Zim Losing $1.8 billion Annually due To Corruption and Illicit Financing
By Transparency International Zimbabwe
Findings show that drugs are mainly smuggling into the country, however some drugs are smuggled out of Zimbabwe. The main source countries for smuggled drugs are Zimbabwe’s neighbours: Botswana, Mozambique, South Africa and Zambia.
The main destination countries for drugs smuggled out of Zimbabwe are Mozambique and South Africa.
In some unique cases, drugs that are legally exported from Zimbabwe find their way back into the country through smuggling; this becomes economically feasible when these drugs are stolen from the importing country’s health facilities.
A source in the pharmaceutical industry cited an example where flu medication was exported to Zambia’s public health system by CAPS, an SOE, and due to leakages in Zambia, found its way back to Zimbabwe through smuggling.
Weak public health supply chain systems in neighbouring countries are therefore an exogenous factor that enables smuggling of drugs into Zimbabwe.
Smuggling of drugs is done across both legal and illegal crossing points.
Smugglers are commonly known as runners and include travelers stashing drugs at the bottom of a bag to sophisticated syndicates that allegedly comprise of public sector doctors and pharmacists who use their proximity to decision makers to facilitate the smuggling and sell the drugs in their privately-owned pharmacies, surgeries and hospitals.
There is an informal transporting sub-sector that evades import taxes at Zimbabwe’s porous borders through bribery.
This informal transport sub-sector has occupied the market space created by the demand by the large Zimbabwean diaspora in neighbouring countries for a means to send.
The theft of drugs and other medical supplies from Zimbabwe’s health system deprives poor citizens from access to subsidized medication, leads to transfer of public wealth to the pockets of a few individuals and undermines the manufacturers and registered importers of drugs.
Theft is driven by low incomes in the public sector, poor corporate governance in state institutions which manifests in weak supply chain management systems.
Theft takes place in many areas of the health sector, but most frequently involves theft of drugs from the public health supply chain, especially from public health facilities and NatPharm.
Further, medical supplies provided by aid organizations are also stolen.
Theft also affects other medical supplies and paraphernalia used in public, private and aid sub-sectors of the health sector such as linen, curtains, syringes and PPE.
Theft in the public health system is perpetrated by a wide range of public health workers, ranging from doctors and pharmacists who take drugs from government institutions to their private surgeries and pharmacies, nurses, to officials responsible for managing hospital stores departments and NatPharm officials.
A leading expert in public health noted that low remuneration is one of the drivers of illicit activities while another source added that [officials] only steal medicines for resale because they are hard pressed and need to survive.
A registered nurse in the public sector earns the equivalent of USD 30 per month a fraction of what registered nurses in Zambia and Mozambique earn – USD 295 and 529 per month respectively.
Prior to the onset of inflation in 2018, nurses were earning USD 520 per month.
Health experts note that it is these low incomes that lead to nurses taking ready-to-use therapeutic-food (RUTF) meant for patients and cooking it at home and doctors taking drugs that have subsidized prices from the public sector and selling them in hard currency.
A lab scientist who has worked in both Zimbabwe’ and Botswana’s public health facilities compared the two noting that, health workers in Botswana are paid enough to not think of engaging in corruption whereas in Zimbabwe health workers are underpaid and want to earn more.
A community health expert pointed out that theft became a challenge in the public health sector in the mid-90s when structural economic reforms led to job losses and stagnation of wages.
Poor governance enables theft.
The poor governance is epitomized by lack of basic checks and balances for example, some primary health facilities are under-staffed and the same officer responsible for procurement is responsible for quality assurance of the procured goods and services.
A former junior doctor in the public sector noted that theft is more likely to occur in primary health facilities in the public sector like clinics, which due to their small size have fewer staff members and may have one procurement officer who conducts the procurement and conducts the quality assurance of the goods that are delivered [therefore] such a person is likelier to engage in corruption.
The junior doctor contrasted this to large facilities where there are multiple officials participating in the various steps of public procurement.
Stolen drugs have a similar market as smuggled drugs.
They are sold to patients, pharmacists and the public.
A pharmacy owner described how some health workers sell stolen drugs to a few unethical pharmacies and how other health workers sell the drugs through runners, individuals who act as middlemen between the nurses and pharmacies.
The pharmacist noted that most of these runners are the same runners smuggling drugs into the country.
Pharmacists are incentivized to buy the stolen drugs because they are authentic products that are sold for way less than their actual price thereby creating a rent that the pharmacists can easily earn.
Health officials are reported to also sell stolen drugs directly to patients in the facilities they steal from who would have failed to get the drugs.
An operator in the pharmaceuticals industry noted that stolen drugs are sometimes stored in a way that affects their quality thereby creating a health risk for those who then use the drugs.
A public health expert in the aid industry added that drugs such as insulin, which are rendered ineffective by room temperature, are a serious health risk as taking a tainted dose can lead to death.