A report by Transparency International Zimbabwe (TIZ) has identified medical staff at public health institutions as key drivers in fuelling rampant corruption, worsening the decay in service delivery.

This comes as Zimbabwe’s collapsing health sector has been hamstrung by low remuneration, inadequate medicines and equipment, among other challenges.

The research, which studied corruption risks in the medicines supply chain focus sing on public health, said corruption risks existed at several layers of the system, in cluding facility inventory management and at points where medicines are dispensed.

"According to key informants, at public health facilities, the actors are clinicians and other health workers such as general hands and pharmacy technicians,” TIZ said.

“The drivers of corruption at the facility level are low remuneration, partially effective medicine stock management, and high demand against low supply,” excerpts from the report read.

“Medicine stock is managed electronically from the national level up to the district level while at the facility, paper-based systems are used. At higher levels, there are qualified designated officials (pharmacists/pharmacy technicians) managing medicines and there is more accountability compared to public health facilities where there are no specific pharmacy personnel, fidelity to stock takes is infrequent and there is no proper handover from person to person, which was recently worsened by staff resignations to look for greener pastures,” the report added.

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It noted that at some clinics, nurses were selling medicines to consumers.

Medicines on sale included those smuggled into the country.

Such activities compromised the effective delivery of services to consumers, TIZ noted.

TIZ claimed medical staffers at Sally Mugabe Hospital psychiatric unit were selling medicines which were not for sale.

"In one group discussion, it was mentioned that some medical doctors keep medicines, especially injectables such as cephtriaxone in their rooms without following proper authorisation or registration to dispense medicines with the MCAZ (Medicines Control Authority of Zimbabwe).

It was reported in the same group that "sometimes the medicines are supplied by people where the index of suspicion for theft as a source would be high and some of the suppliers were health workers, but no questions are asked."

The report said some senior staff were diverting small amounts of medicines for use by themselves, family and friends and justified this diversion as necessary to compensate for their perceived low remuneration.

“It was also reported that the senior staff take advantage of the unofficial exemption from being searched when exiting health facilities. Some key informants perceived corruption at the facilities as mainly petty, but occurrence may be on a large scale with great frequency while perceived corruption at procurement level is huge and infrequent. The corruption at both levels results in reduced access to medicines for women, children, the vulnerable and the marginalised," TIZ further said.

The anti-graft watchdog added that there was a general disregard by medical staffers to adhere to regulations such as the National Anti-corruption Strategy.

The report confirmed the rampant pilfering of drugs at public hospitals.

"They get their medicine supplies from Zambia as well as from some health workers who deliver the medicines to them. The health workers are clinical and non- clinical staff. Sometimes the health workers use runners (third parties) to mask their identities. The street medicine vendors are aware that the medicines they get are diverted from the public health inventories.

“One street vendor mentioned that some local pharmacies sometimes procure medicines from them. The medicines found in the street include prescription preparation medicines such as antimicrobials (antibacterial, antifungal, antiviral), analgesics, non-steroidal anti-inflammatory medicines, antihistamines, short acting contraceptives (combined oral contraception and the progesterone only pill)," TIZ said.

The research noted that the high profits available may be attractive to health workers who are driven by perceived poor remuneration to divert medicines.

"Psychotropic medicines such as diazepal have a high demand on the market among the youth and health workers were also implicated in the supply of these medicines,” the report underscored.

“Users of the psychotropic medicines openly approach health workers soliciting them to divert these medications into this drug abuse market. Poor remuneration drives health workers to divert medicines from the mainstream public health supply chain.”

Underscoring reports of rampant corruption in the public health delivery system, the Auditor General said in May that at Mpilo Central Hospital, key members of staff who had left the organisation were still signatories.

The auditor general said Mpilo had weak internal controls.