System exposes drugs to theft
A significant quantity of drugs and medical supplies from public hospitals end up in the hands of vendors who sell the same to unsuspecting Malawians at a higher price. However, such medical services are supposed to be free-of-charge in public facilities. Apart from costing the government money, theft of drugs in public hospitals creates a big shortage of medical supplies, a development which affects innocent Malawians. YOHANE SYMON exposes it all.
For three years, a 42-year-old man, who we will only identify as Mustafa for the sake of his privacy, has been buying anti-retroviral drugs (ARVs) and other medicines for his family members from a vendor at Ulongwe Trading Centre in Balaka District.
Mustafa says he lost trust in public hospitals because, in most cases, the facilities have no drugs.
“We are told by medical personnel to buy the drugs from vendors and private hospitals,” he says.
The Ulongwe vendor, identified as Bwanali Zulu, was eventually arrested. At the time of his arrest, he was found with 79 complete monthly dosages of ARVs, among other drugs which he was selling.
Cases of drug theft are rampant across the country.
For instance, vendors in Mangochi District areas such as Katuli and Namwera sell medical supplies in the same way they do merchandise such as kaunjika (second-hand products).
Recently, theft of drugs at Katuli Health Centre forced some members of the community to apprehend and hand over a vendor and two medical personnel from the centre to the police for allegedly stealing drugs at the facility.
“We have been reporting to the authorities at Mangochi District Health Office (DHO) about the conduct of the health workers who are fond of stealing drugs. Every time people go there, they are told that the facility has no medicines. Instead, we have been seeing vendors coming out of the facility with boxes of drugs,” says Omar Magombo, who is Katuli Ward councillor.
Magombo accuses some senior officers at the Ministry of Health of shielding juniors who are caught stealing drugs from hospitals.
He says, in most cases, hospital personnel are reluctant to present evidence in court against their colleagues, hence it becomes difficult to convict such suspects.
“But in some cases, we believe that the courts have helped perpetrate cases of theft of drugs because the punishment which they give to people found guilty is lenient compared to the crime committed,” he says.
But in an earlier interview after the arrest of Katuli medical personnel, Mangochi District Health Officer (DHO), Henry Chibowa Junior, denies that his office shields officers who are implicated in drug pilferage.
He says the DHO sent a team of investigators who established that the drugs were indeed the property of Malawi Government.
“But what usually happens is that, when there is an arrest, we conduct an audit into the drug stock to establish if there has been any drug stolen. So, in most cases, the culprits move faster to balance the stocks before our audit and it becomes impossible for us to connect them to the stolen drugs. But, for the Katuli scenario, we moved in quickly and established that the drugs were indeed stolen,” Chibowa says.
Despite the suspects being taken to court, drugs in public hospitals continue to be stolen, thereby creating a crisis.
A day hardly passes without reports of either vendors or medical personnel being arrested in connection with stolen medical supplies.
However, the amount of the reported stolen drugs present a picture of a malfunctioning system which needs fixing.
During the current financial year, the Ministry of Health allocated K14 billion for the purchase of drugs from Central Medical Stores Trust (CMST).
As it stands, 40 percent of the funds might go down the drain due to drug pilferage.
The Daily Times’ investigations have established that, among the many ways, unscrupulous medical personnel take advantage of high illiteracy levels among service users and unavailability of pharmacy technicians in most health centres.
By requirement, every health facility that has a dispensary is required to have a pharmacy technician (pharmacist) to manage drug stocks.
However, due to high vacancy rate in the ministry, most facilities do not have pharmacy technicians, leaving the pharmacies and dispensaries in the hands health surveyors’ assistants (HSAs) and other unqualified personnel.
Our findings further show that an average of 70 percent of health centres in districts such as Mangochi, Machinga, Ntcheu, Karonga, Nsanje, Ntchisi and Nkhotakota lack qualified pharmacists to manage drugs at the facilities.
The majority of trained pharmacists are stationed at district and referral hospitals, leaving drugs in the hands of unqualified personnel.
“This means t h a t unscrupulous medical personnel take advantage of lack of trained pharmacists to steal medical supplies in the hospitals. The situation is bad because, as DHOs, we cannot manage to be monitoring drug stocks in health centres regularly,” says a DHO who refused to be named.
Additionally, lack of qualified pharmacists, according to the DHO, results in people being given unnecessary drugs.
We have also established that most health centres do not have properly designed drug stores, meaning that drugs are stored in offices which are accessible by any member of staff.
This, according to some hospital personnel, exposes the drugs to theft.
Speaking in an interview on the sidelines of this year’s Society of Medical Doctors in Malawi annual general meeting held in Mangochi, Secretary for Health, Dan Namarika, acknowledges that his ministry is struggling to fill vacancies in public hospitals.
Namarika explains that the ministry has a vacancy rate of 52 percent in all departments.
The vacancy rate for nurses is at 63 percent, while that of HSAs is at 50 percent.
He, however, says the ministry has started the process of filling the critical vacancies.
“We can end these challenges and others if the ministry is not considered a consuming ministry as is the case now. We need to take the Health Ministry as a productive sector that can improve productivity of the country,” he says.
At the national level, the ministry’s publicist, Joshua Malango, observes that the Drug Theft Investigation Unit is doing enough to stop theft of drugs in public hospitals.
He explains that the primary objective of the unit is to ensure that drugs are not stolen from public hospitals.
But if they are stolen, Malango says the department has the mandate and capacity to investigate and prosecute suspects.
“Currently, there are a number of cases which the department is investigating as well as prosecuting in court. We are doing a lot and we will continue. Most importantly, we want to build capacity of the communities to ensure that they take a leading role in identifying theft of drugs at their respective heath facilities,” Malango says.
Malango says the unit works closely with district hospitals and CMST to fight those engaged in drug theft.
Every year, an estimated 40 percent of drugs and medical supplies are reportedly stolen from the country’s public hospitals, resulting in the loss of billions of kwacha.
But Maziko Matemba, health rights activist at Health and Rights Education Programme, says there is need to strengthen the country’s drug-supply chain to avoid drug pilferage.
He says studies which some players in the sector conducted show that 95 percent of drugs are stolen from health centres and district hospitals.
Matemba says perpetrators take advantage of illiteracy among members of the health advisory committees (HAC) across the country because the committees are unable to monitor how the drugs are issued.
“Most members of HACs are not knowledgeable enough to do a proper monitoring of how the drug stock is managed at the facilities. They need awareness and serious capacity-building so that they can be playing their role from an informed point of view.
“The other problem is that, in Zambia, Mozambique and some countries in eastern and Southern Africa, people pay to access health services. This, in part, creates a parallel market for drugs from Malawi especially in border districts,” he says.
Matemba says there is need to introduce a system where patients can be receiving drugs using national identity card numbers.
This, he says, can help when auditing drugs at each facility.
He also urges the government to employ more pharmacists to manage drug stores in public health facilities, saying lack of such personnel increases cases of drugs’ theft.
“Pharmacy is a science which cannot be assigned to everybody as is the case in Malawi. Instead of purchasing drugs that are required, we have had cases where facilities purchase drugs which are not required, leading to theft,” he says.
Matemba also asked the government to renovate and construct proper drug stores in all health facilities.
At the moment, Matemba, says, drugs will continue to be stolen because the system has many loopholes.
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