In Malawi’s public hospitals, a quiet but devastating crisis is unfolding. Patients are increasingly being forced to buy medicines that are supposed to be free, as chronic drug shortages continue to erode confidence in the country’s already fragile health system. Inadequate access to essential medicines has been linked to rising neonatal and maternal mortality, threatening Malawi’s commitment to Universal Health Coverage (UHC) and exposing the vulnerabilities of health systems in low-income countries battling governance and accountability failures.
Drug shortages are partly driven by unethical conduct among a minority of health workers involved in the theft and pilferage of medicines intended for public use. In some cases, the abuse goes beyond drugs to include the theft of critical medical equipment, further crippling overstretched facilities. A recent and alarming example is the conviction of Yamikani Mapapa, a 30-year-old health worker at Chiradzulu District Hospital.
The Chiradzulu Magistrate Court sentenced Mapapa to 10 years’ imprisonment after finding him guilty of stealing two ultrasound scanning machines used for disease diagnosis. The court imposed five years for each count, to run consecutively. In its ruling, the court noted that the offence attracts a maximum sentence of life imprisonment under Section 183 of Malawi’s Penal Code and found that Mapapa had abused a position of public trust, placing patients’ lives at risk by depriving the hospital of essential diagnostic equipment.
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The government acknowledges that theft and pilferage of medicines and medical supplies remain persistent challenges in the public health system. Ministry of Health spokesperson Adrian Chikumbe said the problem extends beyond outright theft to include pilferage—where health workers take small quantities of medicines for personal use without prescriptions. “Pilferage often involves small amounts of medicines such as Panadol or aspirin.
While this may appear insignificant, repeated losses over time become substantial,” Chikumbe said. Concern over both large-scale theft and routine pilferage prompted the ministry to commission comprehensive studies in 2015 and 2017 to determine what was being stolen, where losses were occurring, and how theft was being carried out. The findings revealed that a significant proportion of losses occurred before medicines reached health facilities, particularly during procurement and ordering stages.
Weak procurement systems had previously allowed some pharmaceutical suppliers to secure large contracts without adequate safeguards. In response, government strengthened procurement processes at the Central Medical Stores Trust (CMST), introducing competitive open tendering and tightening supplier eligibility requirements. The studies also exposed vulnerabilities at CMST warehouses.
To counter this, the ministry installed CCTV cameras, rolled out digital monitoring systems accessible via computers and mobile devices, restricted access to storage areas, and introduced biometric fingerprint controls to track authorised personnel. “These measures are part of our ongoing efforts to ensure medicines and medical supplies reach the patients they are intended for,” Chikumbe said.
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