Six years after a Global Fund survey revealed that 35 percent of drugs found in private healthcare facilities were diverted from Malawi’s public healthcare service delivery system, cases of drug theft continue unabated, with the Universal Health Coverage Coalition (UHC) indicating that the country is losing 30 percent of the national drug budget to the vice.
This means the country loses K7 billion annually.
On August 17 2017, the Global Fund, through its Office of the Inspector General (OIG), indicated that drug pilferage and diversion were rampant in Malawi.
OIG safeguards assets, investments, reputation and sustainability of the Global Fund by ensuring that it takes the right action to defeat Aids, tuberculosis and malaria.
Through audits, investigations and consultancy work, it promotes good practice, reduces risk and reports fully and transparently on abuse.
Established in 2005, the OIG is an independent yet integral part of the Global Fund.
When the Global Fund’s OIG investigated the extent of drug pilferage in Malawi between 2015 and 2017, it indicated, in a report titled ‘Investigation of Drug Theft in Malawi’, thus:
“In September 2015, the OIG received reports that stolen drugs were being diverted from the Malawian public health system to private clinics. A market survey in November 2015 found that 35 percent of private clinics from the sample were selling stolen donor-funded ACT [artemisinin-based combination therapy, an anti-malaria drug] of which Global Fund-financed ACT was found in 19 percent of the clinics. The highest price paid for ACT found in the survey was $11 [approximately K9,009], indicating a strong financial incentive to steal the medicine.
“As a result, the Global Fund adapted its anti-corruption campaign, called ‘I Speak Out Now!’, to the Malawi context and launched [it] in April 2016 in partnership with a USaid [United States Agency for International Development] OIG campaign called ‘Make a Difference’, which also targeted drug theft. Through the supply chain and various media channels, the campaigns actively promote a reporting hotline owned by the Malawi Pharmacy Medicines and Poisons Board.
“In the first year of the campaign, 114 reports were received, of which 62 related to the theft of ACT from Malawi’s public health system. The OIG, working with USaid OIG and a newly created Ministry of Health Drug Theft Investigation Unit (DTIU), helped the national authorities to investigate and act on the information received by the hotline, leading to stock seizures and arrests.”
Between August 2016 and April 2017, the DTIU, working in collaboration with Malawi Police Service agents, took action against 62 individuals suspected of stealing and selling medicines from the public health system. Sixteen of those were public health workers who were subsequently prosecuted for theft of medicines. Three of whom have been convicted to date.
The Global Fund cites non-reconciliation of stock data between deliveries, stock counts and stock cards, ineffective systems and processes to account for commodities, coupled with inadequate storage facilities and conditions to accommodate stocks as some of the loopholes fuelling cases of drug theft in Malawi’s public hospitals.
And, in a latest development, UHC has expressed worry that Malawi’s health facilities continue to lose a significant quantity of drugs to theft.
UHC Deputy Chairperson Dingani Mithi faulted public bodies for doing nothing about the drug pilferage problem.
“Thirty percent of the drug budget in Malawi goes down the drain but we have an institution, namely Ministry of Health’s Drug Theft Investigation Unit, that is well funded but does not receive much support to operate within its mandate.
“Here is an institution that was established specifically to look into issues of drug theft and pilferage, but there is nothing much that the department does. The department does not share reports or any activities it does. They hide information very much, hence the increase in cases of drug theft,” Mithi said.
The 2021 budgetary allocation for drug procurement is K16 billion, down from K17 billion in the 2020 budget.
If cases of theft persist this year, the country will have to use K9 billion worth of drugs instead of the allocated K16 billion.
The figure K7 billion represents a marked increase from K900 million annually that was reported to have been lost to theft in 2019.
Ministry of Health spokesperson Adrian Chikumbe said the ministry was aware of cases of drug theft.
He, however, said they had put in place measures that are helping stakeholders track down processes.
“We, as a ministry, conducted a survey to understand how drugs are stolen in the country. We found that drug pilferage can occur during transportation from the supplier or manufacturer to the national warehouse such as Central Medical Stores [Trust].
“The drugs can either be stolen from warehouses or during transportation to health facilities. Furthermore, the drugs can also be stolen from pharmacies and drug stores within health facilities. So we, as a ministry, have put in place measures for tracking down all of the processes,” Chikumbe said.
Pharmacy and Medicines Regulatory Authority (PMRA) Public Relations Officer Joseph Josiah said, as regards drug pilferage, especially in government facilities, “we do what we call drug policing exercises in collaboration with the Drug Theft Investigation Unit in the Ministry of Health and Malawi Police Service targeting illegal drug vending and routine inspection exercises targeting licenced establishments to make sure that no government drugs are sold there because doing so is a crime under the PMRA Act.
“We are aware that illegal drug vending is fuelling drug pilferage in public health facilities and the authority will not relent to play its rightful role, as guided by the PMRA Act, to stop the malpractice and ensure that the country has access to quality, safe and efficacious medicines,” he said.