It is funny. The more I listen to pharmaceutical industry players on increasing access to quality medicines, the more relevant Nkrumah’s African unity becomes. And yet for an industry where the supply and distribution of medicines is described as “more than a mafia” in the words of Ghanaian Pharmacist Enoch Osafoe, this is certainly no laughing matter. The World Health Organization defines access within the framework of selection, supply, financing and health systems.
From the perspective of the man on the street however, all these pillars remain potentially meaningless unless they result in his ability to buy top quality drugs at prices that are not financially emasculating to him. In other words, to what extent does the end user get the needed drug in the right quantities with the appropriate certified levels of quality?
The unfortunate picture that emerges though in our quest to secure quality drugs for our kith and kin is that of individual West African States, striving against the tides as individuals, constrained by limited resources and weak regulatory enforcement mechanisms while challenged by the common desire to meet standards on access and quality. What remains is how these States can collectively leverage economies of scale to our mutual benefit to address access and quality concerns. Interestingly, it would appear that both aspirations-seeking economic advantage and improving health outcomes do not always converge.
Interesting, my argument for us to tilt the scales in our favor via African unity receives support from an unlikely ally, the British Medical Journal of 2005 in which it states, “Similar needs for medicines, shared sources of supply, and lack of national expertise in procurement all argue for greater collaboration among neighbouring countries. Regional partnerships might include sharing information on pricing and suppliers, establishing formal group purchasing schemes, and contracting with commercial distributors to supply health programmes throughout the region”
There are three ways that I can think of immediately
Let me hazard a guess. All West African countries are commonly faced with the ravages of the wicked triplets; Malaria, HIV/AIDS and tuberculosis. And yet, by adopting individualistic approaches in sourcing essential medicines, they lose the one leverage that could have been utilized through a pooling of our resources. For starters, could we use the data to select which drugs actually could address the largest proportion of diseases that commonly affect us? Subsequently, could all these countries engage in what experts call “pooled procurement” by which all West African states identify their medicine needs and identify the supplier that offers the best competitive pricing and quality terms? In this case, you no longer get to deal with us as Ghana or Togo but as the whole West Africa! Standing together, we declare, beat down the prices or else…we walk of course!
By this time, we have succeeded in leveraging competition the big multinational positively bring to the fore and then raises the issues of regulation and standards. How do we ensure that the drugs coming in are of the required standards? Ghana has its Food and Drugs Board which is commended by Dr Frank Nyonator of the Ghana Health Service “for ensuring a well-functioning pharmaceutical regulatory system which had shown evidence of commitment by local manufacturers to achieve international Good Manufacturing Practice (GMP) standards”. Hopefully this means that only drugs of a certain standard gain access to our market and hence to our patients. The trouble is that many others are probably doing the same things in other countries. What happens by way of checking quality after this initial registration, asks Pharmacist Osafoe?
“Having secured market authorization, are they able to check drug quality and efficacy regularly and who funds this; government or the same drug companies whose products are being vetted?” He refers of course to what his compatriots call a rigorous post-marketing surveillance that includes testing for bioequivalence of generics. This I’m told is expensive, but as we know, cost may be relative. What costs may be prohibitive for one nation may be small fry when confronted with the might of many states united in a common resolve to ensure our patients only have access to quality drugs.
Could West African States thus consider a future of shared roles and responsibilities, one where Ghana does post-market surveillance for anti-malarials, while Nigeria sorts it out for anti-retrovirals while the Ivory Coast does same for all anti-tuberculous drugs on the West African market? In the absence of such a system that is continuously testing and sampling, we may find ourselves saddled with some powdery fakes in lieu of Paracetamol. Then there is the not so small issue of visiting manufacturing plants abroad to check for the maintenance of quality standards. Ghana, Nigeria and Togo all do separate trips, I presume for the same drugs. Who pays for these trips?
But all this of course is on the assumption that all the drugs are coming in via approved routes with applications going to the mandated agencies for testing. Not so at all, it seems. Who doesn’t know how porous the borders are. Customs officials mount a road block near the Togo border knowing fully well that thousands of alternate routes connect the two countries. In the absence of the kinds of capacity required to even conduct medicines searches and tests at the borders, sharing roles is the way to go. Anything else and we will continue to be saddled with chemical sellers peddling sophisticated drugs including antibiotics of dubious origin and which continue to be dispensed to unsuspecting patients with or without prescriptions. Dr Frank Nyonator agrees. “The integrity of the supply chain is also seriously jeopardized by the existence of illegal counterfeit drugs which are mostly imported illegally into the country.”
The last area worthy of collaboration is in the area of building the capacity of local pharmaceutical industries to meet our needs for essential drugs. And as usual, there should be nothing that stops West African States from manufacturing medicines of the highest quality based on predetermined comparative advantages foisted on individual states to meet our collective needs. A highly successful international conference organized by IMANI, IPPA, Mpedigree, AfricanLiberty.org and the Ministries of Health of Ghana and Nigeria, in Accra on November 24, 2009, did give birth to some of the crucial answers.
Dr. Sodzi Sodzi-Tettey is General Secretary of the Ghana Medical Association and an affiliate of African Liberty