In the past, doctors at the Shapola health centre in the Haska Meena district, Nangarhar have prescribed expired medication despite the potential health risk to patients. Today, clinic officials argue that a severe lack of requisite medication in the health centres in Nangarhar means that the directorate of health permits the prescription of expired medicines. Officials maintain that the out-of-date drugs have medicinal benefits for patients, and do not fully accept the increased danger and detrimental impact for local families, particularly children and pregnant women. The practice of prescribing expired medications also violates public trust in the quality of their local health services.

A villager added that “We do not know when the doctors prescribe expired medicines to ourselves, and to our families.”

UNDP’s Afghanistan Anti-Corruption, Transparency, Integrity and Openness (ACTION) project through the Integrity Watch Afghanistan stepped in to improve delivery of health services in the region. Through an intervention to monitor the Shapola health centre, volunteers became aware that expired medication was being prescribed to patients. Acting quickly, the volunteers checked dates of medicine in the clinic, and advised clinic staff that they are not fit for patient consumption, particularly for vulnerable patients such as children and pregnant women.

Clinic officials insisted they had an official license to prescribe the medication from the Nangarhar directorate of health and ADDA, an NGO supporting health services in the area. However, the volunteers (accompanied by a local representative from the village) persisted, and finally convinced the clinic officials to stop prescribing the out-of-date medicine and dispose of them with immediate effect. The drugs were returned to the Nangarhar directorate.

The removal of the expired medicine, and preventing future prescription, will have major health benefits for the community; reducing risk to patients, and improving both public health and the quality of available health services. Having a representative from the village accompany the volunteer increases civic engagement. Importantly, monitoring of the clinic by volunteers has led to enhanced public trust.

The village representative, who participated in the monitoring of the clinic, said:  “After this, I will check every medicine expiry date that I take either from the local clinic or from anywhere else. What happened today, has never happened before in our community”

This initiative is part of UNDP Afghanistan’s Anti-Corruption, Transparency, Integrity and Openness (ACTION) project to increase public trust in, and transparency of, Afghan Security and Justice institutions and is generously funded by Royal Danish Embassy.