In many cases; drug shortage in public health facilities has been associated with underfunding to the health sector, making the purchase of essential drugs a perennial challenge.
More often than not; the sector would get a share below the recommended Abuja Declaration mark of 15 percent in the national budget.
However; for the latest episode to cripple the drug supply chain, this could partly be credited on a policy decision to terminate currency swap deals with the African Export-Import Bank in 2020; which has eventually triggered the prevailing foreign exchange scarcity.
In turn; it’s this forex shortage that has suffocated the medical supply rhythm living both the public and private health sectors paralyzed.
With the currency swap deals in place; then, forex scarcity wouldn’t get this worse … same with the drug supply chain, which couldn’t get this disturbed, for; the swap-transaction provided the lubricant for the Malawi kwacha to stabilize; making it capable to pay for essential imports like fertilizer, fuel and medicine.
However, two years down the line, after termination of the deal; Malawi’s foreign exchange story has taken a down-turn and implicated badly on the health delivery system and drug supply chain in particular.
Both; the public and private sector have either failed or struggled to import medical supplies because of shortage of dollar, a preferred currency for purchase of medical supplies.
For Remigious Njilagoma; a diabetic patient, the forex shortage has been a nightmare as him among others couldn’t access glucosticks; an essential re-agent used for diabetic interventions.
“Eventually, due to the interruption of medical uptake I’ve developed some nerve condition and the doctor says I’ve developed mild heart complications and am observing some struggles with my sight,” says Njilagoma.
On the other hand; Mafuno Symon, guardian to an epileptic patient says the situation has been bad, as at Ulongwe health centre in Balaka district the hospital had to ask patients to provide: syringes, gauze, gloves, cotton and other essential supplies because the facility couldn’t provide.
“We had an epileptic incident at home after my child fell on the fire. It was an accident, which needed urgency but the hospital couldn’t help because it had no medical supplies or medicine,” Symon said.
In the outskirt location of Chikuli in Blantyre some women seeking family planning for implants have had to remove the medical devices by themselves, using razor blades upon being returned to buy syringes for themselves.
Similar tales are shared by expectant mothers.
Malifa Soko at Mwima, Machinga district recounts: “I was compelled to seek attention of a traditional birth attendant after being told at Ngwindima Health Centre that the hospital had run-out of medical supply for removing umbilical cords and placentas.”
Echoing Soko, Joel Moyo, president of the Anesthesia Association of Malawi, says the forex challenge has made it clinically difficult for health officers to operate effectively particularly with hospitals struggling to acquire essential drugs.
This hasn’t spared HIV/Aids patients too.
Java Chindipha, father to a pediatric Aids patient in Likongwe village, Neno district says the scarcity of drugs has had adverse implications on his son who had to momentarily discontinue retroviral treatment after ARVs ran out of stock.
“However, following this treatment-interruption; my son’s condition hasn’t been any stable as he’s had some hospital admissions and I fear he may develop dire complications,” says Chindipha.
So dire has the forex-scarcity played on the medical supply chain that even the Central Medical Stores Trust too has had to struggle with purchase and supply as contractors would hardly deliver due to shortage of foreign exchange.
Stewart Lichapa, warehouse manager for the trust admits: “CMST has largely been affected by the scarcity of forex as we couldn’t meet our obligations to deliver medicine. This; notwithstanding the fact that the trust has had the money.
“However, we cannot meet our 40 percent threshold nor can we procure drugs or medical products because of forex”.
The foreign exchange problem, he says, has largely disturbed the regularity of supply for medical items nationwide as suppliers have been supplying commodities in piece-meal whose quantities cannot be enough to sustain the demand of health facilities for a long period.
Equally hit has been the private sector, which has had to switch to the Euro for importation of medicines according to the Pharmaceutical Association of Malawi.
William Mpute, however, president of the association says this has come at a cost.
“Because the cost of importation has been high. Prices for accessing them have also gone up, living patients with prescriptions having to struggle to afford,” he says.
The problem of forex shortage; he observes has forced many local suppliers failing to meet their drug threshold of 60 percent at the Central Medical Stores Trust.
To address the situation; Reserve Bank of Malawi Governor, Wilson Banda says the bank is continuously reviewing the forex-space to ensure availability of forex for pharmaceuticals and restore the normal supply chain of medicine.
“The Central Bank shall always strive to allocate enough amount of dollar to the pharmaceutical sector to enable them import medicine and medical supplies”.
In correcting the future; moving forward, Khumbize Chiponda, Minister of Health says the disturbance of medical supply for foreign exchange challenges is a thing that mustn’t happen again because of the implications inflicted.
“The scarcity of foreign exchange has left many facilities including major referrals running below capacity … we have to sanitize the situation by ensuring there’s constant flow of forex reserves for effective medical supply chain,” says Chiponda.