African healthcare supply chain is broken, who is fixing it?
Humanity through science and technology has developed tools to end extreme hunger, poverty, and disease. However, about 1 billion people globally still live in abject poverty with no access to good food and affordable quality health care services. The largest of this group live in Sub-Saharan Africa and majority of them are women and children.
In Nigeria, 120 million people 52.22% of whom are rural/peri-urban dwellers would settle for poorly equipped local micro-pharmacy dispensary outlets otherwise called Chemist stores or they risk paying through their noses at the standard pharmacy stores each time they took ill which is usually frequent due to poor hygiene and malnutrition. These are negative footprints on the health and economic outcomes of 1 out of 7 people globally. It is just as if the world is split into two communities both traveling on different routes. The developed communities are getting richer and healthier while the less developed ones are not.
A pathetic scenario of a brilliant young girl comes to mind each time I think about the poor healthcare facilities in Nigeria. Adaobi, 11 years, attends a community high school and was only in her first year when she was hit on the head by a strayed rod her fellow freshman aimed at ripe almond fruits during lunch break. Because the only accessible and affordable healthcare providers in her area were the Chemists, she was placed on a regimen laden with counterfeit drugs. The Chemist store owner also did not know that most of the drugs he sells are counterfeit. According to him, he only checks for expiration date each time he stocks from the middlemen (drug dealers).
This sad scene would jeopardize the seemingly bright future Adaobi holds. She had finished top of her class in her high school entrance examination popularly referred to as common entrance in Nigeria. Her dream was to study aeronautics. She won the Shell merit scholarship but couldn’t see her studies to fruition. Two weeks was all she had to spend in high school and she never recovered from her injury till she gave up the ghost. The doctor who admitted her when she was eventually rushed to the hospital after series of seizures confirmed the poor medication caused severe damages to her visceral organs including her brain. Adaobi’s parents became bereaved of their only hope.
Global estimates place counterfeit drug use at 10% of all prescription medications used with most of them occurring in Sub-Saharan Africa. I also confirmed this through a research I and two other colleagues carried out while developing a healthcare product.
Between September and December 2015, we reached out to 250 chemist stores to ascertain the level of the disparity between demand and access in low-income neighbourhoods with emphasis on supply chain and drug source. 55% of the surveyed Chemists indicated they had inadvertently purchased fake drugs before and 75% have in the past week prior the survey experienced no-inventory conditions for specific paediatric and reproductive health products. Supply chain in Sub-Saharan Africa is inefficient and highly convoluted. This inefficiency paves way for counterfeit drugs’ circulation as the rural Chemists would only sell drugs that are made available to them. They also often run out of drugs which is a recipe for high mortality especially for the bottom of the pyramid population they serve.
A theory of change therefore needs to be developed on three priority levers that target fundamental root causes of supply chain underperformance:
Unrealized synergies from private sector capabilities, expertise and capital;
Insufficient strategic thinking on supply chain issues and limited coordination and knowledge sharing between public and private sector actors in the supply chain ecosystem;
Limited production and capacity of supply chain human resource;
These are critical areas for consideration if we are serious about impacting the Sustainable Development Goals (SDG).
Scientific based evidence exists that technical progress in pharmaceutical access and availability can lead to significant positive outcomes in mortality. So, who are the middlemen that sell drugs to the chemists? How do they connect? Where do the middlemen also buy their drugs from? How can we disconnect the chemists from the middlemen while reconnecting the chemists with accredited and verified dealers? Can we leverage the strengths of the middlemen and convert them to genuine drug distributors? How do we set-up an efficient health care delivery system in rural and peri-urban communities in Sub-Saharan Africa?
No doubt, private and public sectors’ capabilities, expertise, resources and tools would have to be mobilized in order to improve supply chain of health products so they can be accessible to the low-income neighbourhoods. This is an important precursor to improving the availability and coverage of basic life-saving services/products, and reducing maternal and child deaths. We would need visionary leaders globally both in the private and public sectors to take charge. Who is daring this?
