Corruption and political interference at procurement level have emerged as main contributing factors to shortage of medicines and other medical supplies (MMS) in the country’s public health facilities.
Findings of a new study titled ‘The missing and unmentioned truths in the erratic availability of medicines and other medical supplies (MMS) in Malawi’ also hint that what healthcare staff are blamed to steal could just be a drop if not for secrecy surrounding procurement.
Central Medical Stores Trust
The study was conducted by John Kadzandira, a research fellow at the Centre for Social Research of the University of Malawi (Unima) and results were disseminated on Friday in Zomba, with other people attending virtually.
Players in the health sector have since agreed that procurement and supply chains of medicines, medical supplies, equipment, inflated prices, collusion, delivery of substandard goods, and drug pilferage have taken toll, and call for action.
During presentation of the findings, Kadzandira said factors affecting shortages of MMS include mainly, lengthy procurement processes, poor specifications that lead to increased drug expiries, and inappropriate donations.
He also mentioned foreign exchange woes, inadequate and unpredictable funding for medicines where hospitals exceed the budget allocations, thereby failing to pay Central Medical Stores Trust (CMST), which then fails to pay suppliers.
Said Kadzandira: “At CMST, as per their 2024 report, out of total contracts for the supply and delivery of stock of a total of 837-line items, only 368 line-items were delivered in full [44 percent], 98 partially delivered [12 percent] and 371 recording no delivery at all [44 percent].
“Some contracts were terminated for failure to deliver, leading to long periods to identify alternative supplier. Availability of MMS in the year 2023/24, based on the DHO Must-Have-List (MHL), averaged 62 percent, up from 58 percent in the year prior; lower than the target of 80 percent.”
He said the trust’s service level to hospitals, as measured by the Customer Order Fill Rate, was only 45 percent in 2023/24, a drop from the 50 percent in the previous year, meaning MCST supplied only about 45 percent of what hospitals demanded.
Asked to explain political capture at procurement level, Kadzandira took the audience to 2001 when Health Development Partners (HDP) suspended support for the sector because government refused to ban suppliers and prosecute them over drug theft.
He said an audit by the HDP found that several companies belonging to ‘same persons’ supplied medicines, others supplied ‘near expired’ drugs, inflated invoices, one company never supplied but was paid in full and payments were made in full before delivery.
Said Kadzandira: “State capture-style’ is where politically connected companies and individuals share proceeds of the vice with politicians and/or ruling parties. When we asked some people on why these things are not exposed, the answer was simple! I have small kids!
“To better understand how political corruption is affecting availability of drugs and other medical supplies, the Ministry of Health and CMST need to publish ‘Annual MMS Procurement Audit Reports’ including process issues on websites.”
Human Resources for Health chairperson Solomon Chomba, who also doubles as president of Physician Assistants Union of Malawi, said it would be naïve to dispute drug theft and embezzlement of funds in the sector.
He said: “Most affected areas include procurement for medicines and other medical resources/equipment, medicine supply chain, prescription and drug dispersion, special surgical and investigation procedures and special liaison treatment priorities.
“These have negatively impacted on service delivery, resulting into patients being forced to buy essential medicines from private pharmacies and also reducing patients’ health seeking behaviour.”
In a separate interview, Malawi Health Equity Network executive director George Jobe agreed with the findings, saying, procurement and supply chains of medicines, medical supplies, equipment, inflated prices, collusion, delivery of substandard goods, and drug pilferage have taken toll.
He suggested full transparency in procurement that should include open contracting, public disclosure of bids, contracts, and suppliers.
“Digitisation and traceability: end-to-end tracking of funds, medicines, and assets like e-procurement, up electronic logistics management information systems [eLMIS] and putting a symbol on medicines and medical supplies,” said Jobe.
This new research comes just weeks after another study showed that corruption continues to undermine government investment in health through diversion of funds meant for infrastructure and services, leading to inefficiencies in health service delivery.
Minister of Health and Sanitation Madalitso Baloyi did not respond to our calls at the weekend, but during a recent visit to Kamuzu Central Hospital in Lilongwe, she expressed concerns over persistent drug shortages and theft in public hospitals.
During the inspection, the minister observed poor documentation, inadequate checks and balances, and the absence of stock cards in some pharmacies which she said compromise accountability in drug management.
