Drug shortages: A national crisis

By Tabitha Mutenga, Features and Supplements Editor

AS the donor community is busy trying to ensure that there is enough food for millions of Zimbabweans facing starvation, another disaster that may soon call for the donors’ attention is unfolding in the country’s hospitals.
A massive shortage of basic clinical drugs at major public health institutions is unfolding.
The situation has been described by health experts as dire, putting the lives of many people at risk.
Basic pain killers are unavailable in hospitals and most rural clinics, where the majority of the country’s ever desperate communities live.
Most of the doctors at major referral hospitals are referring patients to private pharmacies, which are expensive.
“There is no point of travelling all the way to Makanda Clinic; all you get is paracetamol. Even if you have malaria you get paracetamol,” said one villager from Rusape, who preferred to be identified as Magreta.
She had gone to seek treatment at Makanda Clinic.
“Medical supplies such as bandages, syringes, cotton swabs and antiseptic are not even available at the clinic,” she lamented.
Villagers who frequently visit the clinic in the hope of accessing treatment concurred with Magreta saying many were travelling to Murambinda Hospital or Rusape Hospital for treatment.
At both hospitals, it is either that they find the drugs being dispensed at the institutions to be out of reach, or they end up being referred to private pharmacies owing to the prevailing shortages of drugs.
As many fail to access treatment at public institutions, hospitals are fast becoming “waiting rooms for death”.
Community Working Group on Health (CWGH) executive director, Itai Rusike, said while government policies on essential drugs and on equity in health have significantly widened treatment access in Zimbabwe, there is evidence that drug access has fallen in recent years, and that drug availability is falling sharply at State hospitals.
“This represents an unfair cost burden on poor communities, but also opens the way for the growth of private unregulated drug markets. Procurement procedures at the National Pharmaceutical Company (NatPharm) are still determined by the State Procurement Board, even though NatPharm is not a typical State department, and this has led to delays in decision-making. Further, NatPharm suffers from lack of adequate funding from the Government of Zimbabwe. As a result, the country is now highly dependent on donor support for its drug supplies,” Rusike said.
NatPharm, the country’s appointed agent for procurement, storage and distribution of medical supplies to public health institutions, is owed US$24 million from as far back as 2009 and only received US$800 000 from Treasury in October last year, making it unable to purchase drugs.
“Drug supplies at rural health centre level are also problematic and are a constant source of client discontent. The approximately 1 500 clinics in Zimbabwe are the last step in a long chain of drug procurement and distribution.
“Communities have had to spend scarce local funds to guard clinics from recurrent theft of drugs and other supplies, particularly when facilities have no fencing, burglar bars or other security. Not surprisingly, even when clinics do not charge fees, people bypass them for more expensive hospitals in towns where they think they have a chance of getting drugs. For the poorest, this is an unaffordable solution,” said Rusike.
A CWGH survey on the 2016 National Budget indicated that communities noted that Treasury should have prioritised provision of essential drugs and improving staff pay and training, especially for workers in preventive services, clinics and district hospitals.
Government’s essential drug policy aims at promoting rational drug use and ensuring the availability of low cost, but good quality drugs.
The Ministry of Health backed this policy with investments in primary health care to strengthen drug delivery to primary care and district services.
These changes were supported by a significant reallocation of resources to and within the health sector.
The policy on essential drugs and generic (brand name) labelling of drugs was applied across the public and private sectors, saving the country significant resources from the mark-ups of brand-name products.
Bulk procurement and local production also reduced the costs of essential drugs.
However, a number of factors have affected drug availability such as resource constraints, currency shortages, losses in supplied drugs, expiring drugs and theft of the drugs.
“Cases of drug theft and leakages out of public services into private practice have been cited. Those cases under police investigation have not resulted in concrete finalisation or quantification of the drugs. Burglary into drug storerooms has also been reported and hospital staff has allegedly been implicated in such acts. At clinic level, drug theft has been reported as a problem in a number of districts and has led communities to hire security guards and build fencing and erect burglar bars,” Rusike added.
Theft and leakages of drugs from the public sector and sales of drugs brought onto the country for personal use are reported to have led to some drugs finding their way into the black and informal markets.
Contraceptives are also being sold on the black market and the problem with such sales is that they are unregulated, making it difficult to ensure quality or appropriateness of drugs, avoid side effects and complications and also problems of resistance that can happen in unregulated use of antibiotics.
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