Even in the most remote parts of Kenya, there are little shops that sell sodas and mobile phone cards. But too often, the pharmacies of the nation's clinics and public hospitals are empty.
Innovative rural distribution channels are working for Coca-Cola and a new Johns Hopkins study suggests these same methods can work for the distribution of essential medicines.
According to a World Health Organization technical report, “essential drugs are those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms, and at a price that individuals and the community can afford.” To see what makes the cut, check out WHO’s current essential medicines list.
This past May, the pharmacy shelves in Kenya remained bare as the staff awaited a delivery of essential medicines from the national government that was already weeks late. While essential and lifesaving medicines weren't available, junk foods and sodas were.
This is not just a problem in Kenya, but throughout the developing world. Scarcity of basic medicines, health products, and clinicians is an ongoing issue for poor countries with struggling public health systems. In fact, Save the Children published a report this month which claims that "40 million children under five in 25 developing countries live in 'healthcare deserts' where they are deprived even of the most basic health services." In a similar report, the World Health Organization estimates that 30 percent of people worldwide lack dependable access to essential medications — in the most impoverished regions of Africa and Asia, it's 50 percent.
Students at Johns Hopkins Bloomberg School of Public Health's International Vaccine Access Center have taken notice, releasing a study comparing public and private sector distribution structures and how these sectors might collaborate to increase equitable access to medication and health products. “Companies selling soda and mobile phone cards work in the same hard-to-reach markets in Sub-Saharan Africa as essential medicine distributors,” Kyla Hayford, a doctoral student who coauthored the report, explained to Science Daily, “but they have been far more successful at modifying their systems and aligning incentives to overcome distribution barriers.”
Coca Cola, for example, has developed “manual distribution centers” in East Africa that depend on bicycles and carts to deliver crates of sodas to remote and inaccessible outposts. In some places without passable roads, this distribution system accounts for more than 95 percent of sales, according to the IVAC report. Manual distribution could bring vaccines and antibiotics to these isolated communities, too. Mobile clinics and vaccine distribution do exist in places like rural Kenya but they are informal and often spearheaded by a determined health worker or small group of dedicated community health volunteers.
The IVAC study cites that more than 50 percent of hospitals studied in Kenya did not have vital broad-spectrum antibiotics at any given time. Further, Kenya is not just any developing country, but an economic forerunner in Africa with an economy that grew a promising 5.6 percent in 2010, according to moneycontrol.com.
For the IVAC and many others, getting medicine to the developing world is a matter of distribution, distribution, distribution. Public-private partnerships that involve "sharing knowledge, sharing infrastructure, generating appropriate performance monitoring metrics, and investing in product innovation" can help fix this, the study concludes.
But it's no coincidence that vaccines and antibiotics have such a hard time getting to market. The global health system has no arrangement to incentivize their development, production, or distribution. True health equity also requires financial commitments to research and develop lifesaving drugs. Next, they must be produced and sold at prices accessible to the average person in poor countries.
A recent article from The Guardian outlines some ideas about how the poor can become viable consumers and consequently influence the supply-and-demand chain for essential medicines. Poor clientele in developing countries could afford to pay the price of medications in a competitive market with generic production. However, the current system prevents this by allowing companies to patent brand-name drugs and maintain monopolies on their production, often for long periods of time. Instead, The Guardian suggests “annual reward payments based on the product's health impact” be given out to alter the incentive scheme and favor more pro-poor medicine development. If implemented, this policy would reward the research and development of life-saving and essential medicines — those with broad-reaching global health benefits — rather than specific and non-essential medicines which treat the minor ailments of advanced industrial societies.
Increasing access to essential medicines and technologies could prevent and cure diseases for millions in the developing world. The solution is not simple; it’s not just distribution. What makes commercial distribution so effective has to do with profitability and there is no profit to be had in the public health sector. Similarly, the impetus for new drug development depends on what has the potential to make the most money and not necessarily what will save the most lives. But if these techniques can be appropriated and incentives redirected for the greater good rather than profit, the benefits will be tremendous.