Private sector partnership in malaria control does not mean that drugs, nets and other malaria commodities provided by donors for national control programs should disappear from the public sector and find their way into shops and market stalls. Unfortunately this is what has been reported in Cameroon.
The Post of Buea reported Friday that, “Corruption has been identified as the main jinx hindering the effective distribution of modern malaria drugs, subsidised by the Global Health Fund for Malaria AIDS and Tuberculosis. The Permanent Secretary at the National Malaria Control Programme, Dr. Raphael Okalla, made this revelation during a press conference in Yaounde February 14. He said corrupt doctors in some government hospitals were pilfering the subsidised drugs and giving them out to people to sell at higher prices for them to make gains.”
Pilferage is an issue that is often addressed in guidelines, such as ones on ACT from Zambia wherein there is mention that, “A key issue to be addressed is the prevention of pilferage from the public to the private sector facilities.” UNICEF offers advice that looks back near the start of the supply chain, “To avoid pilferage, port storage, container demurrage etc., it is important that shipments are cleared and removed from point of entry (ports/airports as quickly as possible.” WHO Afro recommends proper storage facilities and forecasting of needs as steps to prevent pilferage.
While the problem is often discussed, documentation can be problematic. The Chronical of Lilongwe reported on general pilferage in 2004. “A clinician, who refused to be identified, informed us that the hospital received a lot of drugs but the problem was that most of them disappeared to private clinics which several individuals working at the hospital have opened. ‘For many months now,’ our informant began, ‘the hospital lacks a whole range of antibiotics such as Ciprofaxine, Augmentin or Amoxilin. We may have some of them for one month and then they vanish for another six months. Can you imagine that?'” Those interviewed at the hospital said the problem stems in part from poor documentation and supervision.
In The Daily Champion of 11 December 2007, Nigeria, “Dr. Dora Akunyili, painted a sad picture of how common criminals, petty thieves and child murderers masquerading as pharmacists, patent medicine store operators and government functionaries have been colluding to deprive children and nursing mothers of life-saving high dose Vitamin A capsules, Mectizan and Coartem tablets, Oral Rehydration Salts (ORS), cold chain equipment and other essential supplies.” Again, specifics on the location and extent of these transgressions is minimal.
One of the benefits of performance based funding by the Global Fund may be to institute accountability measures that could reduce leakage and pilferage. The Fund notes that with, “transparently by performance-based funding processes, grants are reaching overall programmatic targets.” The will to monitor, supervise and guarantee accountability needs to be extended to all aspects of malaria programming no matter which donor provides the funds.