The health sector is, in an ideal setup, supposed to be strewn with dedicated workers that are spotless; that is, full of selfless service, hard nuts to crack for corrupt elements and passionate about their job. But, as YOHANE SYMON writes, this is not the case because some public health workers sell government drugs to vendors, who know nothing about drugs.
Honesty in the public health sector can, definitely, save K2 billion Kwacha, which the government loses to theft annually. Not only that; honesty among workers would open the floodgates of integrity, thereby reducing the long-standing flag of corruption— for a long time one of the factors behind poor service delivery— to ashes.
However, the situation is far from it, as the country’s public healthcare service delivery system is littered with some bad elements, as evidenced by how easily Malawians in, for example, South Africa continually access antiretroviral (ARVs) drugs from Malawi.
That is how, for the past two years, Aisha (not real name) and her husband, who resides in Free State, South Africa, have not defaulted on ARVs, which they buy every three months from a supplier at Katuli Market, in the area of Traditional Katuli, in Mangochi District.
They buy the ARVs from the black market despite that the Malawi Government provides free ARVs to all HIV-positive people in the country.
But the life-prolonging drugs are not the only thing to fall into the wrong hands— namely unscrupulous healthcare workers and vendors. Aisha says she gets almost all essential drugs her family needs from the same supplier, who is not registered by the Pharmacy and Poisons Board.
When she fell pregnant in 2018, Aisha and her husband were diagnosed with HIV and, shortly afterwards, were enrolled on ARVs after their CD4 count deteriorated.
In 2013, the World Health Organisation (WHO) consolidated ARV guidelines and recommended that all adults with HIV and a CD4 count at or below 500 cells/mm3 be initiated on ARVs, regardless of WHO clinical stage, giving priority to those with severe or advanced HIV disease (WHO clinical stages 3 or 4) or a CD4 cell count at or below 350 cells/mm3.
The recommendation was based on moderate-quality evidence from three randomised controlled trials and 21 observational studies showing that initiating ART at or below a CD4 threshold of 500 cells/mm3 compared with later initiation reduced the risk of progression to Aids and/or death, tuberculosis and developing a non-Aids-defining illness and increased the likelihood of immune recovery.
That is why Aisha and her husband were enrolled on ARVs. However, six months into the programme, Aisha’s husband moved to the Republic of South Africa to search for greener pastures, as is the case with most men from Mangochi District.
This meant that Aisha, who remained in Malawi, had to be collecting drugs for her husband.
“Somebody from the hospital told us that he could be providing us with the ARVs so that we could no longer be travelling from South Africa back to the hospital [in Malawi] every now and then. As such, we started buying the drugs from him because we thought the hospital could not allow us to collect drugs for somebody who is outside the country,” she says.
Every three months, her husband sends money through one of the mobile money service providers for her to buy ARVs and other drugs for sending to the Rainbow Nation.
Apart from Aisha, there are scores of people across the country that, every month, buy ARVs and other essential drugs for their relations in RSA.
We have established that single month-dose of ARVs costs between K10,000 and K15,000, depending on vendor.
Medical drugs sourced from Malawi are highly sought after across the borders, especially in South Africa and Mozambique, where people pay to access medical services.
At Katuli Trading Centre in Mangochi District, ARVs and medical drugs are sold in much the same way as people sell, say, fish or vegetables.
On any given market day, vendors openly display medical drugs, some with Malawi Government inscriptions, without the slightest fear of penalties from the authorities. The situation is not different at Chiponde and other rural markets where hospitals are not easily accessible.
But Aisha says she prefers buying drugs from vendors because the drugs are readily available, as opposed to public health service delivery facilities, where some workers deliberately make it difficult for people to access ARVs so that they [workers] can then sell to vendors and generate funds.
“When we go to a public hospital, they always tell us that there are no drugs. They refer us to vendors or some private clinic because they know the vendors they sell drugs to. The only available drugs in government hospitals are pain-killers,” she says
At the moment, Aisha says she no longer visits public healthcare facilities to get prescribed drugs.
In most instances, she says, she relies on pieces of advice from vendors.
Our investigations also revealed that some locals are being cheated into buying drugs that with different chemical compositions.
Through the investigations, we sent a member of the community to buy Penicillin from a vendor at Chiponde Trading Centre. However, the member came back with Aspirin mixed with two tablets of Penicillin so that the whole package could be smelling like Penicillin to fool people.
“Inmostcases, villagers identify drugs by their smell; as such, we mix tablets which look alike so that we can disguise them as Penicillin or the antibiotic that is on high demand at a given time. That way, locals pay more for drugs which cost less money,” one vendor discloses.
Not surprisingly, Traditional Authority Katuli is worried with the situation.
“I am worried that my area is used as a market for medical drugs due to its proximity to Mozambique. In fact, people come from Mozambique to buy all sorts of drugs from markets within his area.
“We are not sure why the government is not dealing with this because a lot of people are suffering due to the unavailability of drugs in public hospitals. We also blame the Police for not using the laws properly to protect Malawians from consuming drugs peddled by uncertified dealers,” Katuli says.
He further expressed worry with how the courts are handling people who are caught with drugs which are believed to have been stolen from public health centres.
“Maybe there should be a way to code drugs found in hospitals— instead of labeling them Malawi Government— so that we can know who is selling the drugs to vendors. In addition, the government should review fines imposed on people who are found selling drugs illegally,” he said.
Studies show that about 30 percent of drugs, mainly donor-funded malaria drugs, and medical supplies in public health facilities, are stolen annually, which translates into a loss of K1 billion for the government
However, every now and then, law enforcers pounce on unlicenced drug sellers.
For instance, the magistrate court in Mangochi fined 25-year-old White Maluwa after being found guilty of possessing medical drugs without a licence. He was convicted on June 25 2021 and fined K130, 000.
Among the drugs, Maluwa was found with Amoxicillin, Cotrim 24 bottles of ARVs, 370 Zinc tablets, 1,114 tablets of Bactrim and other essential drugs that are usually found in government hospitals only.
The drugs were forfeited to Malawi Government because it was established that they were stolen from public health facilities.
This is just a tip of the iceberg, according to Dickens Mahwayo, who is Mangochi Civil Society Network Deputy Chairperson.
Mahwayo suggests that Hospital Community Advisory (HAC) committee members should be trained in monitoring drug use.
“Most of HAC members are not familiar with how drugs are administered. As a result, they easily get conned by unscrupulous health officials who steal drugs,” he said.
Meanwhile, Ministry of Health spokesperson Adrian Chikumbe has admitted that theft of medical drugs in public health facilities is rampant in the country.
He says, annually, the government spends about K20 billion on drugs and other supplies but over K2 billion of this amount is lost to theft.
“The figure of drug theft which is reported is on the lower side compared to the actual theft which happens in government health facilities. People are stealing everything they can lay their hands on including mopping materials. It is a serious problem for us,” he said.
But Chikumbe says the ministry is working with stakeholders to make sure that cases of drug theft are reduced in public health facilities.
Among other things, Chikumbe says the ministry has installed CCTV in warehouses and pharmacies to record transactions, which are being made to ensure that drugs are being used for their intended purpose.
He says the ministry is also intensifying the use of hospital management committees to help record drug theft at health centre level.
“We also lobbied for a repeal of the Penal Code to make punishment more stiff than now because people are stealing drugs worth millions of Kwacha only to be fined K50,000. So, we are happy that the Penal Code has been repealed,” he says.
Chikumbe further warned people against consuming medical drugs which are bought from vendors who are not certified to store drugs.
He admitted that, due to the culture of buying drugs from vendors, a lot of people across the country were taking drugs that are hazardous to health.
“Most of these vendors do not know how to store these drugs; as such, people are killing themselves by taking these drugs. We, as government, would like to encourage people to always get medicine from certified dealers,” he says.
That way, the road to the grave will be closed to those that buy stolen drugs from unlicenced vendors.