The country’s district hospitals have blown up 87 percent of their drug budgets, four months to the next budget due on July 1, raising fears that patients could die from treatable ailments because of lack of medication.
The Ministry of Finance, Economic Planning and Development has since said it has no more funds to provide for the drug budget.
By February 27 2017, district health offices (DHOs) had overshot by K2 billion the K6.7 billion budget for eight months. The cost of drugs ended up hitting K8.7 billion.
Ministry of Finance allocated K10.6 billion to the National Local Government Finance Committee for the purchase of drugs for all DHOs nationwide and eight months down the line, only K1.9 billion was remaining in the drug budget.
Given the K10.6 billion annual budget, the DHOs were expected to be spending K833 million a month, but with K1.9 billion remaining, the district hospitals have drug cover for 2.2 months out of four months remaining.
In an e-mail response, the Central Medical Stores Trust (CMST) explained that as at February 2017, the total cost of drugs supplied to all DHOs was K8.7 billion out of which K1.9 billion was expected to be paid from the fourth quarter—April-June—disbursement.
This means that the district hospitals have about K475 million to spend on drugs each month, a drop from K833 million.
CMST spokesperson Herbert Chandilanga told The Nation that in the 2016/17 National Budget, government set aside K15.8 billion for essential medicines and medical supplies which was to be managed through CMST.
He said: “[Out of the amount of K15.8 billion] K9.8 billion was for DHOs and K6 billion was for central hospitals. An amount of K1.6 billion was for blood, blood products and medical gas for public hospitals [and that is] managed by the Ministry of Health [MoH].
Chandilanga also explained that at the beginning of 2016/17 financial year, CMST quantified ‘Must Have List (MHL)’ items and the total value was estimated at K24 billion.
He said: “It is important to note that this is not CMST’s budget, but an estimate of requirements for MHL items based on past consumption by the hospitals. Ministry of Health conducts a quantification exercise to determine annual requirements for drugs for public hospitals and this data, among other factors, informs the annual budgeting process.”
CMST said currently the drugs supplied to all health facilities are within the approved budget, adding that all hospitals are being supplied based on authorisation from the Ministry of Health and the National Local Government Finance Committee, the budget holders.
But Minister of Finance Goodall Gondwe said government has no money and that it would not increase the drug budget for the hospitals.
Speaking in an interview last week, Gondwe said: “Where will I get the money? We do not have money. We will see when we get there.”
Random interviews with district health officers in several districts show that DHOs are either in red or operating on a shoe string budget, putting lives of thousands of Malawians at risk.
As of December 31, most of the district hospitals had already exhausted their drug budget and are currently getting drugs on loan from CMST. This development will likely eat into their budget allocations in the next financial year.
Out of 23 district hospitals The Nation contacted, about 21 indicted that they have exhausted their drug budget and that they were now taking drugs from CMST hoping to pay in future.
Lilongwe DHO Alinafe Mbewe said the district exhausted its drug budget in January and National Local Government Finance Committee advised the DHO to be collecting the drugs from the CMST.
“Our drug budget was K956 million, however as of January 2017 we had already exhausted our drug budget,” she said.
In Nsanje, the district was remaining with only 15 percent of the K236 million allocated to the district. However, the DHO said the remaining funds were for the drugs the hospital could not access.
“The drugs situation is making life difficult for doctors. We ask people to buy their own medicines. We do not really know what happens to these people, they might die for lack of medicine,” said a source within hospital management.
Chiradzulu District Hospital consumed 108 percent of its budget allocation.
According to a Drug Budget Consumption Status Report, the hospital was allocated K286 million for drugs, but as of February the district had spent K 310 million.
Mzimba South DHO Dr Lumbani Munthali said the district was allocated K335 million and remained with K68 million, an amount not enough to meet the needs of the district.
He said Mzimba DHO was restricted to spend K17 million a month on drugs so that the balance should reach the end of the financial year.
Said Munthali: “This is not enough, but we are coping. We have 31 facilities that we supply drugs to and we are trying to cope.”
Ntchisi DHO Dr Grace Momba said they exhausted their drug budget long time ago and that they were advised to discuss with the Ministry of Local Government and Rural Development.
“We are expecting delivery next week, but at the moment we are managing with what we have. We are not even able to provide food to our patient. We owe suppliers millions of kwacha,” she said.
Karonga acting DHO Lewis Tukula said their drug budget was exhausted in December 2016 and that as of end February 2017, drug expenditure was at 130 percent.
Mulanje DHO Innocent Chavinga said the district hospital was now accessing drugs on credit as they are waiting for additional funding from the ministry.
In Mwanza, DHO Piringu said the district drug budget was reduced from the initial K188 million that was allocated at the start of the financial year to K174 million four months later.
Zomba DHO Dr Gift Kawalazira said the hospital’s buying power of the drug budget has been reduced by market forces in terms of inflation rate, “hence we are living on a tight budget to spend within our allocation”.
Parliamentary Committee on Health chairperson Juliana Lunguzi said she was not surprised that the drug budget to districts has been exhausted as her committee pointed out during debate on the national budget that the drug budget was on the lower side.
Said Lunguzi: “It is very unfortunate that we have reached this level. We told the Minister of Finance about this and he told us that there was nothing he could do.” n
