Health Care Assessment, Africa | News | PIEX

Health Care Assessment, Africa

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Africa is home to nearly a billion inhabitants and its population’s median age is very young (20 y.o.) Forecast to grow to Economic Powerhouse status, the continent urgently needs more and better access to healthcare and quality medication to achieve its potential.

Context

Africa is home to the youngest population of the world, (the median age is under 20), and close to a billion inhabitants. Its area is staggeringly large and stores a treasure trove of natural resources. The continent is the next economic powerhouse and could match, or even exceed, China’s GDP as early as 2030 according to forecasts.

Post WWII, Africa entered a new era of accelerated development. There is remarkable progress on human rights, governance, and transparency even though African countries are not all proceeding at the same pace and there can be large discrepancies from one region to another.

Life expectancy, literacy, GDP per capita, all the key indicators of human development have been on the rise since 2015 everywhere in sub-Saharan Africa. Developed countries nowadays understand much better the fact that their own sustained prosperity will depend on fair and equal development in developing countries. This increased awareness in the international community translates into more support for African governments in their reform and growth efforts.

Notably, access to health care for all Africans is becoming a salient topic in the conversation about the continent.

We want to stimulate this conversation, share our analyses, and outline a vision that, without ignoring systemic issues that need solutions, allows for the development of effective strategies and effective cooperation of the public and private sectors.

First Line Barriers

Access to Care

UN member countries target Year 2030 for the full implementation of Universal Health Coverage (UHC). For a better understanding of the challenges in Africa, it is useful to review the definition of UHC and measure it against field realities.

The World Health Organisation (WHO) defines UHC as “all people have access to the health services they need without incurring financial hardship.” Implementation requires a robust health system, universal access to medication and medical technologies. Human resources, must also be adequate and the cost affordable.

Nevertheless, a reliable supply of quality medication and health care products remains a challenge.

The challenges of building a robust health system, training and retaining human resources, and making costs affordable will be topics for further analyses. In this article, we will discuss physical access to medication and health care products.

Access to essential medicines and health products is, on average, passable in urbanised areas of French-speaking Africa. There often is acceptable road access, and hospitals or clinics usually have a manageable supply chain and purchasing processes. Drugstores and dispensaries carry stocks and are reachable without undue efforts or expenses.

Nevertheless, a reliable supply of quality medication and health care products remains a challenge.

Africa produces 3% of the world’s pharmaceuticals. This global share, distributed evenly on the continent, translates approximately into only 10% of local consumption. Of course, authorities must act to make local production a safe and attractive investment. It will require time, especially in French-speaking Western Africa, which trails behind English-speaking regions in the Centre and West.

Imports currently account for 90% of supplies in a market that is immense but where commerce remains extremely fragmented. Per-country volumes are low on an industrial scale when measured against break-even points or profitability thresholds on which international production and quality standards are critically dependent.

A foundation of patient-driven approaches demand availability at all times. Inventory shortages are more difficult to avoid where transportation distances are very long, maintaining quality throughout the supply chain is challenging, compliance with international standards is more difficult to enforce, and political risk is a daily concern. Purchasing, stocking, and delivering adequate quantities in good conditions while managing risk every step of the way is the best way to attain timely availability.

Today, this involves several intermediaries between the producer and the patient at the local (drugstore) national (wholesaler), and continental (distributor) levels. Each link in the chain unavoidably creates a cost as they all play a vital role in ensuring availability and division of risks. These increased costs can be offset by economies of scale that are achieved by grouping products, orders, and deliveries. It requires the capacity and expertise to optimise logistics costs (orders processing and transportation), a significant component of the retail price of medication. Obviously, while complying with the strictest international standards and best practices.

In the future, the supply chain will tend towards rationalising the number of links, a natural evolution and legitimate expectation of African people and authorities.  Distribution will be vertically integrated and grouping purchases under the aegis of point-of-sales networks will appear on the entire continent.

In comparison, rural areas often have non-existent or dangerously obsolete infrastructures for lack of financial means to build and maintain them. Nomadic peoples can cover three or four countries in one yearly migration. Territories larger than any European countries can be impossible to access.  The challenges of physical access to medication and care is on the scale of the continent: 600 million Africans living in rural areas still have little if any access to the quality health care they need.

In the above, the expression “quality health care” might seem a given. However, as obvious as it may seem, it often remains far from actual field reality.

The Curse of Fake Medications

Worldwide, the counterfeit medication business is “valued” at approximately 2 billion euros per year. Africa carries 42% of this burden, which translates into a yearly cost of 850 million euros it certainly cannot afford.

The time has come to put an end to this murderous business.

Translated into human terms, these figures mean that, every year, fake medications kill hundreds of thousands Africans, depending on sources, estimates can vary between 150000 and 500000 victims, children being at the forefront of at-risk populations. The time has come to put an end to this murderous business.

Fakes can be copies of legitimate medications with various excipients and little, or none, of the active ingredients found in the real medication. There are also real medications but prescribed and delivered for conditions foreign to their intended uses. For example, counterfeiters often replace the actual active ingredients of antimalarial drugs with cheaper acetaminophen, deriving large profits from the substitution.

Despite these many shapes and forms counterfeiting can take, one thing remains universal: the size and power of the criminal organisations behind these crimes. During a single operation conducted in 2017, police forces seized 420 tons of fake drugs in seven Western African countries. Producing these quantities is impossible without a large criminal organisation backed by significant protection on several levels.

A tempting conclusion would be that the problem of counterfeit medications belongs to the Legislator, police forces, and courts and, indeed, these authorities on the first line of the fight. However, it is critical to avoid making this a justification for generalised inaction.

On paper, the strategy is simple: increase the cost and risk of producing and distributing fakes to a point at which counterfeiters give up. Executing this strategy implies enlisting the support and participation of all civil society. Three pillars need promotion and support. First, build up the resources of law enforcement. Second, improve pharmacovigilance (drug safety). Third, deploy digital technologies that educate and involve end users and consumers.

Digital technologies have proven they can effect tremendous changes in a very short time in other domains. Pharmacovigilance is not different: there are already developments of applications that confirm the origin of medications, track their path to consumer, and validate formulations or fitness for use, indications… These solutions can be deployed at point of sale or on the patient’s mobile device.

Digital technologies have the potential of recruiting millions of people in the active aspects of fighting counterfeit drugs, thereby achieving a number of active enforcers that criminal organisations can never match.

Outlook for 2030

Seemingly unsurmountable problems do have practical solutions. We believe overcoming the challenges of health care in Africa lends itself to this approach which requires first and foremost a change in mentalities and a sustained will to take action.

In our vision, fair and equitable access to health requires creating a group that integrates pan-African distribution, representing a large portfolio of producers, their medications and health care products, while creating in parallel innovative localised retail solutions adapted to populations.

This is Piex Group’s mission, backed by established and solid financial partners: to help provide quality health products to the largest conceivable number of Africans

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