selected medicines free of charge through participating private pharmacies using prescriptions from both public and private medical practitioners. The programme has improved access to treatment for thousands of patients and has reduced the burden on the public healthcare system.

Medicine procurement within the public health sector is a structured and highly regulated process involving several agencies and approval stages. While specific operational details may vary, the general procurement cycle includes:

•⁠  ⁠Forecasting national medicine requirements based on utilization data and projected demand.

•⁠  ⁠Preparation of tender specifications.

•⁠  ⁠Invitation to Tender.

•⁠  ⁠Evaluation of bids by technical committees comprising representatives of the Ministry of Health, the Chief Medical Officer's office, the Regional Health Authorities, and other relevant stakeholders.

•⁠  ⁠Notification of the intended award and the statutory standstill period in accordance with public procurement requirements.

•⁠  ⁠Finalization of contracts.

•⁠  ⁠Issuance of purchase orders.

•⁠  ⁠Manufacturing, international shipping, customs clearance, warehousing, and distribution to healthcare facilities and participating pharmacies.

This process requires careful coordination among multiple institutions and sufficient lead time to ensure continuity of supply.

Medicine shortages can arise from several factors, often occurring simultaneously. These may include:

•⁠  ⁠Delays in completion of procurement and contract award processes.

•⁠  ⁠Delays in funding approvals and issuance of purchase orders.

•⁠  ⁠Global manufacturing or supply chain disruptions.

•⁠  ⁠International shipping and logistics challenges.

•⁠  ⁠Delays in supplier deliveries, including those associated with outstanding payments.

•⁠  ⁠Increased demand for medicines beyond forecasted quantities.

•⁠  ⁠Changes to treatment programmes or the introduction of additional medicines requiring revised forecasting.

It is important to recognize that medicine shortages are rarely attributable to a single factor. They are often the cumulative result of operational, financial, logistical, and international supply chain challenges.

The Society also notes that, where long-term procurement contracts have expired before replacement contracts become operational, procuring entities may rely on interim purchasing mechanisms, including Requests for Quotations (RFQs), to maintain supplies. While these mechanisms can help address immediate shortages, they are not intended to replace timely completion of the regular tender process.

To strengthen the resilience of the national medicines supply system, the TPSTT recommends consideration of the following:

1.⁠ ⁠Completion of procurement cycles sufficiently in advance of contract expiry to avoid gaps in supply.

2.⁠ ⁠Timely approval of funding and procurement decisions to facilitate early placement of purchase orders.

3.⁠ ⁠Continuous review and updating of medicine forecasts to reflect changes in disease prevalence, utilization trends, and programme expansion.

4.⁠ ⁠Strengthened communication among all agencies involved in procurement, financing, regulation, and distribution.

5.⁠ ⁠Greater transparency through periodic public updates on medicine availability and expected timelines for resolution of significant shortages.

6.⁠ ⁠Continued monitoring of international supply chain risks and the development of contingency procurement strategies where appropriate.

The TPSTT remains committed to supporting evidence-based discussions on pharmaceutical policy and medicine supply. We encourage collaboration among the Ministry of Health, NIPDEC, Regional Health Authorities, healthcare professionals, suppliers, and other stakeholders to ensure that patients continue to receive uninterrupted access to essential medicines.

The Society also encourages responsible public commentary based on verified information. Constructive dialogue supported by facts is essential to maintaining public confidence in the healthcare system while facilitating practical solutions to complex supply chain challenges.

Ultimately, the shared objective of all stakeholders is to ensure that every patient who depends on CDAP receives safe, effective, and timely access to the medicines they require. This objective is best achieved through coordinated planning, transparent communication, and sustained collaboration across the healthcare system.