Abstract
Medicine theft is likely one of the leading causes of preventable disease in low income countries. In Malawi, where our evaluation takes place, Ministry of Health officials estimate that 29% of spending on medicines and medical supplies disappears due to theft alone (Mphande, 2017). Our survey work indicated that 75% of all communities in Malawi have experienced the theft of medical supplies (author surveys). Malawi is a particularly extreme outlier, but these estimates are not far off from estimates in other countries (Bate et al., 2010; Bouchard et al., 2012; Savedoff, 2007; Hope Sr, 2015; Ferrinho and Van Lerberghe, 2002; Lewis, 2006). Additionally, medicine theft costs governments and donors many millions each year between lost medications and spending on supplemental procurement procedures (Vian, 2006; Garc´ıa, 2019; Bruckner, 2019; Ferrinho and Van Lerberghe, 2002; Jones and Jing, 2011).
Documenting and mitigating procurement and corruption challenges is particularly vital amidst the COVID-19 pandemic. Estimates from previous health crises suggest that ineffective health service delivery explains much regional variation in mortality rates and subsequent poverty in poorly institutionalized health settings (Christensen et al., 2020; Maffioli, 2018). Moreover, the rapid expansion of global health aid has created opportunities for higher rates of theft and corruption (Schipani et al., 2020; Thorp, 2020; Gallego et al., 2020; Eze et al., 2022).
One goal of this research was to evaluate how advances in 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 procurement capacity and investment are low (Lewis, 2006; Bruckner, 2019). A second goal of this research was to experimentally identify the deterrent effect of procurement oversight.
