I couldn't find the medicine for rheumatic diseases, nor the eye drops prescribed by the doctor. Medicines were found in private pharmacies, sometimes they were paid for, sometimes they were taken on prescription if the pharmacy cooperated with the Fund, and sometimes I took a substitute for the prescribed medicine, are the words of one of the 248 respondents of the Center for Investigative Journalism of Montenegro (CIN-CG) who answered an anonymous questionnaire about the availability of medicines and health services.
As many as 63 percent of those surveyed faced a shortage of medicine in Montenegrin pharmacies, which was prescribed by a doctor in a public health institution. Some buy medicines from abroad, most often from Serbia, many order from private pharmacies, and it happens that those without money and acquaintances abroad do not get the medicine.
"The finding that citizens often cannot find the prescribed medicine, as you state, is quite contradictory in relation to the data on the number of completed prescriptions in Montefarma pharmacies," said the company for CIN-CG.
From January to October 2024, more than two million and two hundred prescriptions were issued, and the same was true last year, Montefarm explains.
"From time to time, it happens that there are no bids from authorized importers and holders of licenses for placing them on the market in tender procedures for a certain drug or medical device, most often due to problems with the manufacturers themselves due to a lack of raw materials, a complete suspension of the production of the drug, the inability to meet the delivery deadline, then changes of the license holder, problems in transport, etc., they told CIN-CG from Montefarm.
As they claim, of the 1.600 medicines and medical devices that are on the list of the Health Insurance Fund (FZOCG), short interruptions in delivery rarely occur.
"This is solved by procuring the same or similar drugs from the same pharmacological group, if they are on the list of drugs, in the shortest possible time", say Montefarma.
Montefarma explains that there is no complete supply anywhere in the world, and the EU market, where medicines are imported for Montenegro, is not always stable either.
"Thanks to the size of our market and small needs compared to countries with a larger population, we manage to make purchases even before the market in the region and the EU stabilizes," Montefarma said.
The respondents in the CIN-CG survey also expressed their dissatisfaction with drug prices, and said that they get some drugs at a much cheaper price in Serbia.
Montefarma says that they are not direct importers of medicines, so they cannot influence prices in Montenegro.
"The maximum prices of medicines are created by the Institute for Medicines and Medical Devices (CINMED), while the prices on the list of medicines are regulated by the Ministry of Health", they explain.
Lack of basic consumables
State institutions in Budva often send patients to private laboratories because they do not have the reagents to perform blood, urine and swab tests, says one of the interviewees.
Several respondents in the CIN-CG survey also complained about the health center and the hospital in Budva.
Almost 41 percent of respondents answered that they were faced with a lack of basic medical materials in institutions, such as needles, gauze, cotton wool, reagents... Institutions in all parts of the country were mentioned as problematic, and KCCG, DZ Podgorica, DZ Rožaje, Berane Hospital, Nikšić Hospital.
"Something is always missing, the list is long, there is a big shortage", is one of the answers that refers to DZ Berane.
"No gauze, bandages, hydrogen, iodine, plasters, cups for urine", is the answer that refers to DZ Rožaje.
"They didn't have a thin thread for breast surgery, toilet paper and soap," answered one of the interviewees describing the situation in KCCG.
There is also an example of a respondent who faced a shortage of tetanus vaccine in the Emergency Department. However, the Emergency Department in Podgorica claims that they did not have a problem with a shortage of tetanus vaccine.
"There is no toilet paper or soap in the hospitals, it used to happen that they told me that there were no injections, that I should buy them myself," says one respondent.
However, the health institutions that answered CIN-CG's questions mostly deny that there are delays and lack of medical supplies, and say that they have good cooperation with Montefarma. Thus, even in institutions where citizens claim that there was a lack of materials, they said that they generally do not face this problem.
"The Clinical and Hospital Center of Berane had no problems with the supply of the mentioned medical consumables, if it were to happen that they disappeared, and that rarely happened, they would have procured them from their own funds", they told CIN-CG from the Clinical Hospital Center (KBC ) in Berane.
We received similar answers from DZ Pljevlja, Bar, Cetinje, Andrijevica, Mojkovac, Berane, Herceg Novi, Rožaje, Plav, Ulcinj, Nikšić and the special Risan Hospital. Other health institutions - several health centers, hospitals and special hospitals did not respond to CIN-CG's questions about the supply of consumables and medical devices.
Only KBC Berana said that more financial support would be welcome.
"Money is obtained for basic things, and in the future it would be desirable to provide more financial resources for the purchase of medical equipment," said the institution.
From the other institutions that answered, they believe that there is no shortage of money from FZOCG.
A year passes, the tender for MRI never
As many as 83 percent of those questioned in the CIN-CG anonymous survey answered that either they or someone close to them had been waiting for months for ultrasound and magnetic resonance imaging (MRI) examinations. CIN-CG subjects usually waited from three to six months for an MRI scan, but there are also those who waited about a year.
More than 61 percent of those surveyed claim that they had to travel to another city for a certain filming or medical procedure.
"From Pljevlja they often send to Berane, Bijelo Polje, even though there are no bus routes to those two cities, and then to Podgorica", was the answer of one of the interviewees.
There is often a wait of over half a year for a mammogram.
"The mammography machine in Budva is not working," says one of the interviewees.
And the procurement of devices is sometimes really marathon.
Thus, at the end of 2022, the Administration for Capital Projects announced a tender for magnetic resonance imaging for hospitals in Bijelo Polje and Nikšić. Although almost two years have passed, we are still waiting for these devices. Until then, citizens are sent to other municipalities for filming. The procurement of these necessary devices was stopped by several complaints from bidders, after the most favorable bid was selected in September 2023.
"The last decisions related to this procedure were made on August 14, 2024, when the Capital Projects Administration canceled the procurement procedure. The cancellation decision was challenged by the appeal of the tenderer 'Farbalab' on August 23, 2024, which further prolonged the process," the Ministry of Health told CIN-CG.
Complaints from bidders are what delay healthcare procurement the most, the Ministry explains.
"These appeals often lead to the prolongation of procedures, and even to situations in which it is not possible to implement or cancel them," the Ministry stated.
In 2024, the Commission for the Protection of Rights in Public Procurement Procedures (Commission) made 25 decisions on appeals only for KCCG tender procedures. Although the deadline for the Commission's decision on appeal is 30 days, it is often exceeded. Thus, one solution was waited for over three years - it was passed in February of this year, and it refers to the appeal from August 2020.
Inefficient public procurement leads to shortages of medicines, consumables and medical equipment, as well as to the fact that citizens have to wait a long time and go to other cities to have certain types of examinations.
"Health is a specific area in which inefficient public procurement directly affects the awardees and the quality of health services. Although the Ministry of Health does not implement public procurement procedures related to the capital budget or public procurement for health institutions, we have taken measures to improve their efficiency", the Ministry of Health told CIN-CG.
The Commission claims that since the formation of the new convocation at the beginning of this year, they have dealt with requests in a timely manner, "even before the legal deadline of 30 days, or rather within an average of 25 days", they state in their response to CIN-CG.
"The reason that appeals procedures last longer is that in the same public procurement procedure, after the Commission's decision, several bidders file complaints, which significantly delays the public procurement procedure".
"It is evident that the contracting authorities do not prepare the tender documentation and decisions on the selection of the most favorable offer in a proper manner, which endangers the efficient and successful public procurement procedure," said the Commission.
"We believe that it is necessary to further strengthen the capacity of contracting authorities in the first instance, that is, public procurement officers".
In May, the KCCG said that at that moment, they had to wait 23 months for the Commission's decision regarding the appeal on the tender procedure for the procurement of angiographs, which is why the procurement procedure was stopped. However, we have not received a response from KCCG about this case.
FZOCG asked for authority over the procurement of medical and consumables
In March last year, the FZOCG initiated amendments to the Law on Mandatory Health Insurance, when it comes to public procurement, the FZOCG told CIN-CG.
"It was proposed that the competence for the implementation of public procurement procedures for medical devices and consumables for health institutions, which is now carried out by Montefarm, be returned to the competence of the FZOCG", said the deputy director of the FZOCG in an interview with CIN-CG Zdravko Vuksanović.
"The Fund believes that the annual funds allocated for the health system should be adequately controlled, which would be achieved, among other things, by the Fund, as an institution that allocates funds for health institutions, should also implement the procurement process," says Vuksanović.
Montefarm did not comment on this initiative of the FZOCG for CIN-CG, but said that Montefarm has no delays in the delivery of items that are their obligation, that is, the procurement of this part of the needs of the public health sector is functioning smoothly.
From 2021, according to the Law on Health Care, Montefarm is the institution that deals with this procedure and conducts a complete tender procedure through which it procures medicines and the main medical equipment and consumables for health institutions.
The Fund says that the main cause of the lack of numerous types of materials is inefficient public procurement procedures.
"The lack of basic necessities in health institutions is not the result of a lack of finances, but rather a delay in tenders. The reasons for the delay are various: lack of stock, lack of promptness of health institutions individually to plan the quantities, late publication of the tender in relation to the quantity, etc. The experience of countries from the region where the Fund has jurisdiction over the implementation of public procurement procedures shows that the procedures are completed faster and easier when they are implemented by the Fund", they emphasize from this institution.
The majority of health institutions to which CIN-CG sent questions do not see a difference in the procedures of FZOCG and Montefarm, or they are satisfied with the current situation and the way in which Montefarm procures.
"It is important for us that we get the necessary quantities of consumables and medical equipment within the stipulated time, while it is less important who does the procurement," they told CIN-CG from DZ Plav.
In healthcare, some of the biggest tenders are difficult to control
In Montenegro, the highest turnover is achieved in public healthcare procurement: healthcare institutions are among the ones who order the largest tenders, and the bidders who achieved the highest turnover through contracts with Montenegrin institutions are those who concluded contracts in the field of healthcare.
Of the ten bidders who achieved the highest turnover through contracts in public procurement from 2021 to the end of 2023 in Montenegro, seven companies are engaged in the distribution of medicines, goods and devices in the field of healthcare, and the turnover was achieved entirely with healthcare institutions. Glossary ranks first in terms of traffic in Montenegro, with hundreds of millions of traffic. CIN-CG previously wrote in more detail about this company, which has a kind of monopoly.
The largest client in the field of public procurement in Montenegro between 2021 and 2023 was Montefarm, and among the top ten is KCCG, which has the largest number of public procurement contracts - 1.646.
Not only in healthcare, but in general, in the field of public procurement in Montenegro, there are numerous irregularities, including corruption. In the reports of the European Commission, year after year, it is repeated that it is necessary to improve this field, so that abuses do not occur.
In the Report of the State Audit Institution (DRI) on the regularity of the implementation of simple procurements in the public sector for 2023, which was published in July of this year, it was stated that more than one million and five hundred thousand direct procurements and many other irregularities were not reported in the mandatory reports .
The SAI points out for CIN-CG that the implementation of public procurement audits is very demanding and that numerous analyzes need to be performed.
Also, they point out that in health institutions as well as in other bodies, attention should be paid to the specification in the tender documentation.
"The narrow technical specification is a so-called 'red flag', i.e. indicates the potential possibility of adjusting the specification to a specific bidder, as well as inadequate criteria for selecting the most favorable bid. To determine the above, experts are necessary for the subject matter of procurement, but even that is not enough, i.e. it is necessary to carry out numerous investigations which are certainly not within the jurisdiction of the SAI", said the institution.
Attention should also be paid to the implementation of public procurement contracts, i.e. compare the prices from the offer (of the most favorable bidder) with the submitted invoices, and in case of certain doubts, it should be investigated, i.e. compare prices from the offer with the market price. This institution also states that reports on the implementation of public procurement should be more detailed.
"From February 2024, technical experts will review the specifications for the procurement of medical equipment to ensure their compliance with quality standards, and at the same time enable the participation of all relevant bidders in tenders," the Ministry of Health told CIN-CG.
Currently, the legislation solves the issues of transparency, openness of procedures and methods of collecting bids in a high-quality manner, and the Ministry of Health believes that none of these aspects should be changed.
However, it is necessary to find a way to prevent the endless prolongation of complaints procedures, because the price paid by patients is too high, the Ministry says and points out that they will work on improving the process with the Public Procurement Directorate.
"It is important to remain aligned with the highest European standards, but also to take into account the specifics and limitations of a small health system, such as the Montenegrin one," they said.
In the meantime, citizens are left to fend for themselves.
"My friend is scheduled for surgery in ten days at KCCG. It was explained to her that she had to bring compression bandages, gauze and some other medical supplies," said one of the interviewees of CIN-CG.
Glossary, Farmegra, Urion, in the top and the Clinical Center
After Glossarij, which is the first on the list, from 2021 to 2023, the companies that achieved the highest turnover in the field of healthcare are: Farmegra, Glosarij CD (daughter of the company Glosarij), followed by Urion, Osmi Red, Medica and Farmont. According to the records of the Moj novac portal, from 2021 to the end of 2023, Montefarm achieved public procurement contracts in the amount of over 233 million euros. KCCG is also among the largest contractors in the country, in seventh place, with contracts worth around 43,5 million euros in the given period. The number of KCCG contracts is significantly higher than any Montenegrin institution - 1.646 realized contracts in public procurement in the given period.
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