Malawi risks plunging back into the Covid-19 induced sickness and death trap endured early this year as the health system remains ill-equipped to handle the pandemic’s third round effects, experts have warned.
Assessment reports by Medical Council of Malawi (MCM), Ministry of Health and World Health Organisation (WHO) as well as The Nation’s own investigations reveal critical shortages of equipment, essential drugs, treatment centres and personnel.
The situation comes despite government mobilising resources to fight the pandemic, including about K300 billion that we have tracked from multilateral donors since March last year.
Besides external funding, Capital Hill also set aside K17.2 billion whose accountability is yet to be seen and K6.2 billion that an investigative audit President Lazarus Chakwera ordered revealed was mercilessly abused by public officials and dubious private sector players through questionable allowance payouts and misprocurement.
More pressing is the fact that as the Covid-19 third wave looms larger; hospitals have run out of cash and ability to procure drugs due to budget cuts, according to interviews with officials from district health offices and communication we have seen.
The expert reports—presented at an emergency Covid-19 resurgence planning meeting the Ministry of Health and WHO convened on June 9 2021—follow an assessment of public and private health facilities in Malawi providing Covid-19 related services.
The report from MCM, compiled by its acting registrar Richard Ndovie, particularly expresses concern that most treatment centres were operating below minimum requirements in terms of equipment, supplies, oxygen supply and human resource.
“The hospitals were not ready to handle surging numbers of Covid-19,” he said.
Ndovie said while innovations such as field hospitals and private facility-set treatment centres increased access to medical care, challenges still emerged on oxygen supply, shortage of medicines to treat comorbidities and human resource gaps that have strained the existing disease burden.
He said the increasing numbers of infected health workers who succumbed to the disease contributed to disruption to clinical care towards patients.
In its report presented by Dr. Innocent Mhango, the Ministry of Health said most district hospitals have failed to achieve the set minimum of 15 oxygen cylinders per hospital and survived on “5L/min concentrators” instead of the recommended “10-15L/min”.
Other items in short supply, according to Mhango’s presentation, are oxygen flow meters or gauges and tubings (nasal cannula, splitters etc).
There was also inadequate stocks of supplies and medicines; antibiotics, steroids, anti-cloting medicines and shortage of drugs for non- communicable diseases.
In its presentation, WHO emphasised the need to improve the capacity of health facilities so that Malawi can better manage the third wave.
The United Nations agency mentioned Zomba and Mzuzu central hospitals as facilities in urgent need to scale up oxygen supply.
WHO expressed concern that in central hospitals there was little involvement of senior physicians who in most cases simply provided guidance to their juniors through phone calls.
Raw deal on value for money
Our investigations show a mismatch between what Capital Hill intended to implement in the national Covid-19 preparedness and response plan and what is on the ground.
Essentially, the plan launched in April last year, listed a number of activities, including procurement of equipment, supplies, construction and rehabilitation of treatment centres as well as recruitment of staff.
But The Nation investigations show that almost all health facilities have less than half the required oxygen cylinders.
During both first and second waves, Chitipa, for example, had just about six cylinders against the required 20 and it took well-wishers to provide 13 more.
The same is true with Karonga, Kasungu, Ntcheu, Neno, Thyolo and Nsanje which survived on just six to seven cylinders when they needed two times more.
“Before these donations some hospitals such as Nsanje and Thyolo had no cylinders, pulse oximeters and flow meters. The citizen initiative has been a huge boost to operations as government did not seem committed to providing the equipment,” said a Ministry of Health official.
Zomba Central Hospital, with three isolation centres, has 44 cylinders against a requirement of 200 and less than 10 pressure gauges (private citizens gave them 10 more).
The referral facility also does not have crucial regulators to control flow of oxygen supply to patients.
“Without the regulators, you cannot provide oxygen to patients, unless you want to kill them,” explained one doctor, speaking on condition of anonymity.
To put it in context, all surrounding districts of Balaka, Machinga and Mangochi send complicated Covid-19 cases to Zomba, piling pressure on an already strained facility.
Patient monitors are also crucial for observing the condition of the patients, but the whole of Zomba has only six monitors and plans to buy a further 10.
On the other hand, the Northern Region survives on an oxygen plant at Nkhata Bay District Hospital despite promises by Minister of Health Khumbize Chiponda that government would set up one.
In Karonga, district director of health and social services Dr. David Sibale said in an interview that apart from lack of cylinders, “at times, we have run out of PPE [personal protective equipment]. Mostly, we get these from well-wishers”.
Chitipa district director of health and social services Dr. William Ching’ani complained about lack of an isolation centre at the district hospital where they have instead converted the TB ward when the plan was to construct the facility at the former Malawi Young Pioneer base.
Most facilities have improvised treatment/isolation centres instead of purposively built structures despite the Covid-19 national response plan, under the health cluster, highlighting procurement of equipment and construction/rehabilitation of treatment centres as among the activities to take place.
We have also established that hospitals lack crucial drugs that are important in managing Covid-19. Medical officials we spoke to cite Enoxaparin Heparin as an important drug missing in a number of hospitals.
Studies show that Covid-19 patients have blood clotting because they are mostly bed- ridden; hence, this drug dissolves the clots.
Even before Covid, the Central Medical Stores Trust (CMST) did not stock this drug thus it is only available in private hospitals whose charges are way beyond district hospital budgets.
Hospitals broke, but Treasury won’t fund
Meanwhile, when district councils through the National Local Government Finance Committee (NLGFC) cried out for more funding after depletions, Ministry of Health Principal Secretary Charles Mwansambo wrote back on May 18 2021 that the request would not be met.
Reads the letter: “I refer to your request that was made to the Ministry of Health regarding increase in medicines budgets provided to District Health Offices in the 2020/21 Financial Year. The ministry referred the request to the Treasury as they are controllers of government funds.
“The Treasury responded negatively to the request, outlining that it is not possible to provide extra resources due to fiscal constraints government is currently faced with.”
On May 21, hospitals were advised on the government position by NLGFC, leaving them with no option on how to stock their pharmacies.
The CMST itself has struggled to keep stocks, sometimes running out of critical drugs.
Neno district director of health and social services Dr. Grace Momba said they had drug stock outs in the past six months despite having the funds.
“Drugs were not readily available at CMST. Diclofenac tablets, Fluocloxacillin injection, Oxytocin, Diazepam, Promethazine tablet and injection, Piriton and Indocid,” she said.
Erratic and inadequate funding aside, district hospitals are servicing huge debts which are also affecting their cash flow.
For example, Chitipa District Health Office has a debt of about K56 million in utility bills (water and electricity) accumulated over the years.
Karonga’s debts stand at over K100 million for utilities and other supplies while Neno is K120 million in debt.
TOMORROW: We bring you the security breakdown relating to Covid-19 measures in the country’s ports of entry amid funding cuts and abuse.