The Republic of ‘Come Back Tomorrow’

There is a peculiar country somewhere between the Ministry of Finance and the hospital pharmacy where medicines mysteriously disappear.

Welcome to the Republic of Come Back Tomorrow where medicine exists in the national budget, procurement plans and financial documents—but somehow develops legs before reaching the patient.

This is not a joke to the patient.

It is a joke to the system.

In the 2026/27 national budget, Government allocated K108.3 billion for medicines and medical supplies—K58.3 billion for central hospitals and K50 billion for district hospitals. It also allocated K20 billion towards arrears owed to the Central Medical Stores Trust (CMST).

That is a lot of money.

But apparently not enough medicine.

By September, CMST reported that only 40 percent of essential medicines were available, down from 51 percent in April. At central hospitals, availability had fallen to just 18 percent. CMST also owed international suppliers about $18 million, with suppliers reluctant to send more medicines until they are paid.

So here is the great Malawian medical mystery:

How can medicine be in the budget but not in the pharmacy?

It looks like delivering medicine to the patient remains a matter for divine intervention.

Take the wife of a carpenter I regularly hire.

Last week, she became seriously ill. Her husband rushed her to a health centre, then to a central hospital, where doctors diagnosed her and prescribed medicines.

Then came the plot twist.

He went to the hospital pharmacy.

“We don’t have them.”

He was sent to a private pharmacy downtown.

That is the moment a public-health problem becomes a household financial disaster.

The carpenter earns his money with his hands. He has no foreign-currency account, corporate medical insurance or pharmaceutical company on speed dial.

He has wages.

And the medicines cost more than his wages for the week.

You take your wife to a public hospital because you cannot afford private healthcare. The doctor prescribes medicine. The public pharmacy has none. The private pharmacy has the medicine—but your pocket does not.

What exactly is the patient supposed to do?

Perhaps swallow the prescription.

Perhaps rub the budget document on the affected body part.

Perhaps ask the Minister of Finance to administer K108.3 billion orally.

This is where statistics become cruel.

Government can explain allocations. Officials can explain procurement. CMST can explain forex shortages. Suppliers can explain unpaid invoices.

The patient has only one question:

“Where is my medicine?”

The reasons are not mysterious. Malawi imports most of its medicines, leaving the public supply chain exposed to chronic foreign-exchange shortages. CMST needs dollars to pay suppliers. Hospitals owe CMST. CMST owes suppliers. Suppliers withhold supplies.

The chain breaks at the pharmacy window.

The Government’s own budget acknowledges that central and district hospitals owe CMST for medicines previously drawn from the Trust, hence the K20 billion allocation towards clearing those arrears.

In other words, we are trying to buy today’s medicines while negotiating yesterday’s bill.

That is some impressive fiscal choreography.

There are also lengthy procurement processes, delayed deliveries, unpredictable funding and hospitals exceeding allocations. Research on Malawi’s medicine supply chain has identified these as contributors to shortages.

And while officials calculate medicine availability, ordinary Malawians calculate something else:

“Do I have enough money to buy this?”

For the poor, the answer is increasingly no.

That is why the medicine shortage is not merely a procurement problem.

It is a poverty problem.

If you have money, a stockout is an inconvenience. You drive to a private pharmacy.

If you do not, a stockout can become a sentence.

The people who depend most heavily on public hospitals are precisely those least able to absorb the cost when the public system fails.

Shortages extend beyond medicines, with surgical gloves also scarce, forcing some hospitals to divert drug budgets to private suppliers. Perhaps next year’s budget should include K500 million for Bare Hands and Prayers. Paracetamol now seems more elusive than forex. Patients can seek alternatives, but these are coping mechanisms—not solutions.

The responsibility lies with Government.

It must ensure medicine funding moves through the system on time, predictably and transparently; address CMST arrears; secure forex for essential imports; tighten procurement and distribution; and publish information showing what was budgeted, purchased, delivered and distributed.

It must also confront Malawi’s dependence on imported medicines. CMST says the country imports about 80 percent of its medicines. Local production cannot solve today’s stockout, but reducing import dependence could make the system less vulnerable to the next forex crisis.

Because ultimately, a medicine in a procurement file is not healthcare.

A medicine sitting in a warehouse is not healthcare.

A medicine trapped behind an unpaid supplier invoice is not healthcare.

A medicine in the national budget is certainly not healthcare.

Healthcare is the medicine reaching the sick person who needs it.

Until that happens, Government can increase allocations, produce impressive speeches and celebrate bigger health budgets.

Meanwhile, at the pharmacy window, the answer remains:

“Come back tomorrow.”

And tomorrow, unfortunately, is not a medicine.

For some Malawians, it may be too late.

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