Reconceptualising the delivery model for drug distribution, with private sector support of public health supply chains, is the key to addressing Africa’s healthcare delivery challenges, and maximising the availability of life-saving drugs across the continentThis is the contention of Imperial Group Business Development Executive: Healthcare, Dr Iain Barton.

Until recently pharmaceutical distribution in Africa was characterised by supply into Central Medical Stores in each country, from where drugs were distributed to areas of need. This model results in numerous supply chain inefficiencies, mostly around forecasting and inventory, wastage and stock-outs.

Where drug companies work with private sector businesses to change the delivery model for drug distribution, the results can be spectacular.

Drug prices to patients in rural African markets are often inflated by the many intermediaries involved in the supply chain distributing drugs to clinics and hospitals, often in remote rural areas. A global drug manufacturer operating in Kenya partnered with Imperial Health Sciences to reduce the price to patient. By changing the distribution strategy, the price to patient was reduced across a range of six lines of prescription drugs and over the counter products by between 44%-55%. Sales volumes rocketed by 300% in the first and second years after the change.

In the developing markets of Africa, security of supply is poor, quality is not assured, and rigid and high price fixing is the norm. Counterfeit and substandard medicines are also rife and corrupt procurement and supply practices are seldom challenged. In each market there are fragmented services of small product ranges to specific market segments or geographies, often through collusive procurement practices.

In line with the current growth opportunities present in the sub-Saharan African market, Imperial is looking to directly support the improvement of the standards and services of the healthcare supply chain in a number of countries in Africa. Our aim is ‘Big D Development’ – focused on sustainability and long term local growth. An improved supply chain ensures that a larger number of patients have access to medicines. It also improves the affordability of products at patient level, the quality of medicines and traceability and sustainability of supply to patients.

By 2017, pharmaceutical spending in Africa is expected to be worth between US$40 billion and US$60 billion and over the next five years strong growth can be expected in every segment of Africa’s pharmaceutical markets – including prescription drugs, generics, over-the-counter (OTC) and medical devices. This growth is being spurred by a convergence of demographic changes, economic strength, increased wealth and healthcare investment, and a rising demand for drugs to treat chronic diseases.

In Imperial’s view, supply chain support needs to focus on five key elements, which I have dubbed “the five Cs”. These are compliance, capacity, catalogue, credit and customers. Compliance ensures the safety, quality and efficacy of product, as well as the security of product integrity. Capacity refers to the skills, systems and infrastructure to buy, store and sell medicines, and the means to deliver to multiple regions within a reasonable time period. Catalogue is the reliable availability of a wide range of product, while credit is the ability to access and to provide credit, specifically to access product from suppliers and to provide these products to retailers. Customers refers to the purchasing retailers, state institutions and donor supported programmes that need access to the products, and which, as a preferred network, provide positive incentive and due reward for participants.

In line with the way in which donor agencies have begun to redeploy funding to try to promote sustainable local private sector development, initiatives to support the growth and sustainability of a sub-Saharan African healthcare sector are critical to the development of regional African supply chains. Ultimately, it is a robust sector which can minimise wastage and obsolescence and maximize the availability of life-saving drugs across Africa.

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