The youngest population in the world, a median age of less than 20 years, nearly one billion people… Universal access to health care is becoming an important part of the discourse on Africa’s development.
The African continent has the youngest population in the world, with a median age of less than 20 years. The number of inhabitants is approximately one billion. The land area is immense and has the richest reserves of natural resources. It promises an economic strength that could reach, if not surpass, that of China by mid-century. Since the second half of the twentieth century, Africa has entered an era of accelerated economic development. Social development and rights and freedoms are making remarkable progress, even though situations remain very disparate across the continent.
Life expectancy, education levels, and GDP per capita have been on the rise since 2015 across sub-Saharan Africa. Industrialized countries now better understand the fact that humanity is indivisible. This growing awareness is allowing African efforts to gain more support.
In particular, equitable access to health care for Africans has become an important part of the global discourse on the continent.
We want to stimulate this conversation, present our analyses and share a vision that, without ignoring the systemic aspects of the situation, allows for the development of strategies that bring the public and private sectors together.
OBSTACLES DE PREMIER PLAN
LE PROBLÈME DE L’ACCÈS AUX SOINS
The UN member countries want to achieve Universal Health Coverage (UHC) by 2030. To understand the challenges in Africa, we need to see what UHC is and compare it to the reality on the ground.
The World Health Organization (WHO) describes UHC as. “All individuals have access to health services without incurring financial hardship.” This requires a robust health system, as well as universal access to medicines and medical technologies. This requires a robust health system, universal access to medicines and medical technologies, sufficient numbers of health workers, and affordable treatment. The challenges of the health system, human resources, and cost will be discussed later. In urban areas of French-speaking Africa, populations have relative access to essential health products. There is some road infrastructure, clinics and hospitals with a drug supply system, and city pharmacies.
However, one of the challenges remains the reliable supply of quality medicines.
Globally, Africa produces 3% of pharmaceutical specialties. This share of the world market, when spread over the continent’s population, represents about 10% of local consumption. Of course, the authorities must work to improve conditions to make local pharmaceutical manufacturing safe and attractive to investors. However, this will take time, especially in English-speaking West Africa, which is lagging behind the English-speaking countries of Central and Eastern Africa. Cette part du marché mondial, une fois répartie sur la population du continent, représente environ 10% de la consommation locale. Bien sûr les autorités doivent travailler à améliorer les conditions pour rendre la fabrication pharmaceutique locale sûre et attractive pour des investisseurs. Il faudra néanmoins encore du temps, notamment en Afrique de l’Ouest francophone qui présente des retards par rapport aux pays anglophones du Centre et de l’Est.
90% of needs are covered by imports, in a physically huge but commercially very fragmented market. Volumes per country remain low on an industrial scale, in relation to the profitability thresholds required to ensure compliance with international manufacturing and quality standards.
In a patient-oriented approach, the availability of medicines at all times is fundamental. It is difficult to avoid disruptions, despite the distances involved, geopolitical risks and compliance with international business rules, etc. To achieve this, sufficient quantities must be purchased, stored and delivered under the right conditions while ensuring optimized risk management at all levels.
The solution today involves several levels of intermediaries between the manufacturer and the patient, at the local (pharmacy), national (wholesaler) and continental (distributor) levels. Each of these levels induces an unavoidable cost but ensures product availability and risk fragmentation. These costs are in fact offset by the economies of scale that are created by grouping products, orders and deliveries. This implies optimizing logistics costs (order preparation and transport), which weigh significantly on the final price of the drug. Obviously, in compliance with the strictest pharmaceutical standards.
In the future, the reduction in the number of intermediaries will be a natural evolution and one that is expected by the population and their leaders. The distribution structures will be vertically integrated and a mutualization of purchases on the scale of chains of sales outlets will have a continental scope.
In rural areas, the infrastructure, when it exists, is often outdated or not maintained due to lack of adequate financial means. Some nomadic peoples can cross three or four countries in one year. Territories larger than France are practically inaccessible. The problem of getting care to the patient or from the patient to the care is of continental proportions: 600 million Africans living in rural areas have little or no access to the quality care they need.
This proposal does read “quality care”. As obvious as this may seem, it is unfortunately not always the reality on the ground.
THE SCOURGE OF COUNTERFEITING
Globally, the market for counterfeit medicines has an estimated “value” of 2 billion euros per year. Africa carries 42% of this burden, or 850 million euros.
La traduction concrète de ces chiffres ? Chaque année, les faux médicaments tuent des centaines de milliers d’Africains (entre 150.000 et 500.000 selon les sources) et les enfants constituent la population dont le risque est le plus élevé.
It is time to put an end to these murderous activities.
Il peut s’agir de copies de médicaments légitimes mais qui ne contiennent que des excipients divers et pas en quantité exigée les principes actifs requis dans la composition. On trouve aussi de vrais médicaments mais prescrits ou délivrés pour des pathologies très éloignées de leur usage validé. Par exemple, les faussaires substituent souvent de l’acétaminophène aux vrais principes actifs des antipaludiques, ce qui bien entendu est beaucoup plus lucratif. La contrefaçon existe donc sous de multiples formes.
One constant, however, is the size and power of the organizations behind these crimes. A single police operation in 2017 resulted in the seizure of 420 tons of fake drugs in seven West African countries. It is impossible to produce such quantities without a structured criminal organization with multi-layered protections.
One could therefore conclude that counterfeit drugs are a problem reserved for the legislator and the police and justice forces. Certainly, these actors have a leading role. However, this observation should not become the justification for a generalized inaction.
La stratégie est simple : augmenter les coûts et les risques de la fabrication de faux médicaments jusqu’à ce que les faussaires abandonnent cette activité. L’appui de toutes les forces vives de la société est nécessaire. Il faut promouvoir et soutenir trois piliers de la stratégie. Premièrement, renforcer le dispositif juridique. Deuxièmement, améliorer la pharmacovigilance. Troisièmement, mettre à contribution les progrès des technologies numériques pour impliquer et éduquer le consommateur.
This deployment of new technologies can have an immense and very rapid impact, as demonstrated in other sectors. For example, the development of mobile applications that validate the origin, route, composition or efficacy of a drug is particularly interesting because these applications can be deployed at the pharmacy or to the end user: the patient.
L’approche technologique permet de multiplier le nombre de personnes qui luttent contre les faux médicaments de façon exponentielle et d’atteindre des nombres que les organisations criminelles ne pourront pas contrer.
It is therefore possible to find solutions to these complex problems. We believe that the whole issue of health in Africa lends itself to this approach, which first requires a change in mentality and a willingness to act.
Promote access to quality health products for as many people as possible.
We believe that equitable access to healthcare on the continent will be achieved through the development of a group that will integrate a distribution activity for Africa, representing a broad portfolio of manufacturers and healthcare products, while at the same time integrating the design and deployment of innovative retail solutions that promote a localized customer journey adapted to the populations.
It is precisely the project carried out by PIEX GROUP, supported by solid financial partners, that will be ideally positioned to help promote access to quality health products for the greatest number.