When Marizinha, a patient at a bustling peri-urban health facility in Inhambane Province, Mozambique went in June to the pharmacy for a consult, the doctor wrote her a prescription for 60 pills. Just enough for one month. However, the pharmacy tech at the health center dispensed only 30 of the pills. “He acted like he had given me all of them,” she says.
That same morning, Namati’s health advocate, David, was conducting an educational talk in the community. Marizinha approached him and explained what had happened. David, together with several members of the health committee Namati had helped to revitalize, went to the health center later that day and approached the pharmacist. “We had the prescription and the medicine in hand,” David recalls, “and it said ‘certo’ on the pharmacy container (meaning ‘OK’ in Portuguese), which in our mind indicates that he had filled the prescription.”
In talking to the pharmacy tech, they learned that there was a sufficient supply of the medicine available but, according to the tech, they had received a warning that there was going to be a stock-out so they were trying to ration it out. David recalls him saying “My failure was not informing the patient, but it was an honest mistake.’ ” But David and the health committee members had been hearing similar complaints from a number of patients in the community. They knew that this was not an isolated incident, and some suspected that this was a scheme for stealing and selling medicine in the private market.
The president of the health committee responded to the pharmacy tech, “Look – this is a problem we are hearing about in the community. You need to fix your behavior. Whatever is written on a prescription, you should dispense that full amount. If you don’t have the medicine available, you should refer to another facility that has the medicine or report it, but you shouldn’t write ‘certo’.” The pharmacy tech then apologized and gave Marizina the remainder of the pills.
Following this incident, the health advocate and the health committee have been regularly monitoring the situation to ensure that this violation is not repeated. “We go to the health center and we do informal discussions with people as they are leaving the pharmacy,” David explains. “We try to find out whether they are getting the right amount of medicine, and also whether they are getting all the necessary information about how to take their meds and about side effects.”
Over the past several months, there have not been any new reports of cases of this nature.