Reducing Drug Theft Through Information and Community Monitoring in Malawi

This project evaluated how targeted information and citizen engagement could help reduce theft of essential medicines in Malawi’s public health system.

The theft of medicines remains a significant drain on public resources across many low- and middle-income countries. In Malawi, it was estimated that approximately 30 percent of government-purchased drugs and medical supplies were lost to theft. Despite years of investment in third-party distribution systems, a 2015 survey found that more than a third of private clinics were selling anti-malarial drugs originally donated for free public use.

This project tested the effectiveness of three anti-theft interventions. One approach involved informing clinic officials about a government drug-tracking system and the penalties for theft. A second trained community members to track drug delivery schedules, monitor availability, and report discrepancies. A third intervention combined both strategies to assess whether reinforcing accountability from both above and below – top-down and bottom-up – would have a greater impact.

The research aimed to generate actionable insights for improving supply chain integrity, strengthening oversight, and protecting access to essential medicines.

Key Findings

• Approximately 35% of medicines went missing between Malawi’s central medical stores and final delivery points at clinics. This loss significantly affected healthcare access, with patients facing more frequent stock-outs and higher prices near facilities experiencing greater levels of theft.
• Most theft appeared to occur after delivery, likely involving staff at public health facilities. Contrary to common assumptions, theft during transport was minimal.
• While theft was a serious concern, supply chain errors were the most frequent cause of missing medicines. This finding challenged the dominant narrative and pointed to the importance of broader system-level improvements.
• The study demonstrated that remote tracking technologies can serve as effective tools to detect and address irregularities in drug distribution.
• The results suggested that policymakers could achieve greater impact by balancing anti-theft efforts with investments in supply chain oversight, closing gaps that enable both error and corruption.

Impact and Implications

The findings from this study were designed to inform future decisions by the Government of Malawi on how to strengthen accountability in medicine distribution. By assessing the relative and combined effects of top-down interventions targeting clinic personnel and bottom-up interventions engaging citizens, the research provided evidence to support more strategic and targeted anti-theft efforts.

Beyond Malawi, the policy lessons carried broader relevance. The project demonstrated how improved information flows and monitoring mechanisms could reduce theft of essential medicines in a way that may be applicable across contexts. It also offered insights into addressing theft in the distribution of other development materials.

The project contributed methodological innovations in how theft is measured, generated rich data on patterns and risk factors, and rigorously tested two major intervention approaches. These contributions offered value to policymakers, practitioners, and researchers seeking scalable, evidence-based strategies to strengthen supply chain integrity and reduce corruption in service delivery.

Evidence of Impact:

• The research team hosted a stakeholder workshop in London to share findings with representatives from the Government of Malawi, academic institutions, and global development and health policymakers.
• Findings were disseminated through key international platforms, including the World Health Organization’s Global Network for Anti-Corruption, Transparency and Accountability in Health (GNACTA), the Accountability in Action Project, and the UN University World Institute for Development Economics Research (UNU-WIDER).
• The team maintained ongoing engagement with Malawi’s Ministry of Health, civil society organisations, and donors – offering input on procurement system design and anti-corruption strategies in the health sector.
• A UNU-WIDER Working Paper presenting the findings was published, and additional peer-reviewed publications were in progress to contribute to the broader academic and policy evidence base.

Other Outputs

• GNACTA Webinar on Technology for Anti-Corruption
• GI-ACE Webinar on “Detecting and Deterring Medicine Theft.”
• Accountability in Action Policy Forum on Malawi: How can digital audits and block chain elicit corruption in public health procurement in Malawi? What works?