The state of Pharmacy in Malawi

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According to the local newspapers there is a drug crisis in Malawi. There is a 95% shortage of medications which they define as hospitals and pharmacies having only 5% of their needed inventory. Not only funds to buy medications is an issue but also the suppliers do not have sufficient stocks to distribute even if one has the funds to purchase them. The picture on the left and in the middle, at the top, depicts the extend of the variety of medications that is available at the outpatient pharmacy of the hospital in Nguludi. Malaria, TB, HIV are the most common medical conditions seen at the hospital. There are only a few people presenting with CVD but remember the the life expectancy is only about 46 y.o. The only oral medication available for diabetes is metformin and insulin. Insulin is a challenge with the problems with refrigeration and frequent power outages. For pain, there is basically only acetaminophen, ibuprofen, and oral short-acting morphine. There was tramadol at some point but there has been no supplies available for a while. Morphine is available from the government at a very subsidized cost (the hospital pays 12.5% of the actual cost) but availability from the central supplier is patchy.

The actual process of dispensing medications is very different from what we are use to. At Nguludi there is no pharmacist but they have a pharmacy technician which is more than most hospitals can say. A clerck dispenses the medication in the outpatient pharmacy, she is all by herself and may be seeing 40 -60 patients a day. There is no checking process in place. The medication are provided in small plastic bags (see picture top right) which has pictogram for morning lunch supper and bedtime under which she indicates the number of tablets to be taken and for how many days someone needs to take their medication. In the city you can get most medications without a prescription with possibly the exception of antibiotics and morphine. Physicians are very rare to actually prescribe medications and only very basic ones are available. When locals get a fever they assume that it is malaria and treat themselves for it. If it does not get better than it most be another infection of some sort and then seek medical attention. Very few diagnostic procedures are available so that when people have cancer it is detected very late.

I have heard today that sometimes people bring medication as donations but it sometimes remains untouched due to unfamiliarity with them. A lesson to be learned. If you ever consider volunteering as a pharmacist and consider bringing medications there is a good document from the WHO which addressed best practices. Do not bring samples being one of them. If bringing medication bring some that the people will be familiar with and that they have on their national formulary, etc.

Yesterday, there was a child seizing on a ward, and a nurse arrived flying in the pharmacy to know how to dilute it so she could administer it. No reference books available in the pharmacy, no access to the Internet on a regular basis, no package inserts in with the actual medication,…

Today there was another child who had swallowed a coin which got stuck in his throat. They started operating on him to remove the coin but the power ran out, so the child had to be woken up and transferred to the larger district hospital.

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10 thoughts on “The state of Pharmacy in Malawi

  1. Antony, It seems quite a different world and should make us appreciate what we have. Perhaps we should all do a tour of Malawi. Enjoying reading of your experiences.
    Amjad Junaid

  2. Hi Antony,
    Very interested to hear your experiences. I have recently retired but still on the register in Scotland. I am heading out to Balake on June 12th, with Sue Ryder to try and guage how we can improve drug supply and pharmaceutical services in the area.
    Brian Ferguson brferguson140@hotmail.co.uk

  3. I worked as Head of Department Of Pharmacy at the College of Medicine, University of Malawi Blantyre from 2006 to 2010. Our remit was to start a Pharmacy Degree programme to deliver 200 pharmacists (equal share for Government hospitals and MOH/PMPB and the community sector). Approx 60 will now have graduated. Most are in private practice, 4 have done M.Scs abroad and are in academia, some have returned to the Malawi Defence Force Medical Section, about 8 are in Government/Pharmacy Registration bodies such as PMPB and Central Medical stores.Presently approx 35-40 students enter the programme annually (double the original intention!). My great sadness is that so many have felt unable, after serving their Internship, to remain in the hospital service. The apparent lack of support by government for graduates, in many respects, not all financial, leads to “leakage” to the private sector where wages and conditions are better. Much of the public hospital service will therefore remain with Technicians technicians and Interns

    • Hi Michael,

      Thank you for your insight. Over the last week, I have had a request from St. Joseph Hospital to support financially their pharmacy technician to go to Pharmacy School. With the help of staff at the Hamilton Family Health Team and a family member, I have collected sufficient funds to send him to University. I have collected ½ of the 4 year tuition and accommodation and other school expenses for the first year. I am funneling the funds through the World University Service Of Canada to the hospital. The hospital is writing an agreement that the pharmacy technician will stay at the hospital for a period of 5 years following graduation.

      Hopefully, with that agreement (work bond) we will increase the chances of him staying on staff at St. Joseph hospital.

  4. whoah this weblog is great i like studying your articles. Keep up the great work! You understand, a lot of people are searching around for this info, you can aid them greatly.

  5. Hie Antony! am very happy that there are some people outside there who care about the current pharmacy situation at the moment here in Malawi, indeed things are not the way there are supposed to be, now most of the dispensaries in Malawi public hospitals have been left in the hands of non pharmacy people who have no knowledge about medicines, who have only been trained on how to read prescriptions but can not be able to do professional judgement, as a result most of the medicine are being used irrationally which is compromising the whole system of health care derivery since dispensary is the last point that a patient goes before going home .

    • Dear Antony and Clement.

      It is good to hear you have been back to Malawi. I have just seen additions to your Blog and comments by Clement Kandota. If I have used the system right (?) you will find a comment there from me. Perhaps, you are back in Canada now, so some of what I have written may not apply as you can’t physically visit the College of Medicine? Please , if you are interested, do contact me on m.i.berry@hotmail.co.uk for further discussion. Also, depending where you are based in Canada I might be able to meet you next year – my brother lives in Hamiltoin Ontario.

      Keep up the good work with your colleagues. You will appreciate how well blessed we are in UK and Canada!!

      Warmest regards, Mike (Berry)

      Date: Sun, 23 Nov 2014 13:11:17 +0000 To: m.i.berry@hotmail.co.uk

    • The problems of Pharmacy work is cross sectional.Firstly,PMP board has no much control over the running of institution Pharmacies where non professionals like nurses run the pharmacies.Secondly,Health institution administration look down Pharmacy work as just mere table dispensing work as result such institutions have no interest to have professionals in place.Thirdly,the status of Pharmacies is very poor,below standard.Most structures so called Pharmacies do not deserve to be so creating unconducive to both working and storage of drugs.Fourthly,Pharmacy as a center of interest,there too much interference by institution administrators.Lastly,there are very few professionals to take up the job profession giving room to unprofessionals to run the pharmacy unprofessionally or single professional run a pharmacy inefficiently because of to much work for one person alone.It important to know that ideal pharmacy is supposed to have Pharmacist,Pharmacy Technician,Pharmacy Assistant down to Pharmacy attendant and Ppharmacy work is not only about dispensing drugs as other people think.

  6. Dear Antony and Clement,
    I find myself confused and diasappointed by recent correspondence.When I last visited Blantyre (September 2013) the Pharmacy Department at the College of Medicine had enrolled a further 40 Degree students, as they have done for a couple of years. Numbers of Pharmacists on the Register must by now be greatly increased. Meanwhile the College of Health Sciences in Lilongwe has become linked to the University and annually produces numbers of Pharmacy Technicians .
    Anthony, could you visit the Department at the College of Medicine of the University in Blantyre and ask for Mrs Nettie Dzabala (HOD), and /or Prof Lutz Heide, Mr John Mponda or other staff member. You might first see Mary the Secretary. You may also be interested to speak with a new Australian member of academic staff (sorry, forgotten his name) .I will also try to contact Lutz, who is writng a paper on developments in Malawi Pharmacy. There must be ways they can assist at a Hospital in Limbe. I presume it is Catholic, and there will be Catholic students in training. How about getting one involved in a student project with the Hospital – a member of academic staff could help organise a suitable topic to help the work there, as well as give a student something meaningful to do.
    Do you have contact with Lumbani Makwakwa, Chief Pharmacist with the Christian Health Association of Malawi? How might he help? A very good man – I taught him! Oh dear, I sit here very frustrated when I hear of the apparent lack of progress.You and Canadian colleagues are doing a good job. My brother lives in Hamilton Ontario. Are you based anywhere near? I would like to meet if I were to visit in 2015. Enough for now. Mike Berry m.i.berry@hotmail.co.uk

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