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Addressing the critical challenges of medicine supply chain in Africa’s public health sector

The medicine supply chain – the elaborate pathway between a medicine leaving the manufacturer and being dispensed to the patient – is often a ‘hidden’ element within healthcare systems, with middlemen sitting in the middle and playing a critical role in ensuring a constant supply of high quality medicines to the medical front line.

Any functional health system requires supply chains that can ensure a consistent flow of affordable, good-quality medicines, vaccines and other medical products at every level of the health service delivery points.

Unfortunately, across Africa, the medicine supply chain faces severe constraints resulting in critical bottlenecks in the movement of essential medicines from manufacturer to end-user. Although Africa is a continent ripe with potential, the challenges for developing a viable medicine supply chain are formidable, with distribution being consistently one of the largest challenges.

Although Africa is a continent ripe with potential, the challenges for developing a viable medicine supply chain are formidable, with distribution being consistently one of the largest challenges

With the COVID-19 pandemic revealing the critical need for a robust, efficient, and effective medicine supply chain on the continent, Africa must take on this challenge as a top priority in the health sector and urgently develop innovative, cost-effective strategies to strengthen the supply chain.

Challenges of medicine supply chain in Africa

The medicine supply chain is one of the most complicated as it relies heavily on infallible temperature control, meeting stringent border regulations across regions, and logistics systems that assure the integrity and security of the products throughout the entire process.

A single loose link in the chain could mean that essential medicines are rendered unusable or even potentially dangerous, exposing patients to the risks of substandard and falsified medicines, with negative effects on public health. Also, inefficient supply chains significantly increase the final price of medicines to patients, hurting family finances in the largely out-of-pocket private market for medicines.

The medicine supply chains in sub-Saharan Africa (SSA) have over the years faced many challenges, which have impacted negatively on the performance of the chains. These challenges include but are not limited to poor infrastructure, weak regulatory systems, disruptions, corruption, counterfeit and expired drugs, cold-chain shipping, and stock-outs.

Poor infrastructure, such as under-developed road networks and unstable electricity supply, has been identified as a significant structural barrier in the medicine supply chain in African countries.

This is critical as the absence of stable power sources has significant consequences for supply chains, especially the cold chains which rely on uninterrupted electricity for the storage and potency of thermolabile products like vaccines and biologics.

Weak regulatory systems are a critical challenge, and give rise to poor quality medicines in the supply chain. As high as 90 percent of national medicines regulatory authorities (MRAs) in SSA are unable to effectively discharge their basic regulatory functions.

Also, the chaotic drug distribution system in Africa allows for an easy occurrence of fake, counterfeit, and expired drugs in the medicine supply chains.

Among other consequences, these challenges result in significantly high-level stock-outs across health facilities, reducing the net quantity of medicines available to patients and hence weakening the overall quality of healthcare in Africa.

Strategies to strengthen medicine supply chain in Africa

Considering the complexity of these challenges, a multi-stakeholders’ approach involving policymakers, public and private sectors, and financial institutions are required. In view of these, Bloom Public Health recommends the following strategies to strengthen the medicine supply chain across Africa:

Strengthening medicines regulatory authorities and the adoption of innovative screening technologies for combating counterfeit medicines: Given the critical role of MRAs in ensuring compliance to stringent quality standards across the medicine supply chain, African governments must invest in the strengthening of their MRAs to meet the WHO Global Benchmarking Tool (GBT) Maturity Level 3. This feat has been achieved by only four African countries; Ghana, Tanzania, Egypt and Nigeria.

MRAs can also leverage on screening technologies in field-testing to provide on-site and in-time results. These field kits offer MRAs fast and reliable means of detecting counterfeit medicines in the field and removing them from the medicine supply chain.

• Leveraging public-private partnerships (PPPs) to complement public sector efforts: Leveraging PPPs can help overcome the financial, technical, and human resources limitations in the medicine supply chain.

A good example is the Health Supply Chain Transformation Project Consortium comprising Bloom Public Health, Zipline, HealthSpaces, and Sterling Bank, which has partnered with the Ebonyi State Government to implement an innovative healthcare supply chain system in Ebonyi State. The Consortium is also in an advanced discussion with several other states to scale up its supply chain interventions across Nigeria.

• Adopting technology-enabled systems to expedite last-mile delivery: Addressing the difficulties in transporting medicines to health facilities, particularly in remote areas with poor road networks, can be tackled by adopting last-mile aerial delivery of drugs.

Bloom Public Health’s partner, Zipline, has transformed healthcare worldwide through automated, on-demand delivery using drones that travel up to 100 km per hour at a time, reducing delivery time from hours by road to minutes.

Conclusion

Efficient and effective medicine supply chains are vital to the delivery of safe, quality, and affordable health services. Addressing the critical challenges confronting Africa’s medicine supply chain is therefore a non-negotiable pathway to achieving better healthcare in Africa towards universal health coverage.

Anyakora is the CEO of Bloom Public Health and a public health expert, and Odibeli is a pharmacist and the research and communications coordinator at Bloom Public Health

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