Despite increasing cases of pilferage, the courts are convicting fewer public servants charged with stealing drugs from public hospitals than those charged with selling them in private outlets, an audit has revealed.
In its investigation audit undertaken between 2016 and 2017, the Global Fund on Tuberculosis, Malaria and HIV and Aids said it was not able to find an explanation for the variance.
However, the fund said it noted that the public servants were being charged with the offence of theft by a public servant, which is difficult to prove.
The report, titled Investigation Report: Proactive Investigation Into Anti-Malarial Product Theft from Public Health Facilities in Malawi published on August 17 this year, analysed data gathered from the Office of the Inspector General (OIG) of the Global Fund audit in 2016 and evidence gathered during the investigation.
The investigation found that more public servants were being acquitted than other suspects despite that actual theft was happening in public hospitals.
The audit found that at the time of the investigation, only three out of 14 public servants charged were convicted compared to 34 out of 37 other suspects charged with offences related to drug theft.
Reads the report in part: “From the data available, it appears that public servants are more likely to be acquitted than other suspects. The conviction rate for other suspects is significantly higher at 92 percent [34 people convicted out of 37 charged]. The reasons for this variance in conviction rates is unknown.”
Charges levelled against non-public servants included operating a private clinic without authority from the Medical Council of Malawi, operating a pharmacy business contrary to the Pharmacy, Medicines and Poisons Board Act and practising as a medical practitioner without license.
Other charges related to selling or supplying medicinal products without licence, illegal possession of medical drugs and being found in possession of medicinal products identified to belong to the Government of Malawi and suspected to have been stolen or unlawfully obtained.
Between August 2016 and April 2017, the Drug Theft Investigation Unit (DTIU) in conjunction with the Malawi Police Service (MPS) arrested 62 people suspected of stealing and selling medicines from public hospitals. Out of this number, 16 were public health workers.
Of the 16 workers, three had been convicted at the time of issuing the investigation report, according to the report.
As part of the investigations, Global Fund commissioned three market surveys, the first of which in September 2015 found donor funded malaria drugs stolen from public hospitals and sold in 14 of the 192 informal or private vendors and pharmacies in 11 districts.
Another market survey in November 2015 targeting 201 private pharmaceutical vendors found that 67 were selling donor-funded malaria drugs originally intended for public health facilities.
A third market research in August last year of test purchases targeting 25 vendors found nine with stolen donor funded malaria drugs, five of which were from the Global Fund.
A crackdown between August 31 and September 1 2016 by the Anti-Malaria Drug Task Force acting on the theft reports, diversion and resale of United States Agency for International Development (USAid) and the Global Fund-financed anti-malaria commodities resulted in the arrest of six people prosecuted by Pharmacies, Medicines and Poisons Board.
However, five of those arrested received fines ranging from K50 000 to K300 000 or three to 12 months imprisonment in default.
Further reads the report: “All of these individuals were private-resellers of the medicines and were not responsible for the theft of the commodities.
“In March 2017, the Malawi authorities arrested two public sector health workers [both health surveillance assistants] and one other individual, all identified through information received by the hotline. One health surveillance assistant currently awaits charges, while the other was charged with ‘theft by public servant’.”
However, low penalties for drug theft were observed as the one health surveillance assistant was charged with “being found in possession of property suspected of having been stolen or unlawfully obtained” and to pay a fine of K65 000 or serve nine months in jail in default.
Ministry of Health (MoH) Principal Secretary Dr. Dan Namarika has since bemoaned the low penalties for offences of drug, which, as observed by the Global Fund report, are not commensurate with the value of the drugs stolen from hospitals and sold to private individuals.
In an earlier interview, he said the government was reviewing the 1988 Pharmacies, Medicines and Poisons Board Act to enable stiffer penalties for drug theft suspects.
The Global Fund has also faulted the weaknesses in the supply chain for health products which enabled theft of malaria drugs for sale to the private sector.
These included ineffective systems and processes to account for commodities at health facilities and inadequate storage space and conditions.
Malaria drug stockouts were also seen as a contributing factor to the high demand for the medicines in the private sector because they are sold at a high price.
The Global Fund has provided over $1.2 billion of grants, including $167 million in support of the National Malaria Control Programme (NMCP) which is dependent on procurement and distribution of commodities including malaria drugs.
Between 2009 and 2016, the Global Fund used over $26 million to buy anti-malarial medication known as artemisinin-combined therapy (ACT) amounting to 7.5 million blister packs regarded as the most effective treatment for uncomplicated malaria.
Reacting to the report, Malawi Health Equity Network (Mhen) executive director George Jobe said public servants who steal government drugs can only be caught through heavy investment in security features such as closed-circuit television and labelling on tablets and whole packaging at pharmacies.
In an interview yesterday, he said: “There should be strong charges and offences for those who conceal evidence because public health workers shield each other. Charging those who steal drugs with operating a pharmacy without a licence is not an offence for stealing drugs.”
In the wake of rising drug and medical supplies pilferage in public health facilities, there have been several efforts to curb the malpractice.
Last year alone, 125 people were arrested in connection with drug theft of which 64 cases are in court while 30 have been convicted, according to Namarika.
In partnership with USAid and the Global Fund, government has also put in place a tip-offs hotline, 800 00 847 from land lines and 847 from mobile networks, to curb theft of malaria drugs.
In May last year, a report titled Assessment of Drugs and Medical Supplies Leakages from Medical Stores and Public Health Facilities commissioned by MoH showed that a third of drug stocks in public hospitals were being lost through pilferage almost 10 years after the ministry suggested measures to curb theft.
Former Minister of Health Peter Kumpalume said K5 billion worth of drugs and medical supplies out of a MoH drug budget of K17 billion were stolen in the 2015/16 financial year. n