After four years of government’s inability to procure essential drugs and medical supplies for nationwide health centres, the long-awaited consignment finally arrived at the Zambia Medicines and Medical Supplies Agency (ZAMMSA) on June 28, 2023.

Government’s re-engagement of medical supplier Missionpharma for 42,000 health centre kits represent a significant milestone.

The deal was brokered by the government’s successful settlement of an outstanding debt of US$28 million owed to the company and other medicine suppliers.

“The procurement for these health centre kits in such large quantities was carried out three to four years ago, and the last batch of kits had to be withdrawn from public distribution due to various reasons,” revealed Billy Mweetwa, Director General of ZAMMSA.

Mweetwa informed MakanDay that there are also ongoing bulk procurements from the United Nations Children's Fund (UNICEF) amounting to approximately US$13million, and a further US$9 million from the United Nations Development Programme (UNDP).

An additional US$2 million fund has also been secured through the United Nations Population Fund (UNFPA) for reproductive health commodities.

"These procurements primarily aim to acquire essential medicines... In particular, the procurement of mental health commodities is of great importance, addressing an area of concern. These supplies will be adequate to cover the entire year of 2023," he said.

The impact of the country's debt

The crisis in the health sector stems from multiple factors, including corruption within the procurement system. It also reflects the repercussions of Zambia's debt crisis, which are expected to alleviate following the country's long-awaited agreement to restructure $6.3 billion of its debt, including loans from China, its largest private creditor.

Zambia's struggle to repay loans to international banks amounting to billions of dollars has severely affected the country's financial stability. As a consequence, spending on essential social services such as health and education declined by 21% between 2019 and 2021, according to Debt Justice, an anti-poverty campaign group.

Standoff between government and Missionpharma

The health procurement system was further paralysed by a stand-off between the previous government, under the Patriotic Front (PF) party and Missionpharma.

The Ministry had accumulated a debt of approximately US$16 million owed to Missionpharma for drug supplies. In 2018, Missionpharma halted drug supplies and demanded the settlement of the debt owed, prompting the Ministry to seek an alternative supplier.

The government then opted to sign a controversial contract worth US$17 million with Honey Bee Pharmacy for the supply of 22,500 health centre kits nationwide. However, it was later discovered that some of the procured drugs were already expired.

"The disruption of the drug supply chain in Zambia began in 2017 during the PF government when they stopped paying Missionpharma for the supply of health centre kits, which were instrumental in ensuring that millions of people across the country had access to essential medicines," explained the source.

This fact was further substantiated by ZAMMSA’s Mweetwa, who stated: “One of the reasons Missionpharma ceased supplying (drugs) was due to the outstanding debts they were owed. It became financially unsustainable for them to continue supplying when payments were not being made.”

Light at the end of the tunnel

In addition to resolving the Missionpharma debt, MakanDay has established that the government has commenced a government-to-government bulk procurement arrangement with Egypt.

A reliable source at the Ministry of Health disclosed that the bulk drug supply from Egypt, comprising a three-month stock, will serve as a supplement to the health centre kits and contribute to the restoration of the disrupted drug supply chain resulting from the previous government's actions.

The health centre kits supplied by Missionpharma consist of 58 products, including items such as tetracycline eye ointment used to treat eye infections, benzathine penicillin, doxycycline tablets, cord clamps, umbilical disposables, and sterile pieces, among others.

The source explained that it takes approximately eight to nine months to assemble the health centre kits. The process involves sourcing products from different suppliers, with Missionpharma assembling the kits. The kits are then shipped, taking nearly a year to complete the entire process, which contributed to the drug shortage in the country.

The source further disclosed that Zambia consumes approximately 3,500 health centre kits per month. To address the ongoing scarcity, the Ministry, managed to liquidate the significant debt owed to Missionpharma and secured an agreement for the delivery of 42,000 health centre kits. The source said government is also actively working towards clearing its outstanding debts to other pharmaceutical suppliers, with 80% of the debt already cleared.

The poor have paid the price

During the last two and a half years, the government has been unable to provide health centre kits to health facilities, resulting in severe drug shortages. This situation has particularly affected the lower-level supply chain system, where the majority of disadvantaged individuals reside. The disruption of the kits has disproportionately disadvantaged these vulnerable populations.

Since 1997, Missionpharma has been Zambia's preferred supplier of the kits, developed in close collaboration with the Ministry of Health. These kits have played a crucial role in ensuring that millions of Zambians have access to necessary medicines.

Zambia has a greater number of rural health centres, over 1,120, compared to tertiary hospitals, and the majority of the population resides in rural areas. Consequently, the shortage of essential drugs has primarily affected rural health facilities, whereas higher-level hospitals have managed to maintain relatively better drug availability, with only a few items occasionally out of stock.

Source: Ministry of Health Strategic Plan 2022 - 2026

The source highlighted that the Ministry has been working diligently over the past two and a half years to address the supply chain challenges related to kits. Efforts have been made to exert pressure on the government to settle the debts owed to Missionpharma and other pharmaceutical companies.

Despite these positive developments, drug challenges persist in different parts of the country. Residents of Mpika District, such as Peter Chilupula and Bernard Chanshi, have shared their experiences of struggling to access medicines in rural health facilities, often being forced to buy medications themselves due to shortages. They expressed their frustration with the lack of drug availability and called for the government to prioritise the procurement of essential medicines.

Read all the investigative articles in the health series: