Thursday, May 8, 2008

An AFM study about low quality drugs in Africa

Dear Colleagues

The following message was recently circulated by Africa Fighting Malaria (AFM). It describes a study about the quality of drugs being distributed in various places in Africa.

The quality of the drug supply in Africa has been in question for a very long time, and surprisingly little has been done about it. The Tr-Ac-Net view of this is simply that little changes when there are financial benefits in the status quo.

This is what AFM circulated.
Dear colleagues,

AFM's study of antimalarial drug quality in six major African cities is now live on PLoS One:

Reuters India has provided a nice summary:

I'm copying the study abstract here for your information. Please feel free to contact me directly for more information.

Abstract: A range of antimalarial drugs were procured from private pharmacies in urban and peri-urban areas in the major cities of six African countries, situated in the part of that continent and the world that is most highly endemic for malaria. Semi-quantitative thin-layer chromatography (TLC) and dissolution testing were used to measure active pharmaceutical ingredient content against internationally acceptable standards. 35% of all samples tested failed either or both tests, and were substandard. Further, 33% of treatments collected were artemisinin monotherapies, most of which (78%) were manufactured in disobservance of an appeal by the World Health Organisation (WHO) to withdraw these clinically inappropriate medicines from the market. The high persistence of substandard drugs and clinically inappropriate artemisinin monotherapies in the private sector risks patient safety and, through drug resistance, places the future of malaria treatment at risk globally.

Philip Coticelli
Africa Fighting Malaria
My own observations of drug distribution in Africa go back to the early 1980s. Originally I did not give much credence to the "stories" about the dumping of out of date drugs in African markets ... so over the course of many months I took every opportunity I had to visit store rooms in hospitals and clinics to see for myself. The outcome of this was that I rarely found any drug that was within date ... and in general the drugs, many of which were labelled "store in a cool place" were in store rooms where the temperature was around 100 degrees F.

It is now 20 years later ... and for all practical purposes the situation is as bad as ever. There is a problem not only in the fact that there are unsatisfactory drugs being distributed, but that there is a dysfunctional system that has allowed this to go on for a very long time, and still not much happening to end the bad practices.

This, of coure, is the raison d'etre for the Transparency and Accountability Network ... to help get important changes made so that there can be sustainable progress ... and to deploy Community Impact Accountancy so that the socio-economic outcomes of profitable bad practices can be part of a universal set of performance metrics.


Peter Burgess

Tuesday, April 29, 2008

CareShop Ghana ... what about follow through?

Dear Colleagues

I very much liked the case study prepared by Joel Segre and Julia Tran about the Ghana Social Marketing Foundation Enterprises Limited (GSMFEL) initiative to build a CareShop franchise system in Ghana. But while I liked the case study, I am bothered by the fact that the initiative has serious financial constraints that will probably result in its demise unless something different happens. I posted this comment on the WRI blog:
The case study of CareShop Ghana is, in my view, well done ... but the value of the study is only going to be realized if there is appropriate follow through.

But it is far from clear that there will be appropriate follow through ... the global health system and the international development assistance community are good at studies and writing reports, and not so good at turning the issues raised and the recommendations into action that solves the problems. The issues are big and the funding available limited, and frequently allocated to low impact work.

The issue of drug supply has been around since I first working in the development arena 30 years or more ago ... some of the issues are far worse now than in earlier times, including the sophistication of the drugs and the counterfeits.

My organization has a big concern over sustainability ... and has developed the concept of Community Impact Accountancy (CIA) to help the donor community appreciate the social good that is being created by some organizations that are having difficulties with their financial sustainability.

If CareShop Ghana were the subject of CIA reporting, it might well be a slam dunk for it to get the funding it needs to keep going ... with GAAP reports the raison d'etre for the initiative is totally ignored, which, we would argue, is pretty silly.

Peter Burgess
While I am not in possession of all the facts, the report and the rather modest amount of financial information suggests that while the initiative is in financial trouble, the initiative is delivering a massive social benefit and its community impact is huge.

It would be interesting to do Community Impact Accountancy (CIA) around the CareShop initiative ... and my understanding of the situation suggests that a CIA report would show that the CareShop impact justifies its work.

Note that CIA is an accountancy framework ... not monitoring and evaluation (M&E) ... and not ad-hoc study. What CIA does is to provide for society at large, the public, the people ... a system that enables resources to be better allocated to activities that are efficient and deliver important benefits to society.

This could be a good area for the deployment of CIA.

Please contact me for further information.


Peter Burgess

Health is being compromised by bad drugs

Dear Colleagues

Health is being compromised by bad drugs ... and relatively little is being done about it. There is reference to the problem in many of the academic papers written about health in developing countries, but rarely is anything written about steps being taken to improve the situation.

Knowing more about the scale of the problem is interesting ... but more important is getting to know more about actual progress in addressing the problem and improving patient access to the right drugs in the right strength and purity.

Hopefully Tr-Ac-Net can make some progress on this matter in the time ahead.


Peter Burgess