Tackling drug pilferage from the grassroots

Communities surrounding Makanjira Health Centre in Mangochi have, for decades, lived with the harsh reality of a dysfunctional health system.

The residents were forced to walk long distances to access medical and healthcare services, as their nearest facility could not provide them with optimal service.

“Our health centre persistently ran out of stock of essential drugs and medical supplies,” says Asiyatu Zinenani of Group Village Head (GVH) Makanjira.

Tackling drug pilferage from the grassroots

The situation was not so different at Lugola Health Centre – some 10 kilometres west of Makanjira Trading Centre – where Dunia Samson goes to when taken ill.

Samson, just like Zinenani, rarely sought healthcare services at the facility located a stone-throw away from her house.

“The doctors [healthcare workers] were very cruel. Rarely would give you medicines. If you are lucky, you would only get aspirin and the rest, you would be advised to buy at a local pharmacy,” she explains.

Zinenani and Samson believe healthcare workers have been selling drugs and medical supplies to vendors who are operating uncertified pharmacies around Makanjira.

Their fear was proven right in June 2020 following the arrest of a young man found in possession of over 14 types of medical drugs labelled Malawi Government property.

Makanjira Police Station Officer-in-Charge MacDonald Kachaje confirmed the arrest, saying the law enforcers acted on a tip off from a community member residing close to Lugola Health Centre in the area of Traditional Authority (T/A) Makanjira in the district.

Using a toll free line 3054, which Makanjira Development Foundation (MDF) is operating with support from Tilitonse Foundation, a concerned citizen tipped the police about a young man who was keeping drugs, which he suspected to be the property of the Malawi Government.

“Our law enforcers swiftly went to investigate and arrest the man whose particulars we’ll not reveal now because doing so would jeopardize our investigations,” said Kachaje.

Apart from arresting the suspect, the police also recovered different types of drugs, which included 74 tablets of Sulphamethoxazole and Trimethoprin, 373 tablets of Cotrimoxazole, 48 tablets of Erytheromicine, 360 capsules of Amoxiciline, 13 tablets of Cotrimoxazole (sulfran kids) and 47 tablets of iron (60mg femous fumarate and folic acid) 47.

Others are 77 tablets of LumartemArtemether Lumefentrine (LA), 13 tablets of Sulfran (UCL), six tablets of Ciprofloxacin, 888 capsules of Indomethacin, 121 of antiretroviral drugs (ARVs), and 266 tablets of two types of unidentified drugs.

Of course, cases of theft of drugs and medical supplies in public health facilities is not a peculiar story in Malawi. In 2018 alone, the country’s public hospitals lost drugs and medical equipment and supplies worth over K900 million.

Of course, the amount was slightly lower than the K1.6 billion worth of drugs and medical equipment the government lost through pilferage and theft in 2016, the Ministry of Health said then.

At least, 31 health workers from different public health facilities across the country were interdicted after being implicated in theft of medical drugs and supplies.

The Ministry of Health ranks drug pilferage and theft of medical equipment among the serious challenges leading to deteriorating health service delivery in the country.

According to the Ministry of Health, the vision of the health sector is to achieve a state of health for all the people of Malawi that would enable them to lead a quality and productive life.

This vision is guided by several legal frameworks and policies, which include the Constitution of the Republic of Malawi, the National Health Policy (NHP) and the health sector strategic plan (HSSP) II.

HSSP II emphasises on the need for all the people in Malawi – including vulnerable populations from the hard-to-reach areas – to receive the same high quality health care regardless of geographic location or socio-economic factors.

Furthermore, the Republican Constitution guarantees all Malawians the right to enjoy highest quality healthcare services within the limited resources available.

But this has not been the case as theft of drugs and medical equipment continues to take a toll on the health sector.

Other than drug persistent stock-outs, drug pilferage and theft of medical equipment remain major factors leading to compromised service delivery in public health facilities and hospitals in Malawi, putting patients at risk.

Weak leadership, weak social accountability mechanisms, irrational use of medicines, drug leakage and pilferage are also affecting the quality of service in public health facilities.

A 2020 study by Makanjira Development Foundation established that inadequate oversight role and function among community level health governance structures in monitoring resource for health has been a conventional problem fuelling drug pilferage and theft of medical equipment in public health facilities.

The survey further revealed that limited participation of citizens in decision-making processes and demand for accountability in community health systems and inadequate social accountability monitoring mechanisms also contribute to the problem.

To address the endemic theft of drug and medical supplies in government health centres in T/A Makanjira, MDF is implementing a one-year Robust Health Management Campaign (RHMC), which has been designed to create a robust accountability monitoring system through which the community will track and report cases of drug pilferage and beef up their capacity to monitor the utilization of drugs and medical supplies.

Tilitonse Foundation is financing the campaign to the tune of K12 million with support from the European Union (EU) and the Norwegian Embassy.

The campaign is targeting government health centres of Makanjira, Lulanga, Lugola and Maganga and six Madinah Social Services mobile clinics of Namalweso, Mkwanda, Jumbe, Mambo, Lukoloma, and Malamia.

Speaking at the launch of the campaign at Mpilipili Full Primary School Ground on Saturday, MDF chairperson, Ousman Kennedy, said cases of drug pilferage and abuse of medical supplies remain a barrier to improved health service delivery in the area despite the government making significant efforts to ensure that all health facilities have essential medicines and supplies (EMS).

Kennedy added that non-functionality of community level monitoring mechanisms as well as non-participation of citizens to check utilisation of drugs at community and facility level and limited capacity among citizens to demand and enforce accountability and transparency from duty bearers in health service delivery also contribute to poor service delivery in public health faciliteis.

“Furthermore, citizens themselves have been predominantly passive, and perceiving health workers as unquestionable authorities. And this has entrenched the culture of stealing government drugs and medical supplies by healthcare workers,” he said.

Through the project, MDF has been mobilising citizens into action groups called Radio Listening Clubs (RLCs) at a group village head level. The clubs are leading advocacy initiatives in influencing accountability in the utilisation of resources for health, including drugs.

The action groups are also key in mobilising masses to participate in various project activities, including community engagement meetings with duty bearers.

MDF has also procured a toll free line from Airtel Malawi through which communities are now reporting suspected cases of drug theft in public health facilities in the area.

Mangochi District Medical Officer, Dr. Chimwemwe Thambo, described the campaign as critical in complementing the government efforts to improve delivery of healthcare services to the communities.

Thambo said, among others, that the campaign will address the longstanding problem of drug stock-outs since the drugs will now be used on intended beneficiaries and not end in the hands of vendors as has been the case.

“We are very excited with this project because it will help health facilities and health workers to provide optimum care and assistance to the clients or patients, thereby, improving health service delivery,” he said.

Thambo asked the communities to support the efforts of the foundation by reporting cases of drug theft, saying it remains the aim of the health officials to keep people with good health through the robust health care systems.

Tilitonse Foundation Capacity Development and Mentoring Officer, Tukupina Nyirenda, expressed satisfaction with the outcomes of the project thus far, as the campaign has already exposed a syndicate of people who are involved in drug theft.

Nyirenda expressed her organization’s commitment to continue supporting MDF to deal with drug pilferage in public health facilities in the area.

On the other hand, Kennedy assured that the foundation will strengthen community structures so that they are able to track drugs and their utilization at the health centre level.

“We don’t want people to die due to lack of drugs after someone has pilfered them,” he vowed.

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