In many countries, donors and governments lose millions of dollars to the theft of medicines. In one audit, more than half of Ugandan government clinics had no antiretroviral (ARV) or tuberculosis (TB) medicine. In other audits, millions of dollars of donated medicines were missing from Zambia’s main medicine warehouse, and tens of millions of dollars of medicines never made it to clinics in Nigeria. The consequences of this theft are not just about hits to budgets: citizens in affected countries lose access to drugs that can save the lives of their family and community members. Moreover, the impact of this loss falls particularly hard on the poorest who cannot afford commercial medicines.
Our research is focused on identifying and preventing drug theft in Malawi, a country where issues of medicine theft are particularly acute. The country’s Ministry of Health estimates medicine theft consumes about 30 percent of the government’s entire health supply budget (Mphande 2017; The Global Fund 2017). Despite years of donor-funded, third-party distribution systems, 35 percent of private clinics were found to have donor-funded medicines for sale (The Global Fund 2017). In just one government clinic in Blantyre, Malawi’s second largest city, hundreds of patients were told the clinic had no antimalarial drugs left. Given that these medicines are supposed to be available to citizens free of charge, the burden of purchasing them from private clinics disproportionately falls on the poor, who also are the most likely to contract malaria in the first place.
We are excited to be working with Malawi officials and local civil society organizations in an effort to solve this critical problem. Our team of researchers will design, implement, test, and evaluate the impact of several programs intended to reduce medicine theft. One of the main challenges in preventing such theft is that local communities and high-level officials lack sufficient information to monitor drug procurement. While procedures exist to ensure the monitoring and enforcement of procurement rules, these regulations are frequently ignored or poorly understood. Our research will evaluate programs to address capacity, implementation, and knowledge gaps in medicine procurement; for instance, by providing information and training to communities and local clinic officials about drug deliveries in their communities and the ways in which they can take action to prevent medicinal theft.
Our baseline research includes a detailed survey of citizen experiences with medicinal theft in southern Malawi. In a representative survey encompassing 97 clinics and 3,360 citizens, we found evidence that exposure to drug theft is widespread and has very real consequences for the health of communities. Of the respondents, 42 percent have been told in the last 3 months that their clinic could not provide drugs that their family needs. An astonishing 30 percent admit having personally observed the illegal sale of medicines; and 52 percent of respondents believe that the theft of medicines is a main reason why their community does not get high-quality health care. Especially given the entrenched poverty and high rates of malaria and HIV in many of these communities, these data suggest that medicine theft is a leading cause of disease. We believe it is also preventable; and we look forward to sharing insights from our research on this subject in the coming months.
Ryan Jablonski is an assistant professor in the Department of Government at London School of Economics and Political Science. His research focuses on the politics of international development. He is particularly interested in explaining how international organizations and politicians make decisions about development spending and the role of technology in improving political accountability. In other strands of research, he studies the economic effects of transnational crime and the reasons why politicians sometimes choose to use electoral fraud and violence to win elections. Jablonski’s work is largely based in Sub-Saharan Africa, and he has conducted field research in Malawi, Kenya, and Uganda.
Brigitte Seim is Assistant Professor of Public Policy at the University of North Carolina-Chapel HIll. Her research examines the relationship between citizens and political officials, with a particular emphasis on accountability in developing countries in sub-Saharan Africa.
Mariana Carvalho Barbosa is a Ph.D. student in Political Science at the University of California, San Diego. Her research focuses on causes and consequences of political violence, politics of crime, and corruption.
Clark Gibson is Professor of Political Science and Director of the International Studies Program at the University of California, San Diego (UCSD). His current research focuses on the accountability between governments and citizens in Africa, especially during the electoral process and in the provision of public services.