Fact-check: essential medicine sourcing falls short of promises

What is the current situation with medicine availability in the Maldives?

Despite a government pledge to solve the medicine shortage by importing all essential medicine by March 15, it's still difficult to fill prescriptions. Patients across the country continue to struggle to access vital medications. Many are still resorting to  personal connections or posting desperate pleas on social media, seeking help from people returning from overseas.

What did the president promise?

On February 24, President Dr Mohamed Muizzu said the State Trading Organisation was working to import medicine in order to solve the shortage. 

Has STO fulfilled this promise?

STO told state media on March 15 that it had completed sourcing all the drugs on the essential medicine list. But it is unclear if STO has managed to import the medicine.

What’s the difference between "sourcing" and "importing" medicine?

When it claims to have "sourced" medicine, STO has identified suppliers and potentially placed orders. But that does not necessarily entail availability in local pharmacies as the medicine might not have arrived. Importing involves customs clearance and distribution to pharmacies.

What does STO say?

"We have completed the work of sourcing essential medicines needed for Maldives (according to the Maldives Food and Drug Authority list) and the medicine needed has been brought to Maldives in March. We are working on distributing the medicine to the islands now. This will bring some relief to the medicine shortage. STO's priority is to ensure such a shortage doesn't happen again by making sure that essential medicines are available across the country," the STO spokesman told Maldives Independent.

What are pharmacy owners experiencing on the ground?

Persistent difficulties with wholesale purchases of medicine.

"We called the STO wholesale team this week too. We are calling them every week. They are still telling retailers they don't have enough stock to wholesale," a pharmacy owner from Malé said.

What concerns do retailers have about STO's claims?

Retail pharmacy owners were skeptical.

"They are saying we have 'sourced' medicine. What does that mean? Does that mean that they just found exporters from other countries? Or that they just talked to potential exporters? My question is whether they have imported anything beyond taking prescriptions from patients and filling those prescriptions from abroad?," a retailer said.

"All I can say is what they are telling us. They don't have stock to wholesale.”

How is this shortage affecting patients?

Elderly patients with chronic conditions have been unable to fill vital prescriptions. Patients with psychiatric illnesses have suffered episodes after running out of medication. Many people reported trying pharmacies across Malé to no avail. Family members have resorted to personal connections or posting desperate pleas on social media to seek help from people returning from overseas.

What are the root causes of the medicine shortage?

A Maldives Independent investigation into the crisis uncovered a complex web of factors: millions in delayed payments from the national health insurance scheme Aasandha that have left importers without purchasing power, new price controls that have made it unprofitable for pharmacies to stock certain medicines, and strict regulatory requirements that made it difficult to import medicines for the Maldives' small market.

How does Aasandha relate to the medicine shortage?

Unpaid bills have left importers without purchasing power. These payment delays have disrupted the entire pharmaceutical supply chain.

Who does President Muizzu blame for the shortage?

"The medical mafia.” Speaking in Dhaalu atoll last month, Muizzu said: "The difficulty in getting medicines started when the government capped the prices of medicine and businesses stopped importing medicine to make things difficult for the government. These businesses were making 1000 percent or 2000 percent profit through Aasandha, with taxpayers money. That is very wasteful.”

Are these claims about excessive profits accurate?

While price gouging has been a longstanding problem in the local healthcare industry, it is unclear what the president was describing.

"You will see, even on a small island the person who opens a pharmacy will be buying large fishing vessels in less than a year. This is the truth. When we stopped this, the problems started,” he continued, referring to the purported profitability of the industry. 

Health industry professionals including regulators who talked to Maldives Independent confirmed markups of up to 200 percent on some products when compared to prices in neighbouring countries.

How do medicine prices in the Maldives compare internationally?

Pharmaceuticals cost significantly more than neighboring countries with similar income levels, according to the World Health Organisation. The average cost of medicine is 15 to 70 times higher than international benchmarks, a 2022 World Bank report found.

What was the government's plan for the money saved through price caps?

The president said by capping medicine prices, MVR 500 million (US$ 32 million) could be saved from Aasandha, which could go towards funding development projects.

When were the price caps implemented?

Aasandha price caps were rolled out in phases in November 2024, impacting 250 "widely used" medicines.

Have the price caps reduced government healthcare spending?

According to the latest weekly fiscal update from March 6, budget expenditure on Aasandha stood at MVR 426 million, up from MVR 403 million in the same period last year.

What is the current status of the medicine shortage?

After discussions earlier this week, the health ministry announced plans to start compiling a list of patients outside the capital with chronic illnesses and non-communicable diseases. Such a list would make it easier to ensure uninterrupted access to medicine, the ministry said.

Contrary to the government's claims that the situation was improving, the ministry's acknowledgment along with evidence from pharmacies, patients, and healthcare providers suggest the crisis has not been resolved. Pharmacy owners confirm they still cannot purchase wholesale stock, leaving patients without access to life-saving medications. The gap between official statements and ground reality remains significant.