The shift from Missionpharma to an unknown Honey Bee Pharmacy Limited, which won the tender worth US$17.8 million last year to supply 22,500 health centre kits is not without controversy. More than 10 of the 60 medicines in the health centre kit supplied by Honey Bee fail quality tests.
CRITICAL shortages of essential drugs and medical supplies caused by an unexplained and controversial government shift in procurement are widespread in Zambia, according to a survey conducted by MakanDay Media Centre.
The survey done by journalists in six provinces, (Eastern, Luapula, Muchinga, Northern, Copperbelt and North Western) reveals that in many state hospitals and clinics, patients are not able to access life-saving drugs. Alternatively, they are told to purchase the drugs at private pharmacies.
The drugs shortage highlights a major health crisis in the country.
Some of the medicines in short supply are the pain killer Panadol, nifedipine and furosemide for hypertensive patients and insulin used by diabetic patients to control their sugar levels.
“This year has been very bad, because there are shortages of medicine in all government institutions,” said Peter Chishala of Lusaka who was in Eastern Province on a visit. “For instance, I take lente and soluble, these are two medicines which I need to inject, but there is no injectable insulin when you go there, they tell you to buy.”
“If you go to ask for this medication, big pharmacies as well… they don’t have, they only have one type, which is Novapen which is 30 mls which you can only jab for a week and it costs between K 400 and K 450,” he added.
But ministry of health spokesman, Dr Abel Kabalo told Makanday that there is no shortage of medicine in public hospitals and health centres. He said government has a “no to prescriptions and zero tolerance to drug stockout” policy.
“If at all drugs have run out, then it is just at one individual facility which, maybe, due to people managing it, they did not quickly re-order the drugs that have run out,” he said.
Covid-19 has aggravated the shortfalls, but the problems began long before the country announced its first coronavirus cases in March this year.
It is understood that the state’s drugs storage and distribution arm, Medical Stores Limited (MSL), has not stocked insulin for over four months and has not stocked vitally important health centre kits for 18 months.
According to the health ministry, the selection of medicines in a health kit is based on Zambia’s ten most widespread diseases, excluding HIV, tuberculosis and malaria, which are mostly covered by the Bill Gates-backed Global Fund and PEPFAR - the U.S. President's Emergency Plan for AIDS Relief.
The kits are distributed to clinics and hospitals and carry 60 different pharmaceutical products and consumables - sufficient to meet the medical needs of a thousand people for a month.
“Yeah, but we never stopped supplying medicine,” said Dr Kabalo when asked about the 18-month break in the supply of health centre kits... Otherwise, medicine has been supplied through and through.”
Danish-based Missionpharma, which has a subsidiary in Zambia and has since 1997, helped to develop and supply health centre kits and medicine, did not reply to an emailed query asking when last they supplied health centre kits and why they stopped.
On its website, Missionpharma describes itself as “Zambia’s preferred supplier of health centre kits, which was developed in close collaboration with the ministry of health”.
Last year, the government transferred procurement of the kits from the traditional supplier, Missionpharma, to an unknown local company called Honey Bee Pharmacy Zambia Limited.
It is understood that the procurement shift from Missionpharma to Honey Bee was prompted by government’s inability to settle rising debt owed to Missionpharma.
“It is them (Missionpharma) who said, dismantle the debt, and that is when we will supply you,” said Dr Kabalo. “If you don’t dismantle the debt, we are not going to supply you.”
Dr Kabalo revealed that the debt owed to Missionpharma for the supply of health kits and other medical supplies was US$ 12 million (K 230 million), and that the government has paid half of the money owed.
"It's not true that GRZ has paid half of (the) US$ 12 million debt owed to Missionpharma, it is still outstanding," said one of the sources familiar with both government and Missionpharma.
But the shift to Honey Bee, which won the overpriced tender worth US$17.8 million last year to supply 22,500 health centre kits was not without controversy. Makanday has established that the normal price for the kit is US$ 400, while the one supplied by Honey Bee is US$ 790, almost double the price.
After the contract award in November last year, News Diggers website, revealed that Honey Bee did not appear on the company registration database.
A check by Makanday at the Patents and Company Registration Agency (PACRA), shows that Honey Bee Pharmacy Limited was registered on 1 April this year and its Zambian directors are Zakir Husen Motala, Imran Lunat and Abdurrauf Abdubdurrahim.
Mr Lunat has not responded to requests for an explanation regarding how his company registered this year won a tender put out last year.
At a ceremony on 1 September this year, to announce the distribution to rural health centres of more than 2,300 health centre kits supplied by Honey Bee, Minister of Health Dr Chitalu Chilufya described the occasion as a “significant investment in the healthcare system” and that he does not expect health centres to be issuing prescriptions.
Questions have also been raised by the Pharmaceutical Association of Zambia (PAZ) about the quality of the drugs in the health kits supplied by Honey Bee.
The PAZ president Jerome Kanyika said in a statement that his organisation has received numerous negative reports about the medicines.
“While quality tests have not yet confirmed whether these products are substandard or falsified, as professionals we take these reports with keen interest,” said Kanyika in a statement.
“The major problem with substandard and falsified (counterfeit) medical products is that they may cause harm to patients and fail to treat the diseases for which they were intended.”
Recently, the Zambia Medicines Regulatory Authority which analysed samples of paracetamol (panadol) tablets BP 500mg manufactured by Prashi Pharma Pvt. Limited of India wrote to Mr Imran Lunat asking him to recall the medicine because it was found to be “out of specification with respect to appearance”.
But an impeccable source has told Makanday that the list of drugs and medical supplies that have failed quality tests are more than 10 out of the 60 products in the health kits supplied by Honey Bee Pharmacy.
“You know, some of the things (products), they’re like examination gloves, they’re meant to protect the health workers, if they have failed the quality (tests), what it means is that the health worker is at risk of catching infections,” said the source.
Mounting government debt seems to be a factor in the shortages. In the 2020 national budget, finance minister Bwalya Ng’andu proposed to spend over K900-million on medicine and medical supplies from a total health budget of more than K9.3 million. Sources at the ministry of finance say government has faced “liquidity challenges” due to debt repayments, weak kwacha and the coronavirus.
The budget for external debt servicing is K21 billion. If the local debt liability of more than K12.6 billion is included, the debt burden is more than the health and education budget combined.
In addition to problems caused by the switch to a new supplier, health experts pointed to administrative failures and glitches within the medical supply system as one cause of the repeated shortages.
These include the health ministry’s heavy reliance for its drug needs on external donors — some of whom buy and provide drugs, while others provide funding or budgetary support to the health ministry.
Personal experiences from selected provinces
One consequence of the nationwide shortage of essential drugs is that patients are leaving state hospitals untreated – or with prescriptions for life-saving medicines that can only be procured from private pharmacies.
Makanday asked journalists nationwide to check the availability of drugs at local health centres. The survey revealed a similar pattern across Zambia.
Several patients interviewed said they had been sent away from state health facilities with written prescriptions for drugs to be purchased from private suppliers.
“My sister was at Kapata clinic, but I wasn’t happy with what she found there, from early morning to afternoon, she came back with a prescription, panadol to go and buy, piriton to go buy, now what kind of a clinic is this where they just diagnose illnesses?” said John Kantontoka of Kapata Compound in Chipata, Eastern province.
Malamo Mukonde, a patient from Chongwe in Lusaka Province, said that the nurse at her local clinic refused to write out a prescription because she was tired of doing it for patients that could not be supplied with the necessary drugs.
Mukonde, who is in her sixties, said that the nurse complained that the clinic had suffered from shortages “for a long time”.
“I went to the clinic to get help for my swollen eye. I also asked if I could also get my medicine for hypertension, but I was told that the clinic doesn’t have any.”
The situation is worse for patients who require a constant supply of drugs to manage their health condition. Peter Chishala, a diabetic patient, told a radio station in Chipata, Eastern Province, that he has been struggling to control his blood sugar due to lack of insulin.
In Chipata, in Eastern province, senior headman Chinthona, Wickson Lungu said the lack of drugs in clinics in his area is causing much suffering to his subjects.
He said it is now “fashionable” for health workers to present patients with written prescriptions.
At Buntugwa clinic in Mansa, one of our reporters posing as a patient, received no help for a faked migraine. She was advised to buy a diclofenac injection and tablets from a private practitioner and vitamin tablets.
“I have been told to go and buy diclofenac so that it can be used by injection,” she said. “The hospital has no Panadol, no diclofenac...”