Malawi Faces Persistent Drug Shortages in Public Health Facilities, Urgent Measures Needed to Address Crisis

Lilongwe, Malawi - The Ministry of Health, under the Directorate of Health and Technical Support Services, is making continuous efforts to ensure the uninterrupted supply of high-quality health commodities in all public health facilities across Malawi, writes Meclina Chirwa.

This initiative falls under the Master Supply Chain Transformation Plan (MSCTP) as part of HSSP III 2023–2030, a comprehensive seven-year roadmap to improve the country's health commodity supply chain.

The issue of drug stockouts in health centres caught the attention of the Network of Journalists Living with HIV (JONEHA) through their monitoring exercises.

JONEHA has been monitoring the situation since 2020 and has witnessed both progress and setbacks, with drug shortages continuing to have a detrimental impact on patients and service providers.

Chiyembekezo Samson, a resident of Mchemani Traditional Authority Chimutu in Lilongwe, expressed his concern about the lack of drugs at Chiwamba Health Centre.

Samson, who has been struggling with ulcers and nosebleeds, faces a challenging situation as the nearest clinic is located 10 kilometres away from his village.

"I have been struggling with ulcers for quite some time now, but the condition is worsening. Last year, I managed to go to Kamuzu Central Hospital, where I was given Omeprazole. However, at Chiwamba Health Center, they told me there are no such drugs. Since then, I haven't had the means to go back. Every time I visit Chiwamba, I am informed that there are no drugs available, not even aspirin. I don't know what to do now," Samson lamented.

Unfortunately, such cases of drug stockouts are prevalent throughout the country, affecting hospitals and patients alike.

Public health facilities in Malawi have experienced recurring drug shortages, forcing doctors to ration medicines or redirect patients to expensive private pharmacies.

In 2021, the Scotland Malawi Partnership reported an acute shortage of essential drugs in Malawi that lasted over two months, resulting in the closure of operating theatres and clinics, and endangering numerous lives.

More than one-third of Malawi's districts experienced drug stockouts, with some medications, like thiopentone, being unavailable for over a year.

Maternity care was particularly impacted, leading to cancelled caesarean operations, closed clinics, and patients being turned away.

To address the ongoing problem of drug stockouts, JONEHA recently organized a follow-up meeting with stakeholders to assess the current situation and drug availability in public facilities.

During the meeting, Dr Prince Chirwa, Director of Health and Social Services for Mzimba South, highlighted the challenges of stockouts, procurement delays, inadequate drug budgets, and the persistent issue of drug theft and pilferage affecting service delivery.

Efforts have been made to address these challenges, with an increase in the allocation for drug procurement in the 2022–2023 budget.

However, despite some progress, the devolved 10% drug budget, which allows district hospitals to procure drugs from private pharmacies when the Central Medical Stores Trust (CMST) faces shortages, remains insufficient to cover the gaps.

Geoffrey Ngwira, Director of Pharmaceutical Operations at CMST, acknowledged the ongoing challenges in drug procurement due to economic factors, such as foreign currency shortages and increased costs of raw materials.

He mentioned that efforts are underway to address these issues, including reevaluating contracts and tender processes.

The Ministry of Health has been advocating for the recapitalization of CMST to ensure a sustainable supply of medicines.

Although K22.5 billion has been provided in staggered disbursements, a recapitalization plan was submitted to the government in 2019, seeking annual capital injections of K10 billion for three years.

Despite this, the recapitalization process has been slow, hindering the efficient functioning of CMST.

During the follow-up meeting, Dr Mathews Ngwale, Chairperson of the Parliamentary Committee on Health, emphasized the need for adequate health financing to address these challenges.

He highlighted the limited resources of the country and the heavy reliance on donor support, urging the government to explore alternative mechanisms, such as introducing an insurance policy for all government employees and finding ways for non-civil servants to contribute towards their healthcare.

Gladys Ganda, Chairperson of the Parliamentary Committee on Budget and Finance, echoed the concerns about inadequate funding for the drug budget.

She emphasized the importance of generating more revenue and prioritizing spending on essential sectors like healthcare.

Addressing the issue of drug theft and pilferage, Egrita Ndala, Senior Public Relations Officer of the Anti-Corruption Bureau (ACB), emphasized the role of corruption in exacerbating drug shortages. The ACB's focus is on capacitating institutions to detect and prevent drug theft, emphasizing that prevention is better than cure.

Despite the efforts of various stakeholders, including the COMPASS Malawi Initiative and JONEHA, to address drug stockouts, concerns remain regarding the slow progress in resolving the crisis.

Inadequate funding continues to be the primary factor negatively affecting drug availability in Malawi.

JONEHA calls upon the government and relevant stakeholders to prioritize the recapitalization of CMST, strengthen systems and governance, and explore alternative financing mechanisms to alleviate the drug shortage.

As the nation grapples with the persistent challenge of drug stockouts, the need for immediate action and sustainable solutions becomes increasingly urgent.

It is crucial to ensure the availability of essential medications to safeguard the health and well-being of the people of Malawi.