Donors may for a long time continue to be responsible for buying and distribution of drugs to Malawi’s public health system instead of Capital Hill if progress on implementation of procurement and monitoring reforms is limited, says a study.
The study, done by United Kingdom’s (UK) Overseas Development Institute (ODI), is the latest independent assessment of the country’s drug procurement and supply chain. It was published mid last month.
The study also blames donors’ parallel systems for partly frustrating enforcement of reforms.
The findings come when donors such as Britain, Germany and Norway are, among others, supporting donors’ direct procurement of essential medical kits for Malawi under the Primary Health Care Project.
United Nations Children’s Fund (Unicef) procures the medical kits whereas the United States Agency for International Development (Usaid) distributes them to government and Christian Health Association of Malawi (Cham) hospitals through its Deliver Project.
Deliver is a Usaid-funded project aimed at improving essential health commodity supply chains by strengthening logistics management information systems, streamlining distribution systems, identifying financial resources for procurement and supply chain operation and enhancing forecasting and procurement planning. It operates in several developing countries.
The study also comes when the Central Medical Stores Trust (CMST) is struggling to advance the reform process and improve its capacity to address the 95 percent current drug shortage in the country’s hospitals.
“There is a danger that development partners [or other third parties] become locked into external procurement and provision of medicines indefinitely…Policy incoherence and poor monitoring systems may have been unintentionally exacerbated by the existence of parallel systems.
“…Maintaining parallel systems can undermine incentives for change and the link between citizen[s] and State, as people do not hold government responsible for service provision and leaders no longer feel responsible.
“As a result, exit strategies need to be designed to move away [even in incremental steps] from the use of parallel systems,” reads the January 2013 assessment report titled The Supply and Distribution of Essential Medicines in Malawi.
The donors’ medical kits programme was planned to run until June this year when CMST is expected to take over all drug procurements for government.
The trust has, however, asked the donors to extend distribution of their medical kits until December, saying it would not be ready to take over the full task by June as it is still constructing its national pharmaceutical warehouse in Lilongwe and yet to stock much drugs, among others.
“A request has been submitted to the Health Donor Group for extension of the Primary Health care kits Programme to be extended to December 2013. We are also moving towards transparent and value for money procurement [open tendering], proper quantification and forecasting, among others],” said the trust’s chief executive officer Feston Kaupa.
Kaupa said the trust is working with donors to improve its drug procurement, distribution and monitoring systems, saying they expect all parallel drug procurement systems to be collapsed into one system at the trust by end of 2015.
“We have a USaid and Global Fund joint supply chain integration strategy which was done during the last week of July and first week of August 2012. The strategy was developed with specific benchmarks to be met as pre-conditions for phasing out parallel supply chain operations into nationally-managed supply chain systems at CMST,” said Kaupa.
He said the UK’s Department for International Development (DfID) has provided a technical advisory team from UK’s Charles Kendall and Partners to help the trust build capacity on its procurement systems.
Apart from the medical kits programme, other parallel systems relate to the supply of drugs for malaria, tuberculosis (TB) and vaccines, among others.
The ODI’s report adds that “in recent years, reform pressures have focused on strengthening the Central Medical Stores. In theory, as a trust, the CMST is envisaged to work in a more business-like fashion, with better cost accounting measures to ensure it is self-financing and with greater independence.
The report also says legacies of late president Dr. Hastings Kamuzu Banda’s rule are still haunting the performance of drug procurement, supply and monitoring systems.
“Legacies of Dr. Banda’s 31-year strong man rule [1964-94] and his manipulation of public resources to retain power remain today. Neo-patrimonial tendencies remained after transition to multi-party rule, as shown in examples of forms of patronage in the awarding of contracts and staff appointments; the use of State resources to promote the ruling party,” adds the report.
Minister of Health Catherine Gotani Hara on Tuesday said the last largest drug procurement by government was done in October 2009 to last for 12 months, saying health centres, especially in rural areas are currently surviving on the donors’ emergency medical kits.
