Lilongwe — Marita Jeffrey, 30, knew that the health centre which served her village had a shortage of drugs, but did not know the extent of the problem until her children fell sick.
As misfortune would have it, all of Marita’s four children went down with malaria at the same time and the mother rushed them to Ligowe Health Centre in Traditional Authority (TA) Mlauli’s area, Neno.
“When I got there, I could not believe my ears when the medical worker said he was not going treat all the children because of a shortage of medicines, and that instead he would treat one child,” said Marita.
The subsistence farmer from Chikalema Village in TA Dambe, Neno, said she was told to make a choice as to who would get treatment among the four children. She chose her eldest child.
“I was told to go home and buy pain killers for the rest of the children. As I returned home that morning, I realized the drug shortage problem was greater than I thought,” she said.
Marita visited the same facility with a sick child in April this year, two years after the health centre sent her back. She expected to be told again that there were no drugs, but she was pleasantly surprised.
“This is unbelievable as I again expected to be told there are no drugs,” a happy Marita told Mana soon after her child had been treated. “Every patient has been assisted, unless it is a referral case.” That Marita’s child was able to be assisted at a time when the nation was facing serious challenges in procuring medicines was because of the $33- million Primary Health Care (PHC) Kit Project. Malawi experienced widespread drug-stock-outs from around mid 2011, prompting donors to formulate a package of support for the country by way of the PHC Kits.
The objective of the PHC Kit Project is to contribute to the recapitalization programme of the Central Medical Stores Trust (CMST) so that it continues to supply reliably in future. The project owes its existence to governments of Germany, Britain and Norway working through the United Nations Children’s Fund (UNICEF) and United States Agency for International Development (USAID) Public Health Care (PHC) Essential Medicines Support Project.
Until December 2012, the PHC Kit project had procured and distributed a total of 9370 kits. Two consignments of 660 and 930 kits were distributed in January and February this year. Since the project started, no patient seeking primary healthcare has ever been reported to have been sent back to buy medication as was happening before.
And as a result of the PHC Kit, there has been a tremendous reduction of stock-outs for PHC products, and reduction of pilferage. The project has also seen a rise in outpatients in all health facilities.
The PHC Kit comprises Amoxicillin, Doxcycline, Erythromycin, Salbutamol, disposable needles and syringes, Paracetamol, Clotrimazole, Quinine sulfate, Glucose injection,
Tetracycline eye ointment, Abendazole, Magnesium Sulphate, and Catheter, among the numerous essential products.
However, notwithstanding the achievements made, the project has faced some challenges which include Central Medical Stores Trust (CMST) failing to provide medicines outside the kit or topping up when products have been depleted, and late invoicing by CMST affecting payment.
The other challenges are poor government cash flows that affect payments, and rising exchange rate versus kwacha based district budgets, and poor documentation in some facilities, raising questions on transparency and accountability.
Although the kits are supplied as a donation, they are not entirely free of charge. Health facilities, including those under Christian Health Association of Malawi (CHAM) pay for each kit on a prescribed level of subsidy. Currently, they pay 55 per cent of the cost of each kit.
Health care providers, especially those working in public health facilities, are unanimous in their praise for the project, noting that it has relieved the suffering of many Malawians within its short life span.
Dr. Jones Masiye, District Health Officer (DHO) for Neno, said one pleasing thing about the project was that drugs were being delivered straight to health centres, saving district hospitals time and money.
Under the PHC Kit Project, UNICEF procures the drugs while USAID is responsible for delivering to health facilities throughout the country.
“Previously Central Medical Stores would bring medical consignments to us and we would deliver them to health centres. Sometimes we could not deliver them due to transport problems.
“But now, thanks to this project, drugs go straight to health centres and this is saving us a lot of time and money. We wish the project would continue,” Dr. Masiye told reporters.
When journalists visited the district hospital, the facility had drugs that were to last six months, and two months for items in great demand, according to pharmacy technician, Zaona Kalua.
At Mbela Health Centre in Balaka, a facility serving a catchment area with a population of 48,000, health care givers also spoke highly of the medical kits initiative.
“The good thing about this project is that some drugs that were scarce are available in these kits,” said Emmanuel Chiwaya, the health centre’s medical assistant and officer-in-charge.
Wilfred Thadzi, a health worker at Chiyendausiku Health Centre in TA Nsamala, also expressed joy that the project had taken over the task of delivering drugs, ensuring speedy delivery.
“When the programme comes to a close, I hope there will be another to keep the health system functioning smoothly,” Thadzi said. “Drugs for common ailments such as malaria, pneumonia and diarrhea are found in these kits. The kits have helped us tremendously.” The Ministry of Health (MoH) also acknowledges the contribution the PHC Kit project has made to the health sector.
“The impact is visible. Everywhere, health personnel are giving positive feedback,” MoH Spokesperson, Henry Chimbali, told Mana.
Chimbali said looking from where the country was coming, “we do not know how things would have been if it were not for the project.”
He said: “It has been a good intervention and saved many lives. The availability of drugs has also increased morale among health workers who are working with enthusiasm.”
Chimbali said after the phase out, government would ensure to maintain a supply of drugs, and that DFID was coming in with a package worth millions of British Pounds.
Today, Marita still remembers what she experienced at the health centre when all her children fell sick. She said it was like being told to save one child from the four children.
“If you are saying the situation has improved because of donors, May the Almighty God bless these people. What I went through should never happen to anyone,” Marita said.
Fredson Baison, 45, a subsistence farmer from Muli Village in TA Kachenga, Balaka, said the shortage of drugs in hospitals greatly affected their livelihoods.
“You would come here three or four times and all they would tell you was that there were no drugs,” Baison recalled in an interview Mana at Mbela Health Centre.
“You cannot work when you are in poor health. But now, let us tell the truth, things have changed. We don’t go home without receiving treatment.”
BY GOSPEL MWALWANDA
