Case Study Malawi

CASE STUDIES

ONASSET TRACKING DEVICES DEPLOYED TO MONITOR MEDICATION DIVERSION IN MALAWI

Overview

In a country where nearly a third of medical supply budgets are often lost due to theft and other issues, deploying digital tracking deters criminals and enables accurate tracking to ensure medicines get to those who need them.

Problem

Medicine theft is one of the leading causes of preventable disease in low-income countries. It is estimated that 10 to 25% of global health resources are lost to corruption. In Malawi, researchers estimate that 29% of medicines are diverted and 75% of communities have experienced drug theft.

To date, Malawi and other countries have attempted to track the delivery of medications through paper audits and reporting hotlines which were cumbersome, imprecise and expensive. Lack of real-time tracking made it hard to get the insights needed to effectively combat the problem.

In Malawi, researchers estimate that 29% of medicines are diverted and 75% of communities have experienced drug theft.

Solution

A public-private research partnership was formed to track drug shipments in Malawi. With support from the World Bank and the UK Foreign Commonwealth and Development Office (FCDO), OnAsset Intelligence worked the London School of Economics and Political Science, University of North Carolina, Chapel Hill and University of California, San Diego to deploy OnAsset’s family of technologies to the Malawi Ministry of Health.

OnAsset Intelligence partnered with a team of researchers from these universities and the Malawi Ministry of Health to design and evaluate a system for digitally auditing the delivery of medicines from the Malawi government’s Central Medical Stores Trust (CMST) to health facilities in Southern Malawi.

The primary goal of the research was to evaluate how electronic tracking technology might improve the ability of health providers and researchers to measure patterns of medicine diversion and audit procurement networks, particularly in environments where capacity and investment are low. Researchers also tested the effectiveness of a warning label applied to shipment boxes. The label stated that the boxes were being tracked. The theory being tested was that as long as officials receiving the packages perceive the threat of being audited, they will refrain from wrongdoing.

Digital Audit

The team developed a system for digitally auditing the procurement and distribution of government medicines from the Malawi Central Medical Stores Trust (CMST) to healthcare facilities in Southern Malawi. Between October and November 2021, researchers placed OnAsset Sentinel tracking devices in 2,400 boxes of medicine being shipped to 170 Southern Region healthcare facilities.

Researchers followed up by conducting digital audits in person at 144 of the recipient health facilities, as well 143 private pharmacies and markets. These digital audits gave researchers a real-time snapshot of the entire distribution network, allowing them to quantify medicines delivered and diverted.  Perhaps most useful, however, was seeing what happened to medicines after the point of delivery, something which is challenging with traditional audit techniques.

Results

Overall, the research concluded that digital audits and targeted messaging can be effective tools in the anti-corruption arsenal. OnAsset’s low-cost, highly scalable solution was immediately advantageous to the government’s efforts to improve upon the delivery of health services.

By offering a low-cost, low-interaction and easy-to-field tracking device, researchers gained valuable information for shaping future health policies and mitigating procurement and distribution issues.

The study estimated that about a third of medicines could not be found where they were supposed to be; however the study also learned that not all diversion is due to theft. Researchers estimated that about half of the medications diverted during delivery were simply delivered to the wrong facility. Additionally, the study was able to identify areas with higher concentrations of missing medicines and areas where procurement compliance could be improved. Collectively, these findings imply that the Malawi government and its donors should continue to invest in anti-theft interventions and this method of monitoring holds significant promise.

By offering a low-cost, low-interaction and easy-to-field tracking device, researchers gained valuable information for shaping future health policies and mitigating procurement and distribution issues. A promising way forward for this research program is to use digital tracking and targeted package labeling in the anti-theft arsenal. Using information from digital tracking and auditing is an important first step to empowering all parties engaged in healthcare delivery to strengthen accountability for medicine delivery to benefit of the community.