Different medicines and pills on pharmacy table

Detecting and deterring medication theft: A field study in health clinics in Malawi

Different medicines and pills on pharmacy table

This project tests the effectiveness of two interventions designed to reduce medication theft – one aimed at informing clinic officials and one aimed at empowering citizen monitors.

Click here for the Project One-Pager

To learn more about this project, contact Principal Investigator Ryan Jablonski.

Project Summary

The theft of medicines costs governments and donors billions of dollars annually. In Malawi, the government loses about 30 percent of the drugs and medical supplies it purchases to theft. Despite years of donor-funded, third-party distribution systems, a 2015 survey found that 35 percent of private clinics were selling donor-supplied anti-malarial drugs that had been donated for free use.

This evaluation tests the impact of different informational interventions on reducing drug theft, including providing information to clinic officials about a government tracking program to monitor drug supplies in each clinic and the penalties associated with stolen drugs; training communities to obtain information and monitor and report on drug delivery dates, drug availability, and clinic responsibilities; and a combination intervention.

Policy and Programming Implications

Once evidence from this study is provided regarding the relative and combined effectiveness of the top-down intervention among clinic personnel and the bottom-up intervention among citizens who frequent the clinics, the Government of Malawi may decide to shift their efforts to focus on one or both of these intervention types, or to execute them differently than they have in the past.

Further, the policy lessons learned in this context will be valuable elsewhere. Researchers hope to show how interventions designed to improve information and monitoring can achieve reductions in the theft of medication in a generalizable way. Findings also may be useful for identifying and mitigating the theft of development materials more generally. It is anticipated that this project will produce innovations in measurement, provide extensive data regarding the patterns and conditions of theft, and provide a rigorous test of two primary interventions designed to mitigate theft worldwide. These contributions will be useful for a variety of scholars, policymakers, and development practitioners in other contexts.

Research Questions

  • How do the timing and location of medications theft vary with the economic, political, and geo-graphical characteristics of the area surrounding the clinic?
  • Do information campaigns executed among government officials or citizens affect medications theft rates and patterns?
  • Does drug theft affect downstream community welfare outcomes-e.g., access to healthcare, the cost of healthcare, and health outcomes?


This experiment will take place among 200 clinics in Southern Malawi. These clinics will receive one of two interventions: 1) A “top-down” intervention that provides information to clinic officials about a Ministry of Health program to monitor drug supplies; or 2) A “bottom-up” intervention that trains Malawi’s extant Health Centre Advisory Committees to observe and record information about drug arrival and availability at clinics.

Before and after these interventions occur, we will conduct a survey among citizens living in the area around each clinic. The survey will provide us with data on perceptions of theft, costs of health care, and attitudes towards health officials and government more generally. These data will be used in evaluating the interventions.

ACE Impact


  • We estimate that 35% of medicines go missing between central medical stores and final clinics. This theft appears to substantially impact health access: Patients experience higher stock-outs and pay more for medicines near facilities with more theft.
  • We identify little theft during delivery, and we observe higher rates of theft after delivery, possibly by public health staff. However, contrary to what is often assumed, supply chain error is the most common cause of missing medicines.
  • These findings confirm that theft is a severe public health problem, but suggest policymakers could also productively redirect anti-theft investments towards closing supply chain gaps. The study also illustrates how remote tracking technologies can be effective tools in the anti-theft arsenal.


  • The team hosted a stakeholder workshop in London to disseminate and discuss findings with representatives of the Malawi government, academics, and policymakers in the international development and global health communities.
  • The team has disseminated findings at various fora, conferences, and workshops, including for the World Health Organisation (WHO) Global Network for Anti-Corruption, Transparency and Accountability in Health (GNACTA), the Accountability in Action Project, the UN University World Institute for Development Economics Research (UNU-WIDER), and other academic and policy audiences.
  • The team remains engaged with the Malawi Ministry of Health, civil society groups, and donors, advising on the design of procurement management systems and anti-corruption initiatives.
  • The team is in the process of publishing their findings in academic journals. A UN University World Institute for Development Economics Research Working Paper can be found here.

Academic Papers

Other Outputs

Research Team Members

  • Ryan Jablonski, Assistant Professor, London School of Economics and Political Science, Department of Government
  • Mariana Carvalho, PhD Candidate, University of California, San Diego, Department of Political Science
  • Clark Gibson, Professor, University of California, San Diego, Department of Political Science
  • Brigitte Seim, Assistant Professor, University of North Carolina, Chapel Hill, Department of Public Policy


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