As a Procurement and Supply Management (PSM) officer, when Chukwunonso Umeh began his search for a vendor who could supply some of the life-saving commodities needed for a project he was working on, one organisation ticked all his boxes. His project is helping to accelerate nutrition results in Nigeria and aims to increase utilisation of quality, cost-effective nutrition services for pregnant and lactating women, adolescent girls, and children under five years of age. His organisation, Clinton Health Access Initiative (CHAI) is delivering a component of the project in 18 local government areas in Kano State.
Their intervention requires the delivery of medications and health commodities such as micronutrient powders, iron-folic acid, malaria medicines, zinc/oral rehydration solutions, vitamin A supplements and worm medications. Beyond the timely administration of these medicines, it was important to ensure they were of good quality while offering the best value for money. This is a problem that Drugstoc, a cloud-based platform that makes it easy for healthcare providers to access pharmaceutical and healthcare products, was set up to address.
Addressing fragmentation and quality
Nigeria is heavily dependent on imported pharmaceutical imports. The sustained underinvestment in building up the scientific research architecture that would have enabled the country to have a more thriving pharmaceutical manufacturing industry was not prioritised. Pharmaceutical imports to Nigeria reached an estimated $1.56 billion in 2020. The industry however, faces multiple challenges, ranging from the circulation of counterfeit and sub-standard medications to broken and fragmented procurement and distribution mechanisms. The consequences of these challenges are preventable deaths. A 2017 research by the World Health Organization revealed that an estimated 1 in 10 medical products circulating in low- and middle-income countries is either substandard or falsified.
With countries still working to achieve Universal Health Coverage (UHC), substandard medications will hamper their progress because quality is an important pillar of UHC. When these medications enter the global supply chain, the result is socioeconomic loss and damage to health, disease prevalence, antimicrobial resistance, wastage of resources, and increased out of-pocket spending on medical treatments, said the WHO. This prompted the WHO to pass resolution WHA 65.19 in 2012 to establish a Member State Mechanism to address substandard and falsified medical products. But beyond a global push to address this problem, local, private sector led institutions like DrugStoc are also tackling it in innovative ways.
For DrugStoc, it goes beyond ensuring that end users get quality medications. The big problem they set out to address is fragmentation in the pharmaceutical sector which directly affects the supply chain ecosystem, said Chibuzo Opara, DrugStoc’s Chief Executive Officer (CEO) and co-founder. Fragmentation causes three key challenges:
- Quality of medicine issues due to the importation of counterfeit and substandard medications.
- Pricing issues: Because of several middlemen involved, product prices can be between 100 to 200 per cent higher than normal depending on where you buy.
- Access issues where patients and healthcare providers find it difficult to access lifesaving medications.
According to Opara, “this fragmentation is such that the manufacturers in the upstream of the supply chain are not communicating well with the last mile. What that means is that products move between several middlemen and the wholesomeness of the product can’t be guaranteed”. And considering that pharmaceuticals such as thermolabile maternal medicines lose their potency when they are not handled in the right conditions, it becomes even more important to ensure that the supply chain is seamless, from the point of production till it gets to the patient. When this doesn’t happen, “at best, the medication doesn’t work when administered to the patient but at worst, you will be giving the patient a poison,” Opara said. The situation is also complicated by people who go out of their way to produce and introduce into the supply chain counterfeit medications, Opara added.
With DrugStoc, all a healthcare provider or pharmacy needs to do is visit the online store, create an account if they are a first-time user, access the wide array of medications, place their order, and wait for delivery. All these can also happen via a mobile app that is available on play store and Apple Stores.
But it didn’t all start this way, Opara said. He met his now co-founder and co-CEO, Adham Yehia, at Maastricht University in the Netherlands. Being responsible for managing health facilities, they encountered issues around delays in sourcing pharmaceutical products, price fluctuations and uncertainty in quality when dealing with several variations of a product. So, their biggest pain points were how to ensure the availability of the products, ensure they are cost-effective and of the best quality. Thus, DrugStoc was created to address these issues. Opara said they initially started with excel sheets before they pivoted to a completely online platform. Now, they empower healthcare providers with direct access to quality medications including hard-to-reach products.
Prioritising client needs
CHAI represents just one out of the over 3000 healthcare facilities and organisations that DrugStoc has worked with. According to Umeh, “engaging DrugStoc saves me the headache of sourcing for the required commodity. It’s their job. Just that I will pay some mark-up for their services and have them still deliver the commodity to me”. He doesn’t mind paying an extra fee for their services to ensure he gets value for money. For him, the platform is like Jumia or Amazon, only it’s for healthcare products. Like these online stores, all he does is log onto the platform, makes his choice based on specification, quality, and price. Once he pays, the products will be delivered to him. However, sometimes they can be slow in securing the required commodity during the sourcing process. “I think if they can build a pool of suppliers across different brands and stock keeping units, it will shorten their time of response if the need arises,” he said.
DrugStoc has obtained ISO 9001:2015 certification, which means, among other things, they have demonstrated their ability to consistently provide products and services that meet customer and applicable statutory and regulatory requirements. “The most important person in the ecosystem is the client,” said Opara so, “it’s important that we continue to focus on what the client wants because you keep your business going by continuously delighting the clients.”
Not a walk in the park
Basic social amenities like good road networks and uninterrupted power supply are still lacking in most Nigerian states and this poses infrastructural challenges for DrugStoc’s operations, said Opara. In addition, lack of access to finance on the part of some hospitals or pharmacies is another challenge but they have launched a credit financing product — DrugStoc Credit — to address this. Out-of-pocket payment for healthcare is also another challenge as this causes patients to place more premium on cost over quality.
But despite these challenges, DrugStoc’s work is critical in supporting government’s efforts to ensure that every Nigerian, no matter who they are and where they live, have access to medications that can achieve the purpose for which they were produced — save lives.