On a scorching Thursday afternoon, Ellina Yakobe is sweating profusely as she has walked over a kilometre from Machinjiri Area 5 to Luwanda Health Centre in Blantyre with a three-year-old baby saddling on her back.
Without money to pay for a minibus, the mother, 36, has endured this walk to seek medication for Thokozani, her sick child who has been sleepless due to fever, vomiting and headache the previous night.
“This could be malaria,” she says when we meet at the clinic. “My child’s health is more precious than the comfort a minibus offers.”
Here, a clinician may have confirmed Yakobe’s fears that Thokozani is taken ill by the common disease that kills the highest number of children in the country.
But the rapid malaria test was not the end of her search for the child’s healing.
Instead, it set in motion a painful merry-go-round faced by patients at risk of dying of treatable diseases as government struggles to settle bills for essential drugs at Central Medical Stores Trust (CMST).
Yakobe recalls that the health worker looked at her with pity, saying: “The clinic has run out of drugs. If you can, go and buy from a pharmacy.”
The desperate mother went home shattered.
When we meet on Monday, she is standing in a lengthy queue at the public clinic where some patients, including mothers carrying whimpering babies, had visited and waited for a week to grab essential drugs.
“I’m back because I couldn’t afford the drugs,” she explains.
Previously, she left the clinic heartbroken. The facility that offers hope to poor patients could not come to the rescue of her baby who was gasping for a breathe.
“Today, my colleague is lucky. She received enough medicine for her daughter,” says Yakobe with envy.
Her chances remain uncertain until she gets the prescribed drugs, she said.
She put her uncertainty and heartache in perspective: “When drugs come, stocks do not last. We just hear they have run out. Where medicine goes we do not know.”
This mirrors the suffering of many patients struggling to get medicine in public hospitals owe CMST almost 12 billion.
Our visit to Ndirande and Limbe show that those patients are leaving state-owned health centres without malaria drugs.
According to Ministry of Health statistics, malaria accounts for nearly 6.2 million patients treated in health facilities across the country and 36 percent of outpatients of all ages.
Nearly 33 percent of children under five are diagnosed with malaria parasite which spreads via mosquito bites.
Even as the treatable disease kills, we saw malaria patients lining up for medication in health facilities hit hard by erratic drug supply.
“Sometimes we find medicine, sometimes they just test us and prescribe drugs that we have to buy elsewhere,” says a Manje resident in an interview at Limbe Health Centre.
In an interview, Blantyre district health officer (DHO) Gift Kawalazira said health facilities sometimes run out of medicine because officers delay to write a report requesting medicine.
“At times it has to do with logistics. These factors combine to delay the distribution of medicine. However, malaria drugs are found in all 29 health facilities in Blantyre District,” he says.
According to Kawalazira, when a hospital exhausts its stock, the district health office redistributes medicines from neighbouring facilities which has more supplies.
However, the future looks uncertain. As hospitals grapple with whopping debts at CMST, our sister newspaper, Nation on Sunday, revealed that some pharmaceutical companies have threatened to stop supplying drugs to the public trust until they receive the money it owes them.
However, the on-off drug supply, which mostly affects poor Malawians who rely on free healthcare services government offers, is a result of a number of factors.
These include delay by Treasury to disburse funds to CMST to pay suppliers and theft of drugs in public hospitals.
The Ministry of Health has decentralised funding for health to district health offices, with each hospital managing its own drug budget.
According to its spokesperson Joshua Malango, the ministry encourages health facilities to form committees to oversee procurement and utilisation of drugs and other medical supplies.
“Some hospitals, especially central hospitals, do not get all required drugs despite money being available for their drug budget lines at CMST. The reason is that, for central hospitals, the more diverse specialists we have, the wider the needs,” he said.