Investigation of Drug Theft in Malawi
This OIG investigation report documents work to disrupt the theft of donor-funded artemisinin-based combination therapy (ACT), an anti-malaria drug, from public health facilities in Malawi. The Global Fund OIG worked closely with Malawian authorities and other donor organizations, particularly the United States Agency for International Development’s (USAID) OIG, to find those responsible for the theft, to encourage the public to report wrongdoing and to support national capacity building to prevent further leakage.
In September 2015, the OIG received reports that stolen drugs were being diverted from the Malawian public health system to private clinics. A market survey in November 2015 found that 35% of private clinics from the sample were selling stolen donor-funded ACT of which Global Fund-financed ACT was found in 19% of the clinics. The highest price paid for ACT found in the survey was US$11, indicating a strong financial incentive to steal the medicine.
As a result, the Global Fund adapted its anti-corruption campaign, called “I Speak Out Now!”, to the Malawi context and launched in April 2016 in partnership with USAID OIG campaign called “Make a Difference”, which also targeted drug theft. Through the supply chain and various media channels, the campaigns actively promote a reporting hotline owned by the Malawi Pharmacy Medicines and Poisons Board (PMPB). In the first year of the campaign, 114 reports were received of which 62 related to the theft of ACT from Malawi’s public health system.
The OIG, working with USAID OIG and a newly created Ministry of Health Drug Theft Investigation Unit (DTIU), helped the national authorities to analyze and act on the information received by the hotline, leading to stock seizures and arrests.
Between August 2016 and April 2017, the DTIU, with the Malawi Police Service, took action against 62 individuals suspected of stealing and/or selling medicines from the public health system. Sixteen of those were public health workers who were subsequently prosecuted for theft of medicines. Three of whom have been convicted to date.
The issue of stolen ACT being sold in the private retail sector is widespread and complex. A number of vulnerabilities have been identified by both the DTIU and a Global Fund OIG audit in 2016. These include non-reconciliation of stock data between deliveries, stock counts and stock cards, ineffective systems and processes to account for commodities, coupled with inadequate storage facilities and conditions to accommodate stocks.
The Global Fund OIG has committed to continuing support for the Malawi authorities in gathering intelligence on drug theft. As a result, the Global Fund’s “I Speak Out Now!” campaign has been extended until the end of 2017 and the OIG continues to support local authorities by analyzing the information received and recommending local enforcement action.