Continuing drugs shortages in Malawi: exploring Scottish coordination
16 December 2021
Following media reports highlighting the scale of drugs shortages in Malawi, the SMP received strong concerns from a number of SMP members and those in the diaspora community. Listening to senior health leaders in Malawi on this issue, there was strong appetite on all sides for the SMP to facilitate discussions to better understand the issue and explore a possible Scottish response.
The SMP has made clear from the outset that it does not have funds, expertise or capacity to make a meaningful contribution to what is a longstanding, complex and deep-seated challenge in Malawi. In keeping with its Partnership Principles, the SMP’s top priority is to ‘Do not harm’ in this, and all its work.
The SMP quickly convened a coordination Zoom meeting of key stakeholders in December 2021 to better understand the issue by listening to Malawian health leaders and to explore possible coordination of effort
For more than two months there has been an acute shortage of essential drugs in Malawi, causing operating theatres and clinics to close, endangering many lives. Hospitals are lacking a wide range of pharmaceuticals including anaesthetics, which has hit maternity care hard, with caesareans cancelled, clinics closed, and patients turned away. It has been reported that over a third of Malawi’s 28 districts have run out of many drugs, with some drugs, like thiopentone, not having been available in Malawi for over a year. The Anaesthesia Association of Malawi has described the situation an emergency and the Chief Medical Adviser to the British Red Cross, SMP Member Dr Barry Klaassen describes the current situation as a maternal humanitarian crisis in Malawi.
In our coordination meetings, Malawi’s health leaders have identified the current acute shortage of key medicines and anaesthetics being principally due to:
A) Delivery challenges – several major scheduled supplies of drugs from India, (Malawi’s main supplier, as local markets do not have quantities needed) have not arrived when promised. Malawi leadership suggest difficulties are in both India and at the Malawi end of the supply chain and procurement. Fundamental drugs that are not currently available in some district hospitals include Oxytocin, Ketamine, Spinal Lidocaine, Propofol and Suxamethonium.
The cost of drugs in nearby South Africa is at least double that of India and Malawi is exploring sources of drugs in Dar-es-Salam. Learning is that a lead-in time for supplies of Oxytocin are 6-9 months. Shipping delays have increased from 3 weeks to 2 months.
B) Lack of funding for the drugs budget. The Malawian Kwacha is not currently strong and (whilst Malawian friend were discrete in not asserting this) international donors have reneged on Aid commitments causing problems for budgets. The cost of medicines has increased very significantly since the start of COVID. Shipping costs have also gone up.
Malawian Ministry leadership asked whether SMP members would look to help facilitate support in 2 ways:
1. Using its networks to help urgently fill the immediate drugs needs especially NCDs and anaesthetic medicines in this short-term gap. A quick solution is needed, that might call for an airlift of anaesthetics and medicines and the Ministry has provided the group with a list of essential medicines needed.
2. Helping to convene expert input towards a longer timeframe. This could involve collaboration on systemic challenges, including procurement, supply chain and stock control, working together with Malawi’s Central Medical Stores (CMS) and CMS Trust.
SMP member, the Scotland Malawi Anaesthesia Project has launched an urgent appeal fund to help colleagues in Malawi purchase and distribute anaesthetic and life-saving drugs to almost all hospitals in Malawi, where drug shortages have resulted in the total cessation of all life-saving surgery since early November. Their Just Giving Page can be found: here.
The SMP recognises that this is a longstanding, complex and multi-faceted issue which cannot be solved by the SMP. We are aware of the myriad legal and ethical complexities in Malawi, as elsewhere, compounded by the current global supply and logistics challenges precipitated by Covid. Whilst especially acute at present, these are long-term issues which require a long-term sustainable solution, which is beyond the SMP.
As a small Scottish charity with a handful of staff, it is important to emphasise the SMP itself has neither the capacity nor expertise to make a meaningful contribution to the underlying issues here. It is important we are clear on this, managing expectations carefully, in keeping with our partnership principle of ‘Do No Harm’. However, as friends of Malawi, we are keen to listen and respond when our partners are flagging an urgent humanitarian issue. We should not confuse “do no harm” with “do nothing”.
In this spirit, we look to work within the SMP’s capacity and existing modalities of support: focusing principally on creating a convening space to share, connect and amplify our friends in Malawi. We recognise that we have members in Scotland and partners in Malawi who have far greater capacity and expertise that the SMP and hence mobilising them is a valid response for the SMP.
We see four main roles the SMP can usefully play here following the invitation from our friends in Malawi:
- Creating a space to listen to and learn about the issues in Malawi, amplifying a range of different voices in Malawi.
- Encouraging active collaboration between SMP members and organisations in Malawi, and supporting them to consider how, together, they could respond to the challenges identified by Malawi, in partnership and solidarity with Malawi.
- Raising awareness of and actively promote an appeal in this area, having done some very basic due diligence to satisfy ourselves it is an appropriate response, in keeping with our values.
- Looking to use the SMP’s relationship and positioning to influence potentially government: making them aware of this issue and actively encouraging governmental support for Malawi on this.
We have begun this process by:
- Convening a meeting, with some very constructive points shared.
- A Scottish MP asking a UK Government Minister about this in the UK’s Westminster Parliament on Tuesday December 2nd 2021:
- Having initiated informal dialogue with senior FCDO Malawi officials to discuss this issue.