With the Central Medical Stores Trust (CMST) not fully stocked and its capacity to procure drugs still on trial, Malawi could face another drug crisis as the donor-funded stop-gap emergency kits project expires next month.
The 18-month distribution of the K5.4 billion kit project, funded by Britain, Norway and Germany, phases out next month with unclear transitional measures on the ground to bridge possible gaps.
The development has irked health rights lobby group, the Malawi Health Equity Network (Mhen), which has described the uncertainty over sustainable drug supply to public hospitals on the back of the kits’ phase-out as “lack of seriousness” on the part of government.
But the Ministry of Health has played down the potential public health scare, saying it has put in place measures to fill the gap that the drug kits initiative—the major source of drugs in public hospitals during the one and a half years the trust was unable to procure medicines as it was undergoing reforms—will leave in June.
In an interview last Saturday, Unicef deputy country representative Dr. Jane Muita confirmed that the emergency kits initiative will not be extended, but said it will continue up to August with the remaining stocks that had not been distributed in April.
“The problems of the kits were already expected, but the proposed re-distribution of drugs for either regional or district hospitals did not work out.
“Some facilities have lacked particular drugs for a long time and forgot how to use them. We want to utilise the remaining time to help facilities use the excess drugs they have in stock and re-distribute,” she said.
Trust owed billions of kwacha
Also at issue is the ability of public hospitals—who owe the now commercialised trust more than K3 billion and a further K1 billion to private suppliers—to buy drugs from the trust given their dire financial situation.
The lack of information on the kits’ phase-out has brought confusion in some district hospitals, which said they were not aware of the phase-out and do not know where their next consignment would come from.
During a recent media tour to appreciate the impact of the kits in Chikhwawa, Neno and Balaka, Prince Katchika, in-charge of Ngabu Rural Hospital said the lack of information on sustainable supply of drugs would worsen the problem of drugs availability in his catchment area of 73 244 people.
“Both systems of kits and ordering from CMST have gaps and shortfalls. While the kits lacked some essential drugs, contained some that we did not quite need as an area etc., ordering drugs from CMST can be frustrating because sometimes the trust lacks medicines to supply. If we are to revert to the CMST system, it will worsen our situation,” said Katchika.
District health officer (DHO) for Neno, Jones Masiye, admitted that he had not communicated to personnel in the eight health centres under him. He said he was yet to arrange for a sensitisation programme on the same.
Ministry of Health spokesperson Henry Chimbali confirmed that government had been written in March this year by donors that there would be no continuation of the emergency kits.
Money pumped in
He, however, banked on the Department for International Development (DfID) which he said, on request from Capital Hill ahead of the phase-out, has pumped in about K10 billion (£17 million) towards the purchase of drugs for the next six to nine months.
He said the DfID drugs will cover primary, secondary and tertiary health care and have already started arriving in the country.
Chimbali was responding to a question on government’s preparedness to resume drugs supplies to hospitals and health centres at the phasing out of an emergency drug supply kits next month.
“We still have some stocks from the kits programme that will be supplied until July or August before they completely phase out. Thereafter, we will begin the consignment from DfID,” he said.
He availed Nation on Sunday a statement by Sarah Sanyahumbi, head of DfID, confirming that the procurement process had started with CMST’s involvement of the tendering process to ensure that the items requested arrive as quickly as possible while maintaining value for money.
She said the process covers two components with the first one being the immediate emergency requirement for the central hospitals.
“A few months ago, DfID was requested to procure the drugs and commodities by the government of Malawi and CMST using funding from DfID support to the Malawi Health Sector Strategic Plan,” she said.
Sanyahumbi said component two, which will be much larger, was for essential drugs and commodities and is planned to succeed the drug kit programme.
“Component two will serve the country’s need for essential drugs and commodity for an estimated nine to 12 months. Up to 80 percent of the drugs selected are from Malawi essential drugs list and provides for both primary and tertiary health care requirements. Component two is the subject of an international competitive bidding tender which currently closes on 28th May.
“Until the evaluation and contract awards are made, we are still in a confidential process with regards the information we can provide, but we can inform you that the major tender includes the same items as already mentioned [but in larger quantities] as well as antibiotics, painkillers, anti-malarials for pregnant women, vaccines, sutures, surgical and hospital equipment, dispensary items, X-ray films and equipment,” she said.
She further said all items will be shipped by air, sea or road freight as it was appropriate to obtain a balance between speed and value for money.
Sanyahumbi said CMST will be responsible for the warehousing and distribution and were in the process of planning how best to do this to ensure effective, efficient and timely distribution to health posts.
She also said the UK was happy to be able to provide this support as part of its wider health programme in Malawi.
Sanyahumbi said there was still a lot of work to be done, but with political commitment to take some tough decisions, coupled with the significant support available from donor partners including the UK; a positive difference can be made.
Central Medical Stores Trust (CMST) public relations officer Herbert Chandilanga said an extension would give the trust enough time to complete their recapitilisation project.
“The emergency drug kits were meant to give us enough time to implement the ideal system in line with the World Health Organisation [WHO] specifications in terms of temperature regulation and general sanitation.
“We have had to change archaic infrastructure, including refurbishing old pharmaceutical warehouse. Other changes include security to control drug pilferage and heavy repairs or replacement of the environment,” said Chandilanga.
He, however, said under the circumstances, CMST was in a position to resume its duties because a big chunk of the re- capitalisation had been covered.
With support from developmental partners and implemented by Unicef, government embarked on a long-term process to reform and strengthen the CMST by identifying a third party to supply the essential medicines kits and other essential supplies.
The supplies, valued at K5.4 billion moved in two phases from January to March 2012 for phase one and April 2012 to June 2013 for a period of 18 months.
District hospitals were buying the kits at 55 percent of their value, with the proceeds directed to CMST towards its re-capitilisation.
But Mhen national coordinator Martha Kwataine has hit at government’s reactive approach to a problem it should have anticipated well before the kits’ phase-out deadline and given the problems at CMST.
“I don’t think CMST is ready. It is unfortunate that these are the questions we should be getting now on whether we will not disrupt the delivery drugs in hospitals and health centres.
“This programme was brought in to give CMST time to put its house in order. We cannot continually rely on donors who have their own challenges because the economic hardships are all over,” she said.
CMST director of pharmaceutical operations Dr. Moses Chisale said last week that the trust was making several efforts to increase drug stocks in its warehouses.
“Recently, there were reports of 95 percent drug shortage as CMST. The situation is still very critical but we are sure that it will improve,” he said.
He and CMST chief executive officer Feston Kaupa said the 95 percent shortage was reduced to 80 percent, a development Chisale admitted has affected a wide range of drugs including anti-malaria drugs and insulin for diabetes.