...continuing from previous blog...
Then acting as PACAM board chair – and now its National Coordinator – Thambo and his fellow Malawi delegates realized that the barriers to implementing such a program in Malawi were many. Different stakeholders, such as the Central Medical Stores, the private sector, and the Pharmacy, Medicines, and Poisons Board were not collaborating on the drug’s procurement, supply, and monitoring.
Malawi had lagged in previous years in reporting its statistics on national morphine use to the International Narcotics Control Board in Vienna, Austria, resulting in the Board lowering Malawi’s annual morphine import quota. And Malawian law did not allow the distribution of the drug to all levels, such as community health centers. Thambo knew that launching a program in Malawi similar to that of Uganda’s would require the buy-in and coordination of important decision makers who could confront these barriers.
Luckily, PACAM already had an ally in the form of Francis Chafulumira, Chief Pharmacist in the Malawi Ministry of Health, who had traveled with Thambo on the Uganda study tour. In February 2008, PACAM and the Ministry of Health co-hosted a workshop in Lilongwe on “Opiod Analgesics Availability” to raise awareness among key stakeholders and involve them in the campaign. Deputy Registrar for the Pharmacy, Medicines, and Poisons Board Aaron Sosola was invited to give a presentation on drug import licensing. Ivy Zingano, Director of Malawi’s Central Medical Stores, spoke about the drug procurement cycle. These individuals would later prove to be essential in helping PACAM’s advocacy campaign to succeed. Outcomes from the conference included a recommendation that Zingano’s office order the morphine powder, reconstitute it, and distribute it to the districts. It was also suggested that the Pharmacy, Medicines, and Poisons Board review the national requirements for opiates such as morphine.
Even with these recommendations in place, PACAM and its allies continued to face resistance. Some government officials were hesitant to import the morphine powder necessary to create liquid oral morphine, balking at the logistics of storing large quantities of the controlled liquid. Later on that year, in December 2008, PACAM recruited a new set of allies: participants at an advocacy training it held in Lilongwe on “Strategies to Improve Palliative Care Services in Malawi.” This time, the attendees included members of the media, the private sector, the government, and Kamuzu College of Nursing. One participant present was George Ntonya, then a journalist for The Nation, one of Malawi’s most widely-read newspapers. Two months after attending the training, Ntonya met a woman suffering from cancer who lacked access to morphine. Ntonya wrote an article about her that appeared in The Nation in February 2009.