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Malawi Government

STATEMENT BY
THE MINISTER OF HEALTH
HONOURABLE DR. PETER KUMPALUME, MP
IN THE NATIONAL ASSEMBLY
ON
MEDICINES AND PATIENTS FOOD IN HOSPITALS

23rd FEBRUARY, 2016


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Mr. Speaker, Sir, it gives me great pleasure and honour to present to the August
House, on the following issues; medicines and patients food in our hospitals.
In my statement, Mr.Speaker, Sir, I will report on the current status and I will
also highlight what my Ministry is doing as a response.
Mr Speaker, Sir, allow me to start with the drugs issue.

STATUS OF ESSENTIAL MEDICINE & HEALTH SUPPLIES (EMHS)


AND PHARMACEUTICAL MANAGEMENT CHALLENGES
Mr Speaker, Sir, allow me to brief this August house on the Essential Medicine
& Health Supplies situation in the country.
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I would like to present the availability of medicines by specifically addressing


three topics:
1. The financing
2. Consumption rate of those finances and
3. Actual availability of medicines

1. The Financing
Mr Speaker, Sir, In June last year, this house approved a Drug Budget allocations for District
and Central Hospitals of K10,000,000,000.00 and K5,689,350,716.00 respectively
3

Therefore, for the first 6 months (July Dec 2015), K7,844,675,358 was the combined drug
budget for Quarters 1 and 2 i.e. K5,000,000,000 and K2,844,675,358 for the District and
Central Hospitals respectively.
Govt disbursed K7,359,074,997

A total of K7,359,074,997.00 was paid by MoH (K3,192,070,830.00) and NLGFC


(4,167,004,167.00) in respect of quarterly advance funding for the period 1 st July to 31st
December 2015 as detailed in Table 1 below

Table 1. Payments by MoH and NLGFC


Date
26/10/15

Recei
pt No.
239

24/11/15

241

MOH

NLGFC

Total

631,670,8
631,670,8
35
35
1,596,025,4
1,596,025,4
4

15
30/11/15

242

30/11/15

243

04/01/16*

244

Total

15
2,699,999,9 2,699,999,9
99
99
835,333,3
835,333,3
33
33
1,596,025,4
1,596,025,4
15
15
3,192,070,8 4,167,004,1 7,359,074,9
30
67
97

Note* this cheque relates to Quarter 2 but was collected in January 2016

Please note that while the decision to change the funding model for the drug budget was
made in Quarter 1, the actual payments by MoH and NLGFC to CMST were made in
Quarter 2. This is normal for such huge amounts and the procurement procedures.

2.

Utilisation of the Drugs Budget

Quarterly Drug Deliveries by Hospital


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Total drugs sold and delivered to all public hospitals by CMST during the period under
review amounted to K7,754,149,370.29 out of which drugs worth K6,035,770,453.88 and
K1,718,378,916.41 were delivered and invoiced in respect of District and Central Hospitals
respectively.
While the overall drug budget utilization was at 98.9%, District Hospitals exceeded their
budget by 20.7% and Central Hospitals underutilized their budget by 39.6% as detailed in
Table 2 below.

Budget (K)

District
Hospitals
5,000,000,000

Deliveries (K)

6,035,770,454

Variance (K)

(1,035,770,45
4)
(20.7%)

Variance (%)

Central
Hospitals
2,844,675,
358
1,718,378,
916
1,126,296,44
2
39.6%
6

Total
7,844,675,35
8
7,754,149,37
0
90,525,988
1.1%

Details of deliveries of drugs to District and Central Hospitals and analysis of budget
utilization are provided in the Annex Table 3.

If I am to summarise, Mr Speaker Sir, the data on Financing and consumption


are saying that the amount of money that your house approved for drugs
for the first 6 months (MK7.8 billion), Exactly matches the value of drugs
delivered to the hospitals (MK7.8 billion), even though funding was at
MK7.4 billion.

3. Drug Stock Availability and Future Outlook at CMST

Drug stock availability at the central (CMST) level averaged 60% during both Quarters 1
and 2 of the 2015/2016 financial year.
The low stock availability was due to delays experienced in receiving medicines and
medical supplies bought with support from the Department for International Development
(DFID) which were expected in the first quarter but shipments started arriving towards the
end of December 2015.
CMST floated major procurement tenders in Quarter 1 and contracts with suppliers were
signed in December 2015 and January 2016. Deliveries under these tenders are expected in
Quarters 3 and 4. Delays in concluding the tenders also affected stock availability in both
Quarters 1 and 2.
The quarterly advance payments to CMST have assisted in giving confidence to that Trust
thereby improving its cash flow to enable not only to float tenders that are expected to
improve stock availability but also pay its suppliers within due dates.

As stated above, once the quarterly advance payments are regularized, it is expected that
CMST will have predictable cash flow projections which assist in meeting its obligations and
improve drug stock availability in Quarters 3 and 4.

Drug Availability at facility level

Mr Speaker Sir, The Ministry of Health, through the Pharmaceuticals department,


monitors the availability of essential medicines and medical supplies using the
Logistics Management Information System (LMIS). The system collects logistics
data from all levels of the supply chain and such data is used for analysis to
inform decisions. The availability of medicines and medical supplies, though less
than optimal has improved considerably from the same period a year ago. We

also see an improvement in the availability of medicines used to treat the most
common illnesses that plague the countrys population.
At facility level we find that average stockout rates for tracked tracer items is
8%. This places availability at about 92% of facilities that reported in the period.
This is a decline from the double digit stockout rate the system experienced a
year ago.
What are the critical items that facilities are short of
At central medical level, the majority of shortages relate to antibiotics especially
the more powerful ones that should treat the narrow range antibiotic- resistance
cases i.e. those that are resistant to commonly used antibiotics.
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At primary health care level, the majority of cases relate to antibiotics (narrow
range) and anti malarial tablets. Lately we also experienced a shortage of
analgesics (paracetamol etc) but this was due to non delivery of the supply by a
local manufacturer. Corrective measures have been taken and two other local
companies will take over the allocation.

Even though CMST report 60% stock of Must Have drugs, this figure is based on
whether that item is available irrespective of whether the volume is sufficient or
not. The ministry however, looks at whether for that specific item the volumes
are enough to cover one months supply. When we apply the ministrys criteria
(by analyzing tracer items), stock levels at CMST run at 30% for the 6 months
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from Jul-Dec 2015. A rough estimate of items ordered vs items delivered for
central hospitals stand at 30% for Mzuzu, 20% for KCH and 46% Zomba.
Mr Speaker sir this may explain in part why central hospitals utilised only 30%
of their budget.
Whilst running stock availability at 30% by volume requirements is not a bad
thing in itself, this leaves us vulnerable should there be hiccups in the upstream
supply chain. To increase stock availability the logical solution is to CMST
more finances so they have a lot more resources at their disposal.

Drug Theft and failure to account for drugs


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Mr Speaker sir, you have heard reports of drug theft cases all of which involve
ministry of health staff, be it clinicians, nurses or pharmacists. I want to report
that over the last 6 months, the ministry received reports of 28 drug theft cases.
Mr Speaker sir, the ministry has taken a tough stand against drug theft and I have
no regret to report that all of them were suspended without pay. The majority of
these cases are in court and frankly I dont see any possibility of these people
being re-employed in the ministry again.
Further Mr Speaker sir, we received reports of over consumption of malaria
drugs in 10 of our facilities. In some of these cases, consumption was 7 times
more than the reported malaria cases. Such huge anomalies can not be explained
by simply reconciliation errors considering that the majority of these facilities
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were visited previously . The ministry suspended all staff involved in these
facilities on full pay pending audit. I am pleased to report that the audit was
completed last week and depending on their report further action may be taken
against these individuals.
Mr Speaker sir, the ministry is of the opinion that the 28 cases of drug theft
reported last year are a tip of the iceberg. In order to unravel all drug related
theft, I instructed the ministry to set up a special unit (you may call it the special
branch) to lead the fight against drug pilferage. Mr Speaker sir, the ministry is on
the verge of setting up this unit. This unit will sensitise the community on how
they can join the fight against drug theft, strengthen supervision of health
facilities, investigate all drug cases and prosecute hot cases. Yes , Mr Speaker,
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this unit will have its own lawyers to prosecute cases so we dont overburden
other government agencies. We are expecting to receive $1.4m from
development partners to finance this unit. We owe it to the next generation to
leave the ministry of health in a better state than we found it and we remain
resolute to do that. This is the time and we are the people that must end the theft
of medicines in our hospitals. We in the ministry of health we are and will
continue to deal with this issue as per laid out government regulation. The days
where such people would be transferred to other facilities are gone.

The Pharmacy and Medicines Regulatory Authority


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Mr Speaker sir you may recall that we have been talking about a new bill with
stiffer penalties for those caught stealing medicines. We have amended the bill
and we have also aligned it with international standards so the board will now
become a regulatory authority. The bill was re-submitted to the Ministry of
Justice and Constitutional Affairs for drafting. We are optimistic that the bill will
be tabled at the next sitting of parliament.
FEEDING OF PATIENTS
Mr Speaker, Sir, and Honourable Members of the house,
Allow me now to move away from drugs and update you on the situation of food
for patients in our hospitals. As you might be aware , Honourable Members, the
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situation of food for patients in our hospitals has been a subject of media debate
over the past few weeks.
A few days ago, I contacted the District Health Officers to give me an update on
the current status of food for the patients in our hospitals. I further asked them to
provide hospital bed occupancy as well as their food budget allocation so we can
compare the food situation with number of in patients and the allocated money.
From the reports that we have received, most hospitals are at present providing
patients with 2 meals a day. The ideal is, of course, three meals a day. About 58
percent (14 out of 24) of districts provide 2 meals a day to their patients and 38
percent of them (9 out of 24) provide 3 meals a day

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Now I want to draw your attention to the analysis as detailed in the attached
Excel sheet.
-

What are we doing


1. As a Ministry we want to know the exact amount hospitals spend
on food on a regular basis. For that reason I have asked all DHOs
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to report to me monthly on how much they have spent on patient


food and on what items. This will help us map the best
interventions.
2. The Ministry of Health has received and will be receiving funds
from certain Development Partners (DPs) in respect of new fund
called the Health Services Joint Fund (HSJF). The HSJF is a
funding mechanism designed to receive funding from multiple DPs
and uses elements of Government systems (such as planning,
budgeting, procurement, reporting) but maintains a parallel funds
flow with strong fiduciary and procurement oversight and controls.
It is designed as a means to efficiently and securely channel DP
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funds to approved, priority government budget lines/ activities;


reduce fragmentation of DP support; and strengthen government
fiduciary and related systems, as long as DPs deem it not feasible
to use alternative mechanisms for channelling funds that are more
fully integrated with Government financial systems.
These funds have and will take off pressure which some of our
DHOs were facing in terms of paying

for utilities, fuel for

ambulances and Service Level Agreements. These funds have freed


up resources to procuring food for patients.

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3. As a Ministry, we have intensified monitoring of expenditure in our


facilities so that we can detect misuse and the usual disciplinary
action can be taken.
4. Let me use this opportunity to call upon you members of this
August house to take an interest in the way patient money is spent
in your councils.

CONCLUSION
Let me conclude my statement, Mr. Speaker, Sir, by stating that we have made
substantial progress but we are not without challenges. We will do our best with
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the resources we have and under the able leadership of our State President, His
Excellency Professor Peter Arthur Mutharika, Government is committed to do all
that is necessary to ensure that we deliver and guarantee quality health services
consistent with improving the quality and life expectancy of all Malawians.
Mr Speaker Sir, and Honourable Members, I thank you all for your kind
attention.

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ANNEXES
Table 3.
DRUG BUDGET
ALLOCATION AND
CONSUMPTION FOR JULY
TO DECEMBER 2015

2015/16 Annual
Budget
NLGFC
Lilongwe DHO
Kasungu DHO
Dowa DHO
Mchinji DHO

Total invoices July to


December 2015

963,342,582.02
424,802,367.16
399,992,938.96
332,935,847.35
23

659,435,581.79
287,826,557.36
170,522,908.00
177,692,222.63

Consumption (%)
68
68
43
53

Nkhota - Kota DHO


Ntcheu DHO
Ntchisi DHO
Dedza DHO
Salima DHO
SubTotal
Mangochi DHO
Chiradzulu DHO
Machinga DHO
Mwanza DHO
Mulanje DHO
Blantyre DHO
Thyolo DHO
Phalombe DHO
Balaka DHO
Chikhwawa DHO

348,862,322.17
390,784,079.24
215,038,552.70
457,695,480.15
305,054,491.87

194,857,888.09
340,316,720.76
171,889,435.19
289,832,244.00
133,111,757.95

3,838,508,661.62

2,425,485,315.77

532,173,266.71
300,032,383.35
321,384,405.05
188,755,674.54
402,159,546.53
653,676,427.68
457,563,662.84
263,408,808.84
280,358,129.92
346,529,144.23

268,730,079.52
198,609,432.92
206,277,363.69
116,259,741.22
284,870,962.91
253,720,346.93
376,595,913.64
114,649,119.79
154,062,905.61
190,160,124.08

24

56
87
80
63
44

50
66
64
62
71
39
82
44
55
55

Neno DHO
Nsanje DHO
Zomba DHO

218,501,214.24
245,713,358.61
457,167,448.96

161,565,011.96
132,901,071.54
187,692,006.93

4,667,423,471.50

2,646,094,080.74

358,474,711.81
182,563,026.82
223,411,657.51
213,139,477.50
61,232,794.53
229,809,854.26
225,436,344.45

243,232,619.39
137,520,196.32
123,961,179.68
99,490,189.79
30,279,883.85
183,787,620.65
145,919,367.69

SubTotal

1,494,067,866.88

964,191,057.37

TOTALS

10,000,000,000.00

6,035,770,453.88

SubTotal
Mzimba South DHO
Mzimba North DHO
Rumphi DHO
Nkhata-Bay DHO
Likoma DHO
Karonga DHO
Chitipa DHO

25

74
54
41

68
75
55
47
49
80
65

60

CENTRAL HOSPITALS
Kamuzu Central Hospita
Queen Elizabeth Hospital
Zomba Central Hospital
Zomba Mental Hospital
Mzuzu Central Hospital

1,877,343,314.00
1,980,899,419.00
840,000,000.00
181,957,347.00
809,150,636.00

791,154,695.87
403,591,086.82
181,841,379.23
52,517,810.62
289,273,943.87

42
20
22
29
36

TOTALS

5,689,350,716.00

1,718,378,916.41

30

15,689,350,716.00

7,754,149,370.29

49

GRAND TOTALS

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