Analytical summary - Medical products, vaccines, infrastructures and equipment
The Pharmaceutical Section within the Ministry of Health is the central point for the organization, management and administration of pharmaceutical services in Malawi. It plays an advisory role to the Ministry of Health on pharmaceutical issues. The National Medicine Policy ensures the efficient and effective management and administration of pharmaceutical services in both the public and private sectors.
The Pharmacy, Medicines and Poison Act and the Dangerous Medicines Act ensure compliance with laws related to medicine handling and use in the country. Structures and processes have been established to ensure that all medicines imported into the country are checked for quality. However, lack of handling procedures for counterfeit medicines and no regulations for advertising of medicines are some of the challenges in regulating the pharmaceutical sector. This calls for strengthening the Pharmacy, Medicines and Poison Act and collaborating with other enforcement agencies nationally and internationally on all matters pertaining to handling of medicines.
The Central Medical Stores is one of the key players in the medicine supply chain management. It facilitates procurement, storage and distribution of medicines and medical supplies to the Government of Malawi, the Christian Health Association of Malawi, hospitals and other approved institutions. Following the Public Procurement Act, all procurement is carried out according to the National Medicine List, using generic names. However, a number of challenges are faced in procurement, including the lengthy procurement procedures and inaccurate data on consumption in public health facilities, making it difficult to make accurate forecasts.
The National Medicine Policy highlights strategies to be implemented to strengthen and maintain a reliable and sustainable supply chain at levels of the health care delivery system, including:
- the establishment and maintenance of a reliable medicine management information system
- development of capacity for data collection processing and quantification needs
- coordination and harmonization of all forms of medicine procurement for the public sector with all stakeholders.
The pharmaceutical sector has over the years conducted courses on rational drug use for health personnel involved in diagnosis, prescribing and dispensing. However, there is inadequate control of drug promotion and dispensing by untrained prescribers. This has created a problem in promoting the rational use of drugs. In addition, there is inadequate information to the public, especially at community level, on the rational use of medicine. Other challenges include rampant medicine pilferage and medicine vending.
The Ministry of Health's Expanded Programme on Immunization is mandated to implement Malawi’s vaccine programme. The Expanded Programme on Immunization implements two routine immunization programmes:
- measles, diphtheria–pertussis–tetanus/hepatitis B/Haemophilus influenzae type B (DPT-Hep B-Hib) (pentavalent), polio and Bacille Calmette-Guérin (BCG) vaccinations to children aged under 1 year;
- tetanus toxoid vaccine to pregnant women and women of childbearing age countrywide.
From 2004 to 2011, Malawi has sustained routine immunization coverage rates exceeding 80%. Malawi also conducts polio and measles supplementary immunization activities.
The Ministry of Health is responsible for determining the vaccine requirements and resource mobilization for the procurement of vaccines. Malawi has developed an infrastructure network for vaccine management at national, regional and district levels and facilities. Cold chain infrastructure is in place in 826 health facilities. Cold chain equipment includes refrigerators and freezers, vaccine carriers and cold boxes. Cold chain assessment results show that:
- 70% of refrigerators and freezers are in working order
- 16% of equipment is not working due to lack of spare parts (85%), finances (18%) or fuel/electricity (30%)
- most transportation equipment is not functioning and needs to be repaired.
The availability of functioning and well-equipped infrastructure affects access by the population to quality health services. In Malawi more than 80% of the population resides within 10 km of a health facility. However, most of these health facilities do not have adequate equipment. Maintenance of existing equipment is also a major challenge. The Ministry of Health has implemented an Essential Health Package Capital Investment Plan since 2006 aimed at improving geographical access to quality Essential Health Package services through rehabilitation, upgrading and construction of health facilities and provision of necessary equipment.
The Ministry of Health has developed an Essential Medical Laboratory service. Following this, strides have been made towards improving services, including:
- standardizing services
- developing laboratory supply chain guidelines
- registering laboratories with external quality assurance bodies
- participating in international accreditation schemes to have laboratories graded according to performance
- automating most laboratories.
In line with the WHO call to attain global standards in diagnostics services in May 2011, the Essential Medical Laboratory launched an external accreditation process through a programme called Strengthening Laboratory Management Towards Accreditation.
The Malawi Blood Transfusion Service, an autonomous agency, was established to provide screening for all blood transfusion units in the country. However, not all blood comes through the Malawi Blood Transfusion Service. A large proportion of the blood is collected and screened at individual facilities. In 2006, the Malawi Blood Transfusion Service reported that the national average for HIV screening of blood was 99.9%. The blood safety programme is making progress with respect to blood that is tested for infectious diseases. However, the capacity of the Malawi Blood Transfusion Service is still a concern. There are not enough volunteers coming forward at present to supply enough blood to meet the national demand.
- ↑ Lilongwe, Government of Malawi, Ministry of Health, 2011