Ever since the high tech generic drug production facility, Cinpharm-Cameroon, was set up, it is has become relatively easier for Cameroonians to access medicine. Now, a low wage earner can access a course of antibiotics at a lower price than their Kenyan counterparts.
According to the World Health Organisation (WHO), a 7-day course of treatment with ciprofloxacin could cost close to a month’s wages in Kenya. Unfortunately, this scenario is not uncommon across Africa. In Uganda, it could cost about 11 days worth of household income to purchase a single course of Artemisinin – a combination therapy used to treat malaria for a child under five.
Africa carries 25pc of the world’s disease burden, but consumes less than one percent of global health expenditure. It manufactures less than two percent of the medicines it consumes.
Over 70pc of the world’s HIV/AIDS cases and 90pc of the deaths due to malaria currently occur in Africa. In addition, the continent bears 50pc of the global deaths of under fives, mainly due to neonatal causes, as well as pneumonia, diarrhoea, measles, HIV, tuberculosis and malaria.
The tragedy is that these diseases are treatable: most related deaths could be prevented with timely access to appropriate and affordable medicines.
Africa’s capacity for pharmaceutical research and design (R&D) and local drug production is amongst the lowest in the world. The problem of inadequate investments in this area, unfortunately, continues.
Overall, 37 African countries have some pharmaceutical production, although only South Africa produces some active pharmaceutical ingredients. Where there is local production in Africa, normally there is a reliance on imported active ingredients.
As a result, the supply of African pharmaceuticals remains highly dependent on foreign funding and imports. The pharmaceutical market in Africa is now 70pc imported. According to trade data, India alone accounted for 17.7pc of African pharmaceutical imports in 2011. Estimates further suggest that more than 80pc of antiretroviral drugs (ARVs) across the continent are imported.
The poor access and affordability of medicines is compounded by factors that include the long lead times for international orders and infrastructure gaps, such as poor logistics and storage capacity, as well as high transport and distribution costs. In addition, there have been scarce public finances and deficient public health procurement systems.
It is estimated that there is a scarcity of essential medicines, both in the public and private sector. People are also often being forced to buy medicines that may not be certified.
Many African governments spend a disproportionate amount of their scarce resources on procuring medicines. For instance, in 2006, Mali and Burundi, spent 2.3pc and 2.9pc of their gross domestic product (GDP), respectively, on such imports.
Trends now indicate that new health challenges facing the continent will generate increased demand. Non-communicable diseases, like heart disease, lung disorders, diabetes and cancer, are rising due to demographic and lifestyle changes. These conditions will account for half the deaths in Africa, surpassing those provoked by infectious diseases.
An additional difficulty results from the excessive use of originator brands, with much higher prices than the lowest-priced generic equivalents. To add to this concoction, the poor quality of drugs and their regulation not only fuels illicit transactions, but also contributes to health problems.
To pave a sustainable path for Africa’s health systems, scaling-up pharmaceutical production is essential. It can increase the share of the population with access to vital medicines, including within rural areas, at a lower cost.
Better health is central to people’s opportunities and contributes to an increase in productivity. The economic cost of disease is well known, for both families and the national economies.
The direct and indirect impact of malaria alone is estimated at 12 billion dollars of African income annually. The local production of medicine is possible and has become imperative.
With economic growth projected to keep growing and the continent pursuing an agenda for economic transformation, there is a huge market opportunity. Local manufacturing would create modern jobs, stimulate economic activities and, in many ways, increase productivity.
The pharmaceutical industry involves legal, scientific, technical, fiscal and financial aspects. In order to step up their production capability, countries need to tackle challenges on a variety of fronts. These range from R&D and exploring the full utilisation of the Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, tax and tariff policies, drug regulatory and registration systems and, of course, building infrastructure.
In some pockets of the continent, predominantly in North and South Africa, the status of local pharmaceutical products manufacturing has gained a sturdy foothold. For example, Egypt and Tunisia produce most of their national requirements for essential medicines.
Morocco, the second largest African pharmaceutical producer, after South Africa, has 40 pharmaceutical industrial units supplying 70pc of domestic demand and exporting 10pc of their production, predominantly to neighbouring African countries. Significant production capacity is being developed and enriched in Tanzania, Kenya, Uganda, Ethiopia, Ghana and Nigeria. Mozambique has just commissioned an ARV plant with the help of Brazil.
Africa hosts some of the leading global innovators and generic manufacturers. Starwin in Ghana, Saidal in Algeria, Universal in Kenya, Aspen in South Africa and Cipla in Nigeria are all home grown manufacturers. This just demonstrates that Africa is producing medicine that meets international standards.
In order to enhance the pharmaceutical industry, there is a need for fewer structures and the harmonisation of policies through regional integration. Intra-Africa trade offers the prospect of strengthening and better exploiting regional supply chains and expanding economies of scale. This would also make larger investments attractive.
To be able to generate wealth and give its future generations a chance, Africa must take ownership of its health.
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