Comment: Race is on to find affordable health

Scotlands new testing facility for viral haemorrhagic fevers in action at the Royal Infirmary in Edinburgh. Picture: Lisa Ferguson

THE Ebola epidemic sweeping western Africa has concentrated minds on effective healthcare spend, particularly in the context of international aid.

With more than 8,000 deaths from the disease to date, questions are inevitably being asked about whether more could have been done earlier to prevent the current crisis.

Many aid agencies in Scotland have worked with the Department for International Development (DfID) and the Scottish Government to strengthen health delivery systems in developing countries. The DfID’s recent inquiry “Strengthening Health Systems in Developing Countries” notes that, spurred on by the millennium development goals, considerable progress has been made in this area by DfID and aid agencies. However, the report also highlights that further progress is needed to ensure greater efficiency, tackle non-communicable diseases and move countries towards self-sufficiency.

Access to medicines is paramount but relies on both supply and distribution working well. Which should be prioritised? And what is the role of locally-based pharmaceutical companies in providing safe, efficient, affordable and high-quality medicines?

The Open University is exploring these questions and researching how money could be spent more effectively on healthcare in two developing countries – South Africa and Zimbabwe. As in many nations, healthcare systems in South Africa and Zimbabwe are facing sustained pressure from changing regulations and an influx of patients demanding the same or better-quality care.

At present, up to 70 per cent of Africa’s need for medicines is covered by imports. In addition, although it has 14 per cent of the world’s population, Africa produces only three per cent of the world’s medicines.

Therefore, to meet health targets in Africa – and to satisfy the envisaged growth in the continent’s medicines market – a good place for aid agencies to start might be strengthening the capacity of local producers of medicines. However, it is expensive to set up and sustain local manufacturing plants.

Also, in the absence of guaranteed local markets and good distribution services, the benefits of producing medicines locally may not be fully realised.

Some argue that “health dollars” would therefore be better spent on strengthening logistics and delivery systems to ensure that any medicines (produced locally or imported) are delivered more efficiently to hospitals, clinics and other outlets. The majority of developing countries face constraints in terms of the extent to which health products can be brought to patients, or patients brought to health products. For example, in South Africa and Zimbabwe, getting all deserving patients on to HIV/AIDS treatment programmes can be challenging due to people being located in hard-to-reach rural areas.

For the current Ebola epidemic in West Africa, an effective cure – whether produced locally or imported – would have saved lives, but the success of an effective cure would also have hinged on healthcare and wider system preparedness. So regardless of where the products are produced a “good distribution practice” is indispensable.

It has also been argued that resource-poor African countries should prioritise strengthening their regulatory and governance systems, which would result in more local pharmaceutical manufacturing, leading to positive impacts on health system performance, equity, affordability and low-cost access to medicines and other medical products.

Keeping up with production costs is proving difficult, especially with outdated equipment and the reality that, for many companies, their product range requires them to buy active pharmaceutical ingredients from competitors in India and China.

How African countries meet their need for medicines, especially medicines that multinational companies may not consider profitable, is a daunting challenge. Aid agencies have played – and continue to play – decisive roles in the supply of medicines to patients in Africa, both during emergencies and through programmes aimed at strengthening health systems. Yet, new thinking and innovations in the way medicines are distributed, driven by local realities and experiences, may well be what African countries need most.

When this is working properly, local manufacturers may be able to leap back into producing medicines – and be in a better position to compete.

• Dr Julius Mugwagwa is Research Fellow at INNOGEN, a partnership between The Open University and The University of Edinburgh.

open.ac.uk/scotland