Appendix G · Digital companion · all tools

Medicine missing at the public hospital

Appendix G: The Hospital Medicine Stock and Patient Rights Template

A public hospital should not become a maze where the patient discovers public failure only after illness has already made the family desperate. If a medicine was budgeted, procured, stocked, prescribed, or unavailable, there should be a record. If a patient is told to buy outside, there should be a reason. If equipment is broken, there should be a status. If a complaint is filed, it should not disappear into the same silence that harmed the patient.

This template is for public hospitals, health departments, patient rights groups, journalists, medical colleges, legal aid clinics, local governments, reform teams, and citizen monitors. Its purpose is not to attack doctors, nurses, pharmacists, or hospital staff. Many health workers serve under immense pressure, often with shortages, overcrowding, poor infrastructure, and emotional risk. The purpose is to make the public health chain visible so that patients are not forced to pay privately for failures that public money was supposed to prevent.

A health system becomes more trustworthy when the patient can see what is available, what is missing, who is responsible, and how to complain.

Essential Medicine Stock Record

Every public hospital should maintain and display a patient-facing essential medicine stock record. The public version should be simple enough for ordinary patients and families to understand; the internal version can be more detailed, but the patient's family should not be left guessing.

• The essential medicine stock record should include:
• Medicine name.
• Strength and form.
• Whether it is included in the hospital's free or subsidized list.
• Opening stock.
• Quantity received.
• Quantity issued.
• Closing stock.
• Stockout days.
• Expected replenishment date.
• Supplier or procurement batch reference where appropriate.
• Expiry status.
• Responsible pharmacy officer.
• Last updated date.
• Complaint route if unavailable.

The hospital should not simply say "medicine unavailable." It should record whether the medicine was not budgeted, not procured, delayed in supply, consumed faster than expected, expired, diverted, prescribed outside the approved list, or temporarily unavailable for a documented reason.

Patient-Facing Medicine Availability Board

Each major public hospital should display a medicine availability board in a visible place near the pharmacy or patient help desk. The board should be updated at least daily for high-demand medicines and regularly for others.

• The board should show:
• Available.
• Limited stock.
• Out of stock.
• Expected restock date.
• Alternative available where clinically appropriate.
• Official instruction if patient is asked to buy outside.
• Complaint desk contact.

A patient should not have to wait in line for hours only to discover that the prescribed medicine is not available. If a medicine is out of stock, the patient deserves to know before spending time and money inside the hospital.

Outside Purchase Record

When a public hospital patient is told to buy medicine, supplies, tests, or equipment from outside, the event should be recorded. This protects the patient and exposes the chain of failure.

• The outside purchase record should include:
• Patient reference number, with privacy protection.
• Date.
• Department or ward.
• Medicine, supply, test, or item prescribed.
• Whether item is normally supposed to be available in hospital.
• Reason for outside purchase.
• Doctor or department issuing prescription.
• Pharmacy or stock officer confirmation.
• Estimated cost to patient where available.
• Complaint option offered.
• Whether patient could not afford the item.

This record should be reviewed monthly. If many patients are buying the same medicine outside, the issue is not individual. It is systemic.

Equipment Functionality Record

A public hospital may have equipment listed on paper but unavailable in practice. A machine that is broken, lacks reagents, lacks trained staff, lacks maintenance, or is available only through informal access does not serve the patient.

• The equipment functionality record should include:
• Equipment name.
• Department.
• Date purchased or installed.
• Operational status.
• Downtime days.
• Reason for downtime.
• Maintenance contract status.
• Responsible vendor where applicable.
• Responsible hospital officer.
• Consumables or reagents availability.
• Average daily patient use.
• Referral route when equipment is unavailable.
• Expected repair date.
• A hospital should not be able to claim capacity through equipment that does not function.

Official Fee and Charge Record

Patients should know official fees before they pay. Hospitals should display official fees for consultations, tests, procedures, registration, admission, imaging, emergency services, ambulance, and any subsidized services.

• The fee record should include:
• Service name.
• Official fee.
• Exemption category.
• Subsidized category.
• Free category.
• Required documents for exemption.
• Payment location.
• Receipt requirement.
• Complaint route for overcharging.

No patient should be asked to pay without a receipt. If the fee is waived or subsidized, that should also be recorded so that the patient does not depend on personal pleading or staff discretion alone.

Patient Rights Notice

Every public hospital should display a patient rights notice in clear language. It should not be decorative. It should tell patients what they can expect and what to do when the system fails.

• The notice should state:
• Patients have the right to respectful treatment.
• Patients have the right to know official fees.
• Patients have the right to receive a receipt for payment.
• Patients have the right to know whether essential medicines are available.
• Patients have the right to ask why they are being sent outside to buy medicine or tests.
• Patients have the right to file a complaint.
• Patients have the right to privacy.
• Patients have the right to receive referral instructions.
• Patients have the right to emergency triage according to medical need.
• Patients have the right not to be photographed or publicly exposed without consent.

A patient in distress may not read every notice, but the notice changes the hospital's posture. It tells staff and families that the patient is a claimant, not a supplicant.

Complaint Intake Record

• A hospital complaint system must issue a tracking number. A complaint that receives sympathy but no number is often forgotten.
• The complaint intake record should include:
• Complaint number.
• Date and time.
• Patient reference, with privacy protection.
• Department involved.
• Complaint category.
• Brief description.
• Urgency level.
• Immediate safety issue, if any.
• Officer receiving complaint.
• Expected response date.
• Status.
• Resolution.
• Appeal route.

Complaint categories may include medicine unavailable, unofficial payment demand, rude behavior, referral confusion, overcharging, delayed emergency care, missing test result, equipment unavailable, privacy violation, denial of service, discrimination, cleanliness, staff absence, or other specified issue.

Emergency Care Record

• Emergency care requires special discipline because delay can cost life. A hospital should record emergency triage and response times.
• The emergency care record should include:
• Arrival time.
• Triage time.
• Triage category.
• First clinical assessment time.
• Emergency treatment started.
• Referral needed.
• Referral facility.
• Reason for referral.
• Ambulance availability.
• Bed availability.
• Death on arrival or death in emergency where applicable.
• Delay reason where applicable.

The purpose is not to punish doctors for every bad outcome but to understand whether the emergency system is functioning and where delay occurs.

Referral Record

Patients are often sent from one facility to another without clear explanation. A referral should be recorded so that the patient does not wander between institutions.

• The referral record should include:
• Referring facility.
• Receiving facility.
• Date and time.
• Reason for referral.
• Service needed.
• Whether receiving facility was contacted.
• Transport arrangement.
• Documents given to patient.
• Clinical summary provided.
• Urgency level.
• Patient consent where applicable.

If referrals repeatedly occur because a public hospital lacks a service it is supposed to provide, that pattern must be visible.

Privacy and Consent Record

The poor patient is often exposed in the name of charity, media coverage, public relations, or documentation. This must stop. Illness does not erase dignity.

• The privacy and consent record should apply to:
• Photographs.
• Videos.
• Social media posts.
• Fundraising appeals.
• Media coverage.
• Case studies.
• Public release of diagnosis.
• Release of patient identity.

Consent must be informed, voluntary, and documented. A patient should not feel that care depends on public exposure. Children, women, victims of violence, and stigmatized conditions require special protection.

Medicine Procurement Chain Record

A hospital stockout may be caused by failures outside the hospital. The medicine procurement chain record should follow the process from budget to patient.

• The record should include:
• Budget allocation.
• Procurement request date.
• Tender or purchase method.
• Supplier.
• Contract date.
• Delivery date.
• Quantity ordered.
• Quantity received.
• Quality verification.
• Distribution to hospital pharmacy.
• Stock entry date.
• Issue to departments or patients.
• Stockout dates.
• Payment status to supplier.
• Delay reason.
• This record helps identify whether failure occurred at budgeting, procurement, supplier delivery, storage, pharmacy management, prescribing, or distribution.

Expired or Near-Expiry Medicine Record

Medicine expiry is a serious public failure when preventable. It may indicate poor forecasting, weak stock rotation, over-procurement, delayed distribution, or poor inventory management.

• The record should include:
• Medicine name.
• Batch number.
• Quantity expired.
• Expiry date.
• Reason not used.
• Disposal method.
• Financial loss.
• Officer responsible for review.
• Corrective action.
• Near-expiry medicines should be flagged early so they can be used appropriately or redistributed where clinically safe and legally permitted.

Patient Affordability Hardship Record

When a patient cannot afford an outside medicine, test, device, or referral cost, the hardship should be recorded. Otherwise the system never sees how often public gaps become private crisis.

• The hardship record should include:
• Patient reference, with privacy protection.
• Required item or service.
• Estimated cost.
• Reason item was not available publicly.
• Whether patient could purchase.
• Whether charity or social welfare support was requested.
• Whether treatment was delayed.
• Outcome.
• This data can reveal which missing services create the greatest financial harm.

Public Health Facility Dashboard

• A district or provincial health dashboard should publish facility-level performance without exposing private patient data.
• The dashboard should include:
• Essential medicine stockout days.
• High-demand medicine availability.
• Equipment downtime.
• Emergency response times.
• Patient complaints received.
• Complaints resolved.
• Outside purchase frequency.
• Official fee compliance.
• Referral volume.
• Bed occupancy where relevant.
• Staff vacancy rates.
• Maternal and child health service availability.
• Vaccination status where applicable.
• Facility cleanliness and safety inspections.

The dashboard should be readable. It should not be a technical document buried for specialists. Citizens need to know whether public facilities are functioning.

Patient Help Desk Standard

A patient help desk should not be a symbolic table. It should be able to answer basic questions and create records.

• The help desk should provide:
• Service guidance.
• Fee information.
• Medicine availability direction.
• Complaint intake.
• Referral information.
• Support for elderly and disabled patients.
• Guidance for poor patients needing welfare support.
• Information on official documents required.
• Tracking of complaints.
• Language support where possible.
• A hospital without a functioning help desk often forces patients into the arms of informal brokers.

Informal Broker Risk Record

Hospitals are vulnerable to brokers, touts, referral agents, private pharmacy networks, ambulance operators, and insiders who exploit patient confusion. The hospital should record and act on broker activity.

• The record should include:
• Type of broker activity.
• Location.
• Patient complaint.
• Staff involvement suspected.
• Private pharmacy or lab referral pattern.
• Ambulance referral pattern.
• Action taken.
• Repeat offenders.
• Referral to law enforcement where appropriate.
• The goal is not to prevent legitimate referrals but to prevent fear and confusion from becoming a market.

Staff Protection and Workload Record

Patient rights and worker dignity belong together. A hospital cannot serve patients well if staff are abused, unpaid, understaffed, or unsafe.

• The staff record should include:
• Doctor vacancies.
• Nurse vacancies.
• Technician vacancies.
• Pharmacy staff vacancies.
• Shift patterns.
• Overtime burden.
• Salary delay complaints.
• Workplace violence incidents.
• Security support.
• Training needs.
• Burnout or mental health support where available.

Patient anger often lands on frontline staff even when failure was caused by procurement, policy, staffing, or funding. A fair hospital accountability system protects patients and honest health workers.

Medical Negligence and Grievance Review

Patient complaints about negligence require professional review. Not every bad outcome is negligence. Not every patient complaint is false. The review system must be fair, timely, and competent.

• The review record should include:
• Complaint number.
• Clinical issue.
• Patient outcome.
• Initial review date.
• Medical records secured.
• Review body.
• Doctor or department response.
• Expert opinion where needed.
• Finding.
• Corrective action.
• Patient communication.
• Appeal route.
• The goal is truth and improvement, not mob pressure or institutional cover-up.

Public Financing and Health Insurance Record

If public money pays private hospitals, insurance schemes, or health card systems, the public should see whether the money buys real care.

• The record should include:
• Scheme name.
• Participating providers.
• Eligibility rules.
• Services covered.
• Claims filed.
• Claims paid.
• Rejected claims.
• Extra charges to patients.
• Patient complaints.
• Fraud audits.
• Provider suspension or penalty.
• Outcome indicators where available.
• Public financing should not become a billing market without patient protection.

Model Medicine Stock Entry

A translated version of any form or letter is a draft for your understanding. Submit in the office’s official language, and have the final text checked by someone you trust.

Facility: [Insert hospital or clinic]
Medicine: [Insert name]
Strength and form: [Insert]
Free or subsidized list: [Yes or no]
Opening stock: [Insert]
Quantity received: [Insert]
Quantity issued: [Insert]
Closing stock: [Insert]
Stockout days this month: [Insert]
Expected replenishment: [Insert date]
Responsible officer: [Insert designation]
Last updated: [Insert date]
Complaint route: [Insert]

Model Outside Purchase Entry

Patient reference: [Protected]
Date: [Insert]
Department: [Insert]
Item prescribed: [Insert]
Normally available in hospital: [Yes or no]
Reason unavailable: [Insert]
Estimated outside cost: [Insert]
Complaint offered: [Yes or no]
Hardship recorded: [Yes or no]
Status: [Resolved, pending, escalated]

Model Patient Complaint Entry

Complaint number: [Insert]
Date and time: [Insert]
Patient reference: [Protected]
Department: [Insert]
Complaint category: [Insert]
Description: [Brief]
Urgency: [Low, medium, high]
Officer receiving complaint: [Insert designation]
Response due by: [Insert date]
Status: [Pending, resolved, escalated]
Resolution: [Insert]
Appeal route: [Insert]

Implementation Sequence

Begin with one hospital or one district. Do not attempt to digitize every health problem at once. Start with essential medicine stock, outside purchase recording, official fee display, complaint tracking, and equipment functionality.

Train pharmacy staff, help desk staff, and ward administrators on the record system. Publish patient-facing information in simple language. Review stockout data weekly. Review patient complaints monthly. Identify repeat medicines, departments, or vendors associated with failure. Correct what can be corrected quickly. Escalate what requires budget or procurement reform.

After the first facility proves the method, expand to other hospitals and clinics.

Safeguards

Health data is sensitive. Patient privacy must be protected. Public reporting should use aggregate data unless individual disclosure is lawful, necessary, and consented to. Medical information should not be published for media, charity, political, or institutional promotion without informed consent.

The system should not become a tool for blaming frontline staff for failures created by procurement, funding, staffing, or policy; the record should identify where the chain failed.

False complaints should be handled fairly, but fear of false complaints should not justify no complaint system.