A study by Kamuzu University of Health Sciences (Kuhes) has found that the majority of public health facilities in Malawi, including Queen Elizabeth Central Hospital (QECH), do not adhere to international guidelines for pharmaceutical storage, which threatens the quality of medicines.
The guidelines recommend that the size of a pharmacy should be based on the number of hospital beds, with a rate of one square metre per bed, assuming monthly medicine deliveries. If buffer stock is required, the space should be increased accordingly.
The study also concluded that despite having the necessary knowledge on proper storage conditions, pharmacy personnel often fail to adhere to good practices due to resource limitations.
Conducted from September 2021 to May 2022, the study aimed to assess temperature variations in pharmacies and medicine storage areas in the southern districts, and survey the knowledge, attitudes, and practices of personnel managing the stores.
In an interview this week, Associate Professor Felix Khuluza, who also heads the Kuhes pharmacy department, underlined the impact of inadequate pharmacy construction on pharmaceutical storage.
Said Khuluza: “The lack of proper pharmacies affects the storage of pharmaceuticals, as the rooms are too small, leading to the modification of several rooms for pharmacies or reliance on Storage-in-a-Box (SiaBs),
“For instance, QECH does not have a properly constructed pharmacy, resulting in small storage spaces and reliance on at least three SiaBs, which is not ideal. Some products, especially those requiring cold storage, are kept at the Central Medical Stores Trust.”
He also observed that without these internal arrangements, the quality of medicines would be compromised, and security challenges would arise, as SiaBs are sometimes located far from the main pharmacies.
This situation, he said, also causes delays in dispensing pharmaceutical care as personnel must move around the hospital to retrieve products from the SiaBs.
According to Khuluza, most medicines require storage temperatures of between 15 and 30 degrees Celsius, with some needing cold storage at 2-6 degrees Celsius.
He stressed that all health facilities providing basic healthcare packages should have refrigerators for cold chain products, and district hospitals are encouraged to have them for below 20 degrees Celsius storage.
Commenting on the findings, pharmaceutical society of Malawi (Phasom) president William Mpute agreed that most of the country’s old hospitals like QECH and Zomba Central did have modern pharmacy designs in their initial plans adding that they had to improvise just to have the facilities that operate as pharmacies.
Mpute pointed out that government and development partners have tried to put up temporary storage facilities to assist in storage but these facilities are difficult to maintain.
Said Mpute: “We recommend that the authorities should prioritise building proper modern pharmacies in our old hospitals if plans to build new hospitals are not in the pipeline. For newer hospitals the situation is better and we recommend that pharmacy structures should be equally prioritised as other facilities for future projects as sometimes developers tend to overlook the significance of this important department.”
According to him, the current arrangement of having people to stand on the window to receive medicine is outdated, saying there is need for proper dispensing rooms where patients can sit down and get their medicines and proper advice from pharmacy professionals.
On his part, health activist Maziko Matemba stressed the need for government intervention and support to address the challenges identified.
He said: “Malawi must consistently adhere to national and international standards guidelines, as health is a fundamental human right.”
When contacted for comment, Ministry of Health Principal Secretary Samson Mndolo said he needed to review the study first.
According to Khuluza, the installation of SiaBs in various health facilities began in 2016, with USaid targeting 115 health facilities in the first year.
In 2017, the Global Fund provided funds for an additional 95 SiaBs, and in 2018 USaid added 235 more units.
Currently, over 70 percent of public health facilities and most Christian Health Association of Malawi facilities have SiaBs installed.
