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Persistent stockouts of essential drugs angers people in Dowa

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LACKING VOICE—People are encouraged to demand their right to access essential medicines

People in the district of Dowa, just like others across Malawi, toil to access essential drugs, which is putting their lives on the line. Now community health rights groups are rallying to demand accountability from Government to make sure life-saving drugs are available, Dingaan Mithi writes:

Hannock Mbewe is a Community Based Educator (CBE) and works tirelessly to raise awareness on the health rights of the people. This is a way of empowering them to become active citizens who can hold duty bearers accountable.

“Part of my work is to raise awareness on people’s right to health. People must be able to demand right to healthcare. That can only happen if the people are empowered,” Mbewe, who has been working as a CBE for four years in the area of Traditional Authority Chakhaza, the largest by size in Dowa District in Malawi’s central region says.

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Chakhaza Health Centre is located not far from M1 Road. However, when the facility runs out of essential medicines, one has to travel a distance of 5 kilometres to get medicine at Madisi Mission Hospital, a facility that charges for its services.

Due to inconsistencies by government in subsidising some health services through a service level agreement with Christian Health Association of Malawi (Cham), it simply means people from Chakhaza have to pay out of their pockets for the drugs.

Mbewe is not satisfied with the level of availability of medicines at Chakhaza Health Centre. He says people are struggling to buy medicines from pharmacies which sell the drugs at high prices.

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In addition, the service level agreement between government and Cham only covers a small portion of children’s health needs and other maternal health services.

“We are not satisfied with availability of essential medicines. I think government is lacking commitment. When drugs get finished here at Chakhaza Health Centre, one must pay out of pocket at pharmacies thereby making people suffer from financial stress,” he says.

“Think about those who don’t have money; it is a nightmare. We want the District Health Officer to come here and address us. Unfortunately every time he makes excuses that he is busy.”

Mbewe is not alone, a health worker at the facility who opted for anonymity explains that maternal health services are being hampered due to unavailability of essential drugs such as oxytocin used to stop loss of blood during delivery.

“Right now, we are having challenges of stock outs of oxytocin. This is a very important life-saving drug during delivery. In its place we are using misoprostol which is also not enough,” she explains, adding:

“It is very hard to convince people that we have stock outs of essential medicines, in the end, people rush to conclude that we are stealing drugs which is untrue.”

Maria Kanjoka is chairperson of Nkokoko Village Development Committee in the area of Traditional Authority Chakhaza. She says access to medicines is a huge challenge in the area around Chakhaza Health Centre.

“My role as a chairperson for the Village Development Committee is to also address access to health services by creating a platform for dialogue on various health challenges. Last year, I had a running stomach. When I came here at the health centre, I was told there were no drugs. I simply went back home and did not buy any medicine because of lack of cash,” she says.

Kanjoka says there is an urgent need for health officials in the district, more especially the District Health Management Team (DHMT) and local governance structures such as the Village Development Committee. to meet and find common solutions to reduce stock outs of essential drugs in the area.

As part of work to improve access to medicines in Malawi, the Journalists Association Against AIDS (JournAIDS), with support from Oxfam in Malawi through Oxfam Ireland, is advancing policy advocacy on universal health coverage and access to essential medicines.

According to the 2017- 2022 Health Sector Strategic Plan (HSSP), the health care system in Malawi has been experiencing regular shortages of essential medical products and

technologies for a long period of time.

“This situation is due to many factors including inadequate funding, high disease burden, high purchasing prices, weak supply chain management, lack of drug storage spaces, unreliable information systems, irrational use of medicines, leakage and pilferage,” reads in part of the plan.

The Central Medical Stores Trust (CMST), the body responsible for the procurement of drugs in the public sector, has been implementing recommendations of a 2012 joint supply chain integration strategy, which outlined 36 benchmarks.

The HSSP adds that warehousing and storage of health products continue to pose significant challenges across all levels of the health system.

In addition, CMST is not adequately capitalised, which prevents it from purchasing sufficient medicines for the country and operating a revolving fund to ensure sustainability. It is estimated that Malawi loses about 30 percent of the national drug budget to pilferage.

A health commodity leakage study led to the establishment of the Drug Theft Investigation Unit (DTIU) and an ‘Action Plan for Drug Availability and Security’. However, the DTIU faces numerous challenges especially limited staff.

Program and advocacy manager for Mponela AIDS Information and Counselling Centre (MAICC), George Kaunda is not impressed with reforms at Central Medical Stores Trust (CMST) and bemoans pilferage of drugs.

“Theft of drugs is another real concern here in Dowa. There are many clinicians in public health facilities operating private clinics and pharmacies and are selling government drugs. I strongly feel there is a cartel controlling the drug market and fueling sale of drugs. Government policy is very unclear regarding health workers running pharmacies and found stealing drugs,” says Kaunda.

“These people are not being punished and there is a lot of leniency on the part of Malawi Government. There is a need to move in swiftly and crack down on this syndicate making the national drug budget lose millions of dollars,” he says.

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