Tales about the devastating effects of substandard and falsified medical products might seem exaggerated but nothing could be further from the truth; they are grossly understated. This is, in no small part, due to the dearth of credible medical data in the most affected regions.
The World Health Organisation (WHO) estimates that between 2013 and 2017, the value of trade in illicit pharmaceuticals was in the region of US$200 billion, globally. While the Middle East and North Africa as well as Asia-Pacific regions accounted for 6 and 10 percent of these, respectively, Europe and the Americas were evenly poised at 21 percent each. Africa, on the other hand, saw a staggering 42 percent of these trades.
More worrying is that substandard and fake antimalarial drugs alone are causing an extra 116,000 deaths from the disease in sub-Saharan Africa and costing patients and health systems some US$38.5 million.
One start-up, Medsaf, is on a mission to reverse the phenomenon by harnessing technology to provide transparency and accountability. Founded following a personal tragedy, the start-up has since raised more than US$2.7 million in funding to rid Africa of the scourge that is fake drugs.
The B&FT sits with Co-Founder and Chief Executive, Vivian Nwakah (VN), to discuss the motivation, goals, difficulties, biases and, most importantly, impact and aspirations she has for Medsaf and healthcare provision on the continent.
B&FT: Can you give a brief about Medsaf?
VN: Medsaf is a pharmaceutical technology platform that facilitates the movement of medications in emerging markets. We help stakeholders – hospitals, pharmacies and patients – access affordable and quality medications using technology. These stakeholders are able to purchase all of their pharmaceutical needs from the Medsaf platform, while we work to improve quality control on sources of crucial medications for our clients.
B&FT: It is estimated that globally, the value of counterfeit pharmaceuticals is in the region of US$200billion annually, with Africa accounting for as much as 42 percent of these between 2013 and 2017, according to the World Health Organisation (WHO). Beyond the direct costs, what other factors necessitated the work of Medsaf?
VN: Medsaf was launched in 2017 and I was inspired to launch it following the death of a very good friend of mine, which came as a result of taking a fake malaria pill. The tragic event initiated my research to find out why such incidents were common in Nigeria and to find out if similar was prevalent in other regions. I spoke to people all over Africa and I quickly realised that it was a bigger issue than I had initially anticipated. This moved me to find an effective and sustainable solution to reduce incidents of complications arising from fake or substandard drugs administered to patients.
Around the time, the majority of hospitals purchased medications from an open drug market. Others had to work with multiple suppliers, which came with a host of logistic challenges, among other challenges. This reduced their efficiency levels as they were engulfed in navigating the muddy waters of medication acquisition, when they could be focusing on caring for patients.
Medsaf was built as a one-stop shop for healthcare stakeholders to purchase, manage and track medications across the supply chain, helping health facilities to buy authentic drugs with ease and peace of mind. We are currently operating actively in about 17 states in Nigeria. We have hubs in Lagos and Abuja, and we are opening up in Port Harcourt as well. It is our expectation that by the third quarter, Medsaf would have expanded its operations into other areas in the East. Our goal for this year, at the minimum, is to achieve full coverage of rural and urban Nigeria.
B&FT: Are you planning and envisaging that Medsaf goes continental?
VN: The problem of counterfeit medication is a global one and this is evidenced by the high rates of incidents recorded in the United States and Europe. However, countries within Africa suffer the most. Nigerian has one of the worst expressions of this problem, thus, creating a solution for Nigeria would invariably translate into creating a solution for Africa in general. We engage a wide range of stakeholders and seek to ensure that health facilities are able to manage their supplied inventories and purchased products from reputable global sources and production companies. As such, we are looking to scaleup our solutions.
Going continental is the goal in the medium term. Beyond this year, we intend moving into other West African countries, then to the East and across the world. It is a global menace; it requires a global solution and a global story to be told.
B&FT: The benefits to consumers are evident but what do manufacturers gain from the solutions provided by Medsaf?
VN: Medsaf operates as a middleman, verifying producers and manufacturers before listing their medications, and also verifying health facilities before allowing them to make any purchase. This ensures protection from both ends, leaving the end consumer better for it. Manufacturers, on the other hand, struggle with data to assess how the end-users receive their medications. This is due to poor recordkeeping and a lack of transparency.
However, a platform like Medsaf is providing transparency from the manufacturer all the way to the patient. This transparency provides relevant data that allows for demand planning, forecasting and innovation pertaining to the type of medications that needs to be distributed. That is why many of the manufacturers are supportive of Medsaf because the transparency brings about cost-saving. We are rolling out and will be announcing very soon more innovation around transparency.
B&FT: Where do you source your products from?
VN: We work with a wide range of major local manufacturers as well the international manufacturers and these manufacturers are registered and certified in their respective countries -from India to China, Europe and the Americas. On the local front, we deal with several major players and I can safely say that the brand equity that comes with being on the platform is unparalleled.
B&FT: What has the response to the solutions provided by Medsaf been like? How have regulatory bodies, pharmaceutical companies, healthcare professionals, and end consumers reacted? Has there been any pushback?
VN: The most important thing is that at the end of the day people want quality health care and that tagline: ‘Quality medication, a fundamental human right’ is really important. Thankfully, the work which has been done by Medsaf, has met nothing less than support from regulatory bodies. This is because we are actually providing unprecedented levels of transparency and providing data which hitherto was out of the reach, even of regulatory bodies.
B&FT: What medication categories are the worst affected by counterfeiting?
VN: The category of medications worst affected by counterfeiting are the expensive ‘fast movers’ and over-the-counter types such as the malaria drugs. This, primarily, is because these are mainly used for self-medication. It is thus important to watch out for some of these high-impact medications.
B&FT: Do you see yourself as more or less saving the African economy billions of dollars a year just by introducing your technology that creates absolute transparency in the pharmaceutical industry?
VN: Transparency reduces taxes for manufacturers. Most clients using Medsaf are not using the platform solely because the platform gives access to genuine medication but also because we are able to help companies optimise their operations and increase efficiency in the entire procurement operations and that reduces costs by as much 20 percent.
That alone is huge for a small business; now consider multiplying that across private and government institutions. This creates a massive amount of cost-savings which can only be achieved through accurate demand planning and transparency. It is tremendous in terms of savings because you are able to use your resources in a more efficient manner.
B&FT: All systems are susceptible to breaches, and tech-based platforms are not an exception. What measures has Medsaf put in place to ensure its systems are not compromised, seeing, especially as its services are literally a life and death matter?
VN: The entire chain is guarded with best-in-class monitoring. This begins when hospitals use our software to access their account and pick up the medications that they want. In addition, we have various product lines in the pharmaceutical market place. We also work in the diagnosis sphere and we have subscriptions services for hospitals as well as patients; with this, they are able to choose the service they are interested in and apply. After they are done with the process and check out, medications get to them within 24 to 72 hours depending on their designated location.
B&FT: How easy has it been to access favourable funding? There are growing concerns that African start-ups are being funded by a handful of offshore investors. Do you share these concerns?
VN: Starting as a female founder has been challenging. However, Medsaf can say proudly that with an amount of US$2.7 million raised so far, we have been able to smoothly fund and grow the organisation. Through this, we have been able to build our software, our team and expanded across Nigeria. It is definitely not easy but we are creating value, and we are getting many people on board.
B&FT: Medsaf by the end of the year seeks to expand to the east and also onto the rest of the continent. That’s a short-term goal. What is Medsaf’s medium to long-term target?
VN: Medsaf is meant for Africa and so we want to be present in as many African countries that need our services as possible; but in a long-term, we want to be the go-to platform when it comes to the movement and flow of medication as well as the quality medication for Africa. This includes working with governments and large NGOs, and helping grow hospitals’ capacities while making sure there are affordable medications for small clinics and hospitals across various countries.
B&FT: The COVID-19 vaccine politics, coupled with the fact that most counterfeit drugs come out of China and India – the capitals of generic drugs, has led to a flurry of calls for more production on the continent. What is your take on that? What are the biggest barriers to realising this and would MEDSAF be open to active manufacturing?
VN: COVID -19 has taught Africa that local manufacturing is key, and building up the local capacity to manufacture medication when things hit the fence is a survival tactic that every single country needs to consider.
B&FT: Are you looking at manufacturing the products yourself?
VN: Manufacturing is great and definitely, a lot of qualified companies will dive into manufacturing, but we started the company first because we believe that, everybody should have access to a safe and affordable source of medications. We are not looking at going into manufacturing in the near future.
We are facilitators and our focus is on how we can continuously use technology to improve the movement and financing of medications to ensure that patients who really need medications are supported. Based on research I have come to realise, firsthand, how the most vulnerable are affected by these things. They are our primary focus.
B&FT: Are you looking at other areas once Nigerian and the whole of the continent is covered?
VN: This is an emerging market and I think Medsaf would go global. Medsaf has shown that it is solving a massive and major public health issue in Africa. Solving the problem in the African continent would impact the world directly and indirectly.
B&FT: Are there any chances of seeing Medsaf’s solutions being expanded to areas beyond pharmaceuticals?
VN: Definitely, there is an ecosystem of healthcare into which Medsaf can continue to expand; but for now, we are going to focus our scope on saving lives by facilitating timely access to authentic medication.
