I have always wondered if as a society we are really interested in the quality and standard of healthcare we receive. A number of factors have created this uncertainty in my mind. Primary amongst them is the level of coverage healthcare gets on print, social and electronic media. Last week, the Minister of Health inaugurated the National Medicine Price Committee (NMPC) to oversee the pricing system of medicines and other health technologies in Ghana; a committee whose work in my view will impact every single one of us. Yet, I can confidently say that most of us were not aware such an event took place.
The question of drug pricing is one that we cannot ignore. According to McKinsey and Company, as much as 70 to 90 per cent of drugs consumed in most countries in sub-Saharan Africa are imported. I will be surprised if the situation in Ghana is any different. Research on supermarket products published recently by international research and advisory firm, Konfidants indicated that, in Ghana, 82 per cent of all products were imported; with about 94 per cent of cosmetic and beauty products (the closest in retail by category to medicines) being imported.
This situation has a significant impact on how much we pay as end-users for medicines especially in countries where exchange rate fluctuations are rife. Compounding this further is the fact that with this high percentage of pharmaceutical imports, the likelihood of falsified medicines entering our markets is enhanced considerably. Putting these two pain points together means that we should be actively involved in conversations around how much we pay for our medicines, where they are obtained from and who decides these.
This situation has a significant impact on how much we pay as end-users for medicines especially in countries where exchange rate fluctuations are rife.
Considering that many complain about the cost of medicines locally, I have been trying to understand why we show this much apathy to matters relating to health. My inquisition led me to a quote used to characterise a society’s response to crime. To paraphrase, if a society is exposed to crime, in the first instance, many are appalled. If the exposure continues, they find ways to avoid criminal tendencies. However, with constant crime exposure, they become accepting and even justify why the status quo will not change. I believe if we substituted crime with “poor healthcare” and repeated this paraphrase, many of us will realise that it typifies our acceptance of everything that is wrong with healthcare and why we have become accepting of the status quo.
I believe this jinx must be broken. I hold this view because if one took a population of a size similar to that of Ghana in India or China, we would find that only between five per cent and 20 per cent of the medicines they consume are imported. Before anyone tries to shoot this analogy down, I would want to remind readers that only 40 years ago these countries had net medicinal imports similar to Ghana. In four decades, they have managed to move from net importers to exporters of pharmaceuticals. In fact, India is often given a bad name for being responsible for most counterfeit medicines that appear in sub-Saharan Africa. However, a simple check will indicate that they are also major pharmaceutical net exporters to the European Union and American markets.
Thus, it is not beyond us to fashion a way of influencing medicinal prices in a manner that will benefit us all. Unfortunately, without civil society speaking up, the urgency would be lost on our political leaders. It will because many of the large pharmaceutical companies find it expedient to lobby politicians, and in some instances pay significant bribes to gain traction and monopoly for their products.
This is the irony. Though India led the way to decrease the cost of pharmaceuticals in their country by ignoring drug patents for essential and critical medicines, leading to a booming generic drug manufacturing ecosystem; many of the beneficiary pharmaceutical companies from that country have adapted strategies of the leading lights in large pharma and are employing similar tactics in Africa. Are our governments willing to also take the plunge and behave in a similar manner as the Indian government did to the benefit of us all? For now, the jury is out. It is because, with Africa’s scattered population, such an approach will be most effective with strong backing by the likes of ECOWAS and the African Union. This is a situation I strongly believe we are no closer to.
With the aforementioned option on the back burner for now, the next viable alternative would be to have a national strategy that promotes local pharmaceutical manufacturing of at least for the top 90 per cent of generic medicines we consume, many of which are off-patent. Call this wishful thinking and I will rebut with a challenge that you lack ambition.
He argues that “the Indian pharmaceutical sector is doing well because their government had identified it as important and supports the industry by providing equipment and raw materials, whilst giving loans to those operating in the sector.”
I think we can do the same. Apart from the impact this will have on lowering drug cost overall and the security of quality-assured generics it could bring, such an approach could significantly cut down on the foreign exchange pressures on our cedi, help to stabilize it and create many sustainable jobs.
I hope the new NMPC will have this on its agenda and will not concentrate only on its core mandate. They need to be conscious of the fact that, though the results of such an effort may take at least a decade to manifest fully, we have no other option but to work hard at it. For a country that is paying up to thirty times more for life-saving generic medicines than many in western democracies, it would be diabolic if we have not come to the realisation that our health matters little in the bigger world scheme of things. If that penny has already dropped then we must also realise that those benefiting from this health economic sleaze would not help us with finding a way out. This means we need to roll our socks up and fashion a local solution to this problem.
Sitting on the fence, with regards to this matter, is not an option, at least not for me. I believe it is not for you either as a reader. Our changing disease burden is such that only the naïve will see the wisdom in wasting their finances on medicines they could have obtained for less. We can simply start by asking those seeking the highest political office of our land what their strategy for the local pharmaceutical industry is. In the meantime, try searching for a pharmaceutical manufacturing strategy for Ghana and let me know what you find.
By Kwame Sarpong Asiedu