In Malawi’s public hospitals, a quiet but devastating crisis is unfolding. Patients are increasingly being forced to buy medicines that are supposed to be free, as chronic drug shortages continue to erode confidence in the country’s already fragile health system.
Adrian Chikumbe
Powerful antibiotics are frequently unavailable in government facilities—lost, diverted, or stolen early in the supply chain—leaving clinicians with little choice but to administer basic painkillers such as Panado, while desperate patients scramble to source life-saving medicines from private pharmacies.
The consequences are severe
Inadequate access to essential medicines has been linked to rising neonatal and maternal mortality, threatening Malawi’s commitment to Universal Health Coverage (UHC) and exposing the vulnerabilities of health systems in low-income countries battling governance and accountability failures.
Drug shortages are partly driven by unethical conduct among a minority of health workers involved in the theft and pilferage of medicines intended for public use. In some cases, the abuse goes beyond drugs to include the theft of critical medical equipment, further crippling overstretched facilities.
A recent and alarming example is the conviction of Yamikani Mapapa, a 30-year-old health worker at Chiradzulu District Hospital. The Chiradzulu Magistrate Court sentenced Mapapa to 10 years’ imprisonment after finding him guilty of stealing two ultrasound scanning machines used for disease diagnosis. The court imposed five years for each count, to run consecutively.
In its ruling, the court noted that the offence attracts a maximum sentence of life imprisonment under Section 183 of Malawi’s Penal Code and found that Mapapa had abused a position of public trust, placing patients’ lives at risk by depriving the hospital of essential diagnostic equipment.
Government efforts to secure the supply chain
The government acknowledges that theft and pilferage of medicines and medical supplies remain persistent challenges in the public health system.
Ministry of Health spokesperson Adrian Chikumbe said the problem extends beyond outright theft to include pilferage—where health workers take small quantities of medicines for personal use without prescriptions.
“Pilferage often involves small amounts of medicines such as Panadol or aspirin. While this may appear insignificant, repeated losses over time become substantial,” Chikumbe said.
Concern over both large-scale theft and routine pilferage prompted the ministry to commission comprehensive studies in 2015 and 2017 to determine what was being stolen, where losses were occurring, and how theft was being carried out.
The findings revealed that a significant proportion of losses occurred before medicines reached health facilities, particularly during procurement and ordering stages. Weak procurement systems had previously allowed some pharmaceutical suppliers to secure large contracts without adequate safeguards.
In response, government strengthened procurement processes at the Central Medical Stores Trust (CMST), introducing competitive open tendering and tightening supplier eligibility requirements.
The studies also exposed vulnerabilities at CMST warehouses. To counter this, the ministry installed CCTV cameras, rolled out digital monitoring systems accessible via computers and mobile devices, restricted access to storage areas, and introduced biometric fingerprint controls to track authorised personnel.
“These measures are part of our ongoing efforts to ensure medicines and medical supplies reach the patients they are intended for,” Chikumbe said.
Despite these interventions, persistent stock-outs suggest that funding constraints, procurement delays, distribution inefficiencies and accountability gaps continue to undermine reliable drug availability.
Malawi’s Health Sector Strategic Plan III (HSSP III) outlines reforms aimed at achieving UHC by 2030, focusing on improved health outcomes, financial risk protection and patient satisfaction. However, limited resources and structural weaknesses threaten effective implementation across its nine priority areas.
Civil society and expert concerns
Health expert Dorothy Ngoma has condemned the theft of drugs and medical equipment, describing it as unethical and corrosive to both patient safety and the integrity of the medical profession.
George Jobe, Executive Director of the Malawi Health Equity Network (MHEN), said drug shortages in public hospitals have persisted for more than a decade, affecting treatment for malaria, bacterial infections, maternal health conditions and non-communicable diseases.
According to Jobe, MHEN’s community monitoring and engagement with district health offices point to a mix of causes: inadequate funding, delayed procurement and distribution, theft and pilferage, and rising demand within the public health system.
While acknowledging police reports and arrests involving health workers, Jobe cautioned against blanket condemnation of the profession.
“The majority of health workers continue to serve under extremely difficult conditions,” he said.
Jobe urged government to strengthen supply chain management through better forecasting, procurement planning and timely distribution. He also called for expanded use of electronic logistics management information systems (eLMIS) to track medicines from CMST to frontline facilities.
Additional measures, he said, should include stronger internal controls, regular independent audits, and follow-up checks with patients to confirm that prescribed medicines are actually received.
Jobe further advocated for improved remuneration, better working conditions and whistleblower protection for health workers to reduce incentives for malpractice. He also proposed branding medicines supplied to public facilities to make stolen drugs easier to identify in informal markets.
Community structures such as Health Centre Management Committees, he added, should be empowered to monitor drug availability and report irregularities.
In conclusion, Jobe stressed the need for firm prosecution of proven theft cases, while safeguarding due process and avoiding the scapegoating of frontline health workers. Those found guilty, he said, must face appropriate custodial sentences to deter future abuse and restore public trust in Malawi’s health system.
