Can Innovation and Technology in Pharmacies in LMICs Provide a Pathway to Improved Medicine Quality in Africa?
Exploring the Impact of Modern Pharmaceutical Distribution Models on Medicine Quality in Zambia
Imagine a world where the medicines you rely on to treat illnesses and maintain your health are of questionable quality. Unfortunately, this is a reality for many people in Africa, where complex pharmaceutical supply chains can lead to the distribution of substandard and falsified medicines. But what if there was a way to leverage innovative technologies and business models to enhance the availability, affordability, and quality of medicines? This is the question that inspired my PhD research, using Zambia as a case study.
Poor-quality medicines pose a significant public health risk across Africa, contributing to increased illness, death, and global health challenges such as antimicrobial resistance. The World Health Organization (WHO) estimates that 1 in 10 medicines in low- and middle-income countries (LMICs) is either substandard or falsified. The United Nations Office on Drugs and Crime (UNODC) 2023 report highlighted that as much as 50% of medicines in the Sahel are of poor quality. In rural areas, the problem is particularly acute. Lengthy supply chains and multiple storage points increase the risk of medicine degradation, while the lack of access to medicines in public facilities can lead to out-of-pocket purchases from potentially unlicensed private facilities, where the quality of medicines is often questionable.
In response to these challenges, entrepreneurs in Africa are developing innovative technologies and business models that have the potential to improve the quality of medicines. For example, mPharma, a Ghanaian startup, connects to the pharmaceutical sector to reduce costs and improve patient care. Shelf Life and MaishaMeds are utilizing technology and "pay-as-you-sell" consignment inventory models to help retail pharmacies forecast and optimise inventory, reducing medicine expiries. RightePharmacy is revolutionising access to medicines with medication-automated teller machines (ATMs). mPedigree and Sproxil have developed mobile authentication systems to verify the authenticity of medicines and detect falsified products.
Despite these promising developments, the current literature reveals a scarcity of specific research on the impact of these technological innovations on medicine quality. This gap in research represents a hurdle for crafting policies that enhance medicine accessibility. While some studies have explored the financial and accessibility aspects of these channels, the literature on their effect on medicine quality remains sparse. This paucity of data potentially hinders policy initiatives aimed at improving medicine accessibility.
To address this gap, I investigated the quality of commonly used antimalarial (sulfadoxine/pyrimethamine) and antibiotic (amoxicillin) medicines available in pharmacies supplied by innovative pharmacy chains and those in independent pharmacies served by traditional supply chains in Zambia. Using a mixed-method approach that included standardised surveys, key informant interviews, and laboratory analyses of medicine samples, I aimed to determine if innovative pharmacy outlets provided better quality medicines than traditional independent pharmacies.
Key Findings
The good news is that no falsified medicines were detected in the samples analyzed. However, there were some inconsistencies in the content analysis. Notably, 63% of amoxicillin samples did not meet the standards in content analysis, although all samples conformed to the United States Pharmacopeia (USP) tolerance limits for bioavailability. Interestingly, there was no statistically significant difference in medicine quality between samples purchased from the innovative and traditional independent pharmacies.
The research also revealed that innovative pharmacies, characterised by more streamlined supply chains, adopted digital record-keeping and better transportation practices. However, gaps in professional training and storage practices were evident in both types of pharmacies, indicating that innovation alone is not a panacea. These findings align with previous research in other African countries, such as Nigeria and Kenya, which have highlighted the importance of comprehensive quality assurance systems and regulatory oversight.
The Potential of Innovative Distribution Channels
Despite the lack of a significant difference in medicine quality between innovative and traditional pharmacies in the Zambian case study, this research underscores the potential advantages of incorporating innovative distribution channels to ensure the consistent delivery of good-quality medicines to patients across Africa. By combining these innovative strategies with the established trust in traditional pharmacies, we could develop a novel approach to mitigating the challenges of poor-quality medicines on the continent.
To further enhance medicine quality, several steps should be taken. Firstly, it is essential to strengthen regulatory frameworks to ensure robust oversight and maintain high standards of medicine quality. Secondly, continuous professional training should be provided for pharmacy staff to improve storage and handling practices. Lastly, leveraging technology by expanding the use of digital tools for inventory management and quality tracking will be crucial.
Conclusion
The issue of poor-quality medicines in Africa is a complex one, requiring a multi-faceted approach. While innovative pharmacy distribution channels alone may not be the solution, they offer a promising avenue for improving medicine quality and access. By continuing to investigate and invest in these innovations, while also addressing gaps in professional training, storage practices, and regulatory oversight, we can work towards a future where everyone in Africa has access to the safe and effective medicines they need to lead healthy lives.
For a more detailed exploration of this research, please refer to my published thesis.
This blog post was inspired by my PhD thesis submitted to the London School of Hygiene and Tropical Medicine, funded by the Commonwealth Scholarship Commission.