Editors PickNational News

Drugs situation better but problems remain

Ministry of Health Spokesperson Henry Chimbali inspects a pharmacy at Neno District Hospital stocked with drugs from the PHC Kit Project
Ministry of Health Spokesperson Henry Chimbali inspects a pharmacy

Availability of essential drugs has improved in some district hospitals in the country, but problems remain as the new procurement policy struggles to respond to operational realities at facility level.

During a media tour of three district hospitals and one referral facility to assess the essential drugs situation during the festive period, officials there said with a few exceptions, most essential drugs were available.

The tour—organised by the Centre for Human Rights and Rehabilitation (CHRR) and Centre for Development of People (Cedep) with support from Aids Alliance of Southern Africa—complemented the institutions’ ongoing drug tracking and monitoring initiative being implemented in 20 of the country’s 28 districts.

But the facilities—Thyolo, Dedza and Kasungu district hospitals and Mzuzu Central Hospital (MCH)—said in general, erratic availability of essential drugs was a serious problem in 2013 although the situation has improved towards the end of the year.

At MCH, spokesperson Twambilire Simkonda reported that they had most of the essential drugs although they had run out of BP (blood pressure) medication.

At Dedza District Hospital, the situation was not as good as clinician Paul Peterson reported that they had run out of fragile, paracetamol and gluco-sticks a few days earlier.

They may have to wait for the bureaucracy at the Central Medical Stores Trust (CMST) to process their supplies and that could take weeks, according to hospital pharmacists we talked to during the tour.

Dedza District Hospital’s drug position is also affected by the influx of Mozambicans to the hospital who exert pressure on its already challenging drug situation.

In Kasungu, where officials could only speak off the record, the drug situation was reported to have improved markedly towards the end of this year. Kasungu District Hospital constantly runs of medicine.

“We have very dedicated health personnel, but who are frustrated by the erratic availability of drugs. As I speak, we have run out of several essential drugs,” he said.

The hospitals also agreed that funding levels of their operational budget called other recurrent transactions (ORT) keep dwindling in both nominal and real terms.

This, they said, forces the facilities to drop some planned public health activities and staff welfare as a rationalisation tactic that almost completely focuses on core areas of fuel, electricity, water and general patients care.

The forced spending cuts, especially on staff welfare due to the lower-than-expected funding, demoralises the very people who execute the core activities, including quality healthcare service delivery, according to one district hospital administrator The Nation talked to on Christmas Day.

The new policy of centralising procurement at the CMST with little leeway for the facilities to procure from private facilities after seeking a rapid ‘no objection’ from the trust in case of emergency stock-outs as was the case in the past, has brought delays in replenishing medicine.

For example, at Thyolo District Hospital, where pharmacy head Nelson Nanchinga proudly showed off his well-stocked drug store, the pharmacist bemoaned supply delays.

“As you can see, most essential drugs are here, including anti-malaria, ART and TB. We have enough ARTs to last us more than three months. Of course, we do not have essential drugs such as Benzyl penicillin, which is a first-line drug.

“But the biggest problem is delays, sometimes of up to a month, to get the drugs from the Trust after placing an order,” said Nanchinga in an interview in Thyolo.

These days, the facilities are not allowed to buy directly from private pharmacies—only from the Trust—where administrative and technical problems abound at both central level in Lilongwe and local level at district hospitals and council secretariat.

In theory, the Trust—Malawi’s national pharmacy of the Ministry of Health—is expected to operate in a more commercial fashion with better cost accounting measures to ensure it is self-financing and with greater autonomy.

In practice, however, aspects of how the Trust should be constituted remained hazy in 2013.

The lack of a clear and actionable strategic direction has brought a lot of policy crashes at coordination levels and the health system’s inability to respond to emerging operational challenges at health facility stages.

Thus, erratic decentralisation and policy incoherence in the health sector has contributed to an institutional vacuum at local levels, with unclear lines of decision-making and a lack of defined roles and responsibilities, including in relation to oversight of medicine procurement and distribution.

This, observers say, has contributed to policy incoherence, with mandates not clearly defined horizontally and jurisdictions overlapping across sectors and administrative boundaries.

“Policy incoherence is also present vertically, in that health sector and district policies are not always well aligned or coordinated. This has contributed to a lack of financial sustainability: district health officers [DHOs] have run up debts to the Trust to the point where they have undermined its viability and that of medicine supply, which reflects a lack of checks and balances horizontally [through district commissioners] and vertically [through the Ministry of Health and Treasury],” said CHRR national advocacy and sustainability coordinator Patson Gondwe in an e-mail response.

Related Articles

Back to top button