Sindh’s public healthcare system is once again under scrutiny — and for good reason. A growing body of evidence reveals a disconcerting pattern in which government hospitals, hamstrung by flawed procurement systems and budgetary pressures, are purchasing medicines nearing expiry to cut costs. This practice, while technically legal under certain conditions, raises serious concerns about quality control, regulatory oversight, and the ethics of patient care.
The Cost of Cutting Corners
Despite clear regulations by the Drug Regulatory Authority of Pakistan (DRAP) mandating a minimum six-month to one-year shelf life for hospital-procured medicines, many hospitals in Sindh routinely bypass these standards. Instead, they opt for medicines with just two to three months before expiry — drugs that are significantly cheaper but risk reduced potency and effectiveness.
According to pharmaceutical experts, this loophole in procurement allows hospitals to buy shelf-sliced medicines at steep discounts. The difference in price is often too attractive for under-resourced facilities to ignore. However, the long-term cost is borne by patients who depend on public hospitals for reliable care.
Procurement on Paper vs. Practice
Procurement is managed primarily by the 26-member Central Procurement Committee (CPC), which is responsible for about 75% of medicine purchases across the province. The remaining 25% is handled by individual hospitals or district health offices under local authority. In theory, tenders are awarded based on merit, quality, and compliance. In practice, however, transparency is questionable.
Medications are tendered under their generic formulations — not brand names — and contracts are awarded to the lowest bidder. This often results in lesser-known pharmaceutical companies supplying hospitals with cheaper alternatives. Once a rate is fixed by the CPC, all hospitals are bound to purchase the drug at that price, regardless of brand reputation or therapeutic efficacy. Meanwhile, patients purchasing medicines from private pharmacies are exposed to better-quality, branded options — highlighting a growing disconnect between institutional and retail healthcare standards.
Expert Opinions and Ethical Dilemmas
Dr. Ubaid Ali, Head of Sindh Operations at DRAP, acknowledged the issue, noting that while near-expiry medicines are technically safe before their printed expiry dates, their potency diminishes, making them suboptimal for serious medical conditions. In underfunded public hospitals, where patient vulnerability is already high, this decline in quality can have significant health consequences.
Accountability in Question
The Sindh Assembly’s Public Accounts Committee (PAC) recently held a meeting to review these controversial procurement practices. Committee Chairperson Nisar Khuhro raised serious questions, prompting Health Secretary Rehan Iqbal Baloch to defend the system, citing transparency and adherence to merit-based tenders. Yet these reassurances seem hollow in light of the persistent and well-documented complaints surfacing year after year.
The Drug Act of 1976 and the DRAP Act of 2012 impose strict penalties for the sale of expired drugs, including fines, imprisonment, and license cancellations. But in the absence of a national pharmacopoeia — a standardized reference for drug quality and usage — enforcement remains weak and inconsistent.
Systemic Reform is Overdue
Pakistan currently has around 900 registered drug formulations, of which 400 are considered essential and 500 non-essential. Without urgent reform in procurement oversight and regulatory enforcement, the practice of stocking near-expiry drugs will continue to undermine patient safety, public trust, and healthcare outcomes.
Final Verdict
The continued distribution of short-shelf-life medicines in Sindh’s public hospitals reflects a system more concerned with saving budgets than saving lives. While financial pressures are real, compromising on drug quality is a dangerous gamble in any healthcare setting — and for vulnerable populations relying on public care, it’s a betrayal. The time for policy-level course correction and institutional transparency is not tomorrow. It’s now.
