Belize public medicine tenders: GMP rules and substandard drugs

Medicines for Belize's public hospitals come through one channel: an annual open tender run by the Ministry of Health and Wellness, with stock distributed to hospitals from the Ministry's Central Medical Store¹². In January 2023 Amandala published leaked quality assurance forms that raised a hard question about that channel: had a relaxed tender rule let poor-quality medicines into Belize's hospitals?¹ With Cabinet now pushing to lower the cost of drugs for chronic disease, the trade-off between price and quality is back on the table¹³.

What the KHMH quality forms showed

The forms listed seven products, six medicines and one medical item, reported as substandard or degraded at the Karl Heusner Memorial Hospital (KHMH) and the Northern Regional Hospital¹. Dicloxacillin had black particles, erythromycin had brown spots, gemfibrozil had a disintegrating coating and a lubricating jelly showed mould; all were reported in 2022 and removed¹. KHMH chief executive Chandra Cansino said the hospital's quality assurance team regularly evaluates products and reports problems to the Ministry¹. According to Health Minister Kevin Bernard, medicines for the tender cycle were trickling into the country after delays in the last three months of 2022¹.

The 2021 GMP-or-GDP tender rule

At the centre of the dispute was a 2021 Ministry policy that allowed importers to win tenders without a Good Manufacturing Practice (GMP) certificate if they held a Good Distribution Practice (GDP) certificate¹. The difference matters: GMP concerns how a medicine is made; GDP concerns how it is stored and moved. Former minister Michel Chebat defended the change, saying it would help bring in known brands and "open the market for quality medication"¹. Minister Bernard rejected the claim that it led to inferior medicines, said "serious and intense inspections are done at the suppliers," and described the rule as requiring "a valid good manufacturing practice or good distribution practice certificate"¹. He also conceded: "it is something that I need to clarify at the ministry"¹. Product registration is a separate track: the 2017 registration regulations require a valid GMP certificate for every drug registered in Belize³.

How the Ministry chooses suppliers

In 2019, Director of Health Services Dr. Marvin Manzanero described the process to News 5. "Anybody who has an established company who has a duly license to import pharmaceuticals can submit a bid," he said; "When we do our tender process we do not put any brand to the product," and the committee selects "based on cost, based on the supplier reliability"². On quality he was candid: "we ask for a GMP, a CPP and a COA because we don't have the mechanisms in place to do testings"². Activist Geovannie Brackett, who raised the complaints, said "not all generic brand is bad" but asked whether the Ministry had audited and tested generic brands². In October 2024 Prime Minister John Briceño said Belize had "millions in drugs rejected because they didn't meet standards," and recalled a 2020 case in which a friend's blood-pressure pills were not working⁴; he also spoke of goods worth "a few million dollars plus" rejected for not meeting standards⁵.

Price pressure: Cabinet's push on chronic-disease drugs

On 21 October 2025 Cabinet discussed ways "to reduce secondary complications of chronic disease" and asked the Ministry of Health and Wellness to work with the Ministry of Finance "to explore ways to reduce the cost of certain classes of drugs used in the management of noncommunicable diseases"¹³. One route is regional pooled buying. Dr. Javier Zuniga said in July 2026 that Belize's full membership of the WHO drug-monitoring programme lets the country "purchase medications directly through PAHO from WHO-certified suppliers"⁶. The PAHO Strategic Fund is a pooled-procurement mechanism for essential medicines that "pools demand, thus achieving better value for money in health supplies"⁷. It does not guarantee prices, and freight and insurance are extra⁷. Price matters because of what substandard medicines cost: across 96 studies with 67,839 samples, 13.6 % of essential medicines in low- and middle-income countries were poor quality, including 12.4 % of antibiotics⁹. WHO estimates at least 1 in 10 medicines in those countries are substandard or falsified¹⁰.

Inspection and surveillance since 2023

The Ministry said in June 2023 that officers in its Drug Inspectorate, Pharmacy, and Licensing and Accreditation units were "on the ground daily" with more inspections of pharmacies and businesses in every district¹¹, and Minister Bernard said it is "now customary" for the Drug Inspectorate to check medical supplies inside hospitals¹. In November 2024 he credited the inspectorate: "If it was not because of them, we would not have been able to pick up on many of these issues"¹². Under the 2017 regulations inspectors must "regularly promulgate the results of sampling examinations and inspections on the quality of pharmaceuticals"³. In August 2026 the Ministry and PAHO/WHO began designing a National Post-Market Surveillance System covering quality problems and suspected substandard and falsified products⁸.

What it means for Belizean physicians

Physicians are often the first to notice that a medicine is not working. The 2022 products were recorded on hospital quality assurance forms, and KHMH says its team reports such problems to the Ministry¹. With a national post-market system being built⁸ and Belize reporting to the WHO global database⁶, a documented report of lack of effect or a visibly abnormal product now feeds a system designed to act on it. As Cabinet looks for cheaper chronic-disease drugs¹³, the same reports are the evidence that tells regulators whether lower prices have come at the expense of quality.