As shortages of essential drugs continue to hit the country’s public health system, Queen Elizabeth Central Hospital (QECH) in Blantyre will destroy assorted drugs and medical supplies mostly dumped on the referral when they were about to expire.
In an interview last week, QECH chief hospital administrator Themba Mhango confirmed the planned drug destruction exercise, which is technically called “boarding off”.
He said most of the expired drugs were ‘donated’ to the hospital when their shelf life was almost up.
The drugs and supplies to be discarded include paracetamol suppositories, misoprostol tablets, methotreaxate injection, hepatitis B vaccine, Lumefantrine Artemether popularly known by its abbreviation LA for treating malaria, quinine tablets, SD bioline HIV, salbutamol syrup and selexid 200mg tablets.
It was not immediately clear how much the expired drugs are worth, but the last time the hospital discarded such drugs in 2012, they were valued at K62 million.
Our sources said most of the expired medicine went to QECH in form of donations from well-wishers, including major corporations.
The drugs expired between January 2012 and September 2014—one of the most fatal drug shortage periods that prompted some doctors from Kamuzu Central Hospital in Lilongwe last year to issue an open letter of appeal to then president Joyce Banda.
Mhango confirmed that most of the drugs to be destroyed came from well-wishers and that at the time of the donations, the medicine were closer to their expiry dates.
He said ideally, they should never have accepted the drugs, but the hospital—the nation’s biggest referral centre—was too desperate to say ‘no, thanks.”
“The national drug policy indicates the lifespan of drugs that the hospital is supposed to obtain or procure, but because of poverty and shortages in the wards, we still accept the donations even when we know the drugs have a short lifespan when offered,” Mhango said.
He said there are also some situations when a unit or department head personally sources drugs that are in short supply in their stations.
Mhango said when donors bring the drugs and the hospital rejects them, management faces problems from the heads who question why the hospital rejected a drug donation they urgently need.
He said the hospital has already submitted a report on the disposal to Treasury and is currently waiting for instructions from that office. Treasury spokesperson Nations Msowoya was not available for comment yesterday.
Explained Mhango: “Disposing of expired drugs is not an activity that is done by the hospital itself. The hospital has to receive recommendations from a board of survey comprising the police, city council, the Ministry of Health, Pharmacy, Medicines and Poisons Board and Central Medical Stores Trust [CMST].”
In addition, said Mhango, Treasury is involved because the exercise requires a lot of money.
According to the administrator, prior to the disposal, the hospital spends about K200 000 in allowances during planning meetings with stakeholders.
Sources added that some drugs donated to the hospital while nearing their expiry dates also come from international partners and, due to transport logistics, reach the country when a greater amount of its lifespan has elapsed.
The source said there are also some Malawian companies and institutions that donate to the hospital drugs that have a short lifespan to run away from the responsibility of discarding the medicine themselves.
The hospital, as indicated by the source, registers cases of expired drugs on a weekly basis and these drugs are stored for some time before the actual disposing exercise.
The drug shortages at QECH are almost perennial.
In April this year, while receiving a donation of K500 000 (US$1 214) worth of essential drugs from a local company, Dr Jane Mallewa, head of the Department of Medicine at QECH, said: “This donation is a big relief to our staff who have been contributing some money to buy essential medicine like Fluconazole and Amphotericin from private pharmacies for targeted patients in the wards. It pains us to watch our patients die from treatable ailments”.
However, Mallewa’s statement was disputed by the Ministry of Health and QECH administrators who claimed that the hospital had enough medical supplies.
Sometimes, procurement breaches—largely due to political meddling—have also contributed to the accumulation and discarding of expired drugs at national level.
For example, in April 2013, The Nation reported that the cost of political interference and mismanagement in the drugs and other medical supplies procurement system led to the destruction of $2.3 million (K1 billion) worth of drugs that had expired.
CMST public relations officer Herbert Chandilanga said at the time: “The [drugs] have expired. They are drugs used in health facilities, but change of use [changes in treatment regimen], misprocurement and also mismanagement has led to their expiring on the shelves,” he said.
But an authoritative source explained the problem this way at the time: “As you know, there was a lot of political interference in the procurement of drugs and other medical supplies. People would be given contracts to supply even when they know nothing about drugs and the quantities were exaggerated.”
