Back in 2005 Willis Akhwale of the Kenyan Ministry of Health told me he was worried about the burgeoning black market in anti-malarial drugs. Five years later the situation is no better: Dr. Stephen Malinga, the Ugandan health minister, recently described those stealing anti-malarial drugs as "murderers, causing the deaths of hundreds of children." Unlike his senior colleagues in Kenya and Tanzania, Dr. Malinga has been bold enough to point the finger at local government officials.
Drug shortages have become a serious problem across East Africa. Occasionally the result of poor logistics or epidemic outbreaks, empty shelves are also sometimes due to looting at government stores. Dr. Malinga knows Ugandan public-sector drugs often end up in the hands of private vendors in other countries, such as Southern Sudan.
Dr. Malinga's admission is refreshing because too many donors and most recipient nations are inclined to ignore the problem. In the short term, donated and subsidized products are not reaching the intended patients and their suffering continues; in the long term, black markets undermine legitimate suppliers and entrench illegal actors. Additionally traders, happy to deal in stolen goods, may search for more reliable supplies often leading to counterfeiting; over time, useless but well-packaged fakes replace stolen legitimate brands, endangering patients and increasing drug resistance.
While the situation is bad in Uganda, drug-diversion may be worse in neighboring Tanzania, where it appears tens of thousands of drugs have been stolen from central stores and sold as far afield as Ghana and Nigeria. My research suggests that it is drugs near to expiry that disappear, rather than being incinerated. It is easy to imagine how poor stock-keeping can seed a trade.
Three years ago my research team found no obviously diverted medicines in our survey of important markets in West Africa; in February this year, 9% of our anti-malarial drug samples appeared to be East African public-sector drugs diverted to West Africa's private sector. The packaging indicated that most had been diverted from Tanzania, Zambia, Uganda and Kenya. Our sample sizes were small, but indicate a significant trade.
Assessing how the drugs are smuggled from East to West Africa led me to speak with a few traders from Tanzania's main port of Dar Es Salaam. The whole picture is still far from clear, and I'm still investigating trade from the region, but it appears that at least some (perhaps tens of thousands of treatments) travelled by sea. What we know for sure is that donated products, which are supposed to be given free to clinics, are not reaching patients and are being stolen and diverted. Worse, this often happens under conditions that may degrade lifesaving medicines, particularly on the 5,000-nautical-mile trip from East to West Africa. There is little doubt that some officials from East African nations are complicit in this diversion. The result is unlicensed prescribing, often of clinically inappropriate medicines, and worsening health and financial burdens for Africans.
Donors are aware of this problem. An internal investigation in April at the Global Fund, an international body financed by Western governments to support drug procurement in Africa, concluded: "Quality assured health products imported using Global Fund funds may be exchanged for inferior or counterfeit products which are then distributed to the intended recipients of the grants. The quality assured health products are then sold in commercial centers in the country or exported to neighboring countries." But the Fund is slow to respond and denies a major problem exists. Meanwhile, it points to a lack of drug access to demand more financial support for the Fund.
It is imperative that the Fund and bilateral donors recognize that their inaction on drug theft may be helping organized criminals to create parallel distribution systems, thus contributing to fatal stock-outs and building drug resistance due to expiring or degraded products. This doesn't mean donors should stop funding drug procurement--far from it--but they should improve oversight, increase the security of their systems, and encourage recipient governments to do likewise (perhaps with the threat of cutting funds if recipient nations don't actually respond).
The U.S. government is the largest bilateral purchaser of drugs for Africa. Dr. Bernard Nahlen, deputy director of the President's Malaria Initiative, told me that "transparency and accountability need to be built into the entire procurement system. . . . We all need to work together to strengthen management and oversight process, and, most importantly, must be willing to respond vigorously when red flags arise."
Dr. Nahlen is right. African governments should follow Uganda's example in acknowledging there is a problem, and then introduce basic security measures to ensure that health officials always knows where drug shipments are within the distribution chain--something that is rarely done today. If oversight doesn't improve, donor largesse may actually worsen the health situation in parts of Africa, a truly unacceptable outcome.
Roger Bate is the Legatum Fellow in Global Prosperity at AEI.