Malawi’s drug shortage worries medical doctors – Pregnant women face death sentence

Pregnant women needing surgical operation in the south-east nation of Malawi are at high risk of dying due to lack of anaesthetic drugs in hospitals across the country.

The Society of Medical Doctors in Malawi says pregnant women needing operation across the country are at high risk and on the verge of losing life due to lack of anaesthetic drugs in state-run public hospitals.

Society of Medical Doctors in Malawi, Dr. Mithi: Surgical operations for pregnant women have been cancelled.

Dr Victor Mgonjetsi Mithi, president of Malawi’s Society of Doctors Malawi’s has said the lack of anaesthetics in the country, which makes it impossible to operate pregnant women who needs to give birth caesareans is the highlight of how poor the nation’s healthcare is.

Said Dr. Mithi: “It is very concerning because you can’t do an operation without these drugs and the fact that we don’t have them speaks a lot as to how our healthcare system is organised and governed and some of the procedures are a matter of life and death.”

“If you have a pregnant woman who you need to operate on and you don’t have these drugs, you can either lose the woman or lose the baby, and the decisions are made in haste and this is why we’re worried and we hope the government will be able to chip in and help us as fast as possible.”

Dr. Mithi said the shortage of anaesthetics in Malawian hospitals is “just a tip of the iceberg” adding that there so many problems.

CMST spokesperson, Herbert Chandilanga: Suppliers are struggling to secure stock.

“These are not the only drugs not available in hospitals,” Mithi added. Medical centres had been running out of supplies in many areas.

“People don’t really speak about this. Sometimes patients accuse us of not properly attending to them. But this is because we’re not supplied with the proper working materials.

With the acute shortage of drugs, new private clinics have sprung up across Malawi, profiting from the shortages, taking advantage of the situation by catering to those who can afford their prices.

Malawi risks registering high neo-natal and maternal mortality due to non-availability of essential health commodities in the antenatal care and delivery packages.

Nyasa Times understands that amongst half of Malawi’s almost half of Malawi’ district hospitals have closed their operating theatres due to a dire shortage of anaesthetics.

According to Society of Medical doctors in Malawi maternity care in the country has been affected by a lack of drugs disclosing surgery, including caesareans, has been cancelled and patients needing emergency care have been moved hundreds of miles around the country.

However, Malawi’s minister of health, Khumbize Chiponda, said the government planned to improve funding of the Central Medical Stores, which she said owed medical suppliers more than 19bn Malawian kwacha (£17.2m).

She said the CMST had out-of-date drugs worth more than 2bn kwacha that “may have been procured by the previous administration.”

CMST spokesperson, Herbert Chandilanga said suppliers were struggling to secure stock from India and China amid “a logistics scramble worldwide”.

The Anaesthesia Association of Malawi called the situation “an emergency” and said 11 of the country’s 28 districts had run out of drugs.

The Anaesthesia Association is said to have demanded answers from the Ministry of Health and sought a meeting with the Central Medical Stores Trust (CMST), which buys and supplies drugs to all public hospitals.

President of the association, Joel Moyo said the safety of pregnant women faced with complications during their labour is a big concern.

“One of the drugs that is not available is thiopentone, which we use in surgery, especially for women who are convulsing during delivery and also those who have high blood pressure.”

“This [drug] has not been in the country for a year and we asked [the CMST officials] why it has not been available and it was attributed to logistical issues,” he said.

Moyo explained that they had been improvising by using second-line drugs, although that was not recommended.

He added: “We thought, ‘maybe next month things will change’, but this has been going on for a year now. But when members said that they don’t have suxamethonium, that’s when we raised a red flag.

Moyo said suxamethonium is a very important drug and, therefore, it is supposed to be in an [operating] theatre all the time

“Without it, then the theatres have to be closed. You can lack some drugs, but when we don’t have this, then there is no theatre,” said Moyo.

Moyo said he had received worrying reports that some pregnant women who required emergency surgery were at risk as district hospitals had to refer them to central hospitals where the necessary drugs might be available.

Malawi’s health system faces immense challenges, from lack of equipment to a severe shortage of qualified staff.

Poor working conditions, including low salaries, have led to health workers seeking better-paid jobs outside the country or with non-governmental organisations. People, including pregnant women, have to travel long distances to reach their nearest clinic or hospital.

Many people have been on a waiting list for several years for treatment.

With the drug shortage, Malawi also risks registering rising deaths resulting from Non Communicable Diseases due to limited accessibility to relevant screening services for diabetes and non-availability of medical commodities for diabetes and hypertension.

These are some of the implications cited in a study survey by the Universal Health Coverage Coalition which was conducted in the country’s 10 districts to determine the availability and access to medicines in Malawi.

Malawi risks registering high neo-natal and maternal mortality due to non-availability of essential health commodities in the antenatal care and delivery packages.

Alongside persistent drug stock-outs, the study also found inadequate specialised human resource as another death trap.

The implications of inadequate specialised human resource is the non-adherence to guidelines for oversight on health commodities as stipulated in the Malawi Health Commodities ad logistics manual 2003.

Nyasa Times has established that drug stock-outs should be expected in the current fiscal year because the coalition found that the 2021/2022 budget provision for drugs has been slashed down by 25 percent, falling short of the required budget by K6 billion.

Chairperson of Parliamentary Committee on Heath Matthews Ngwale said recapitalisation of CMST could help the institution to serve better.

Ngwale also said his committee would lobby for increased budget allocations towards drugs.

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