Tackling high costs of medicine

HARARE - Zimbabwe's disease burden continues to get heavier as cases of chronic illnesses and stress-related conditions rise.

The country has approximately 1,3 million people living with HIV while an estimated 1,3 million people suffer some degree of mental disorder — a development Health minister David Parirenyatwa says has to do with social pressures.

Although 92 percent of essential drugs used in the public system are provided by the international donor community, thousands of patients rely on the private sector for various medicines.

For instance, notwithstanding the fact that government, through the assistance of the international donor community, provides anti-retroviral drugs to 750 000 of the approximately 1,3 million HIV positive Zimbabweans, thousands are buying the life prolonging drugs from pharmacies.

Cancer, diabetes, hypertension and kidney problems are among chronic ailments milking thousands in medication costs from patients.

In short, the drugs industry has remained a lucrative sector all things being equal.

However, owing to high production costs, the local drug industry continues on a downward slope trajectory together with the shrinking economy.

Owing to poor economic policies and bad governance systems, the once glorious drug companies such as Datlabs, NatPharm, CAPS, Ecomed, Graniteside Chemicals, Gulf Drug Company, Pharmanova, Plus Five Pharmaceuticals, Varichem and Zimpharm are struggling to stay afloat.

According to the Confederation of Zimbabwe Industries 2013 manufacturing sector survey report, pharmaceutical companies’ capacity fell from 58 percent to 20 percent.

Apart from donors feeding the public system, Zimbabweans have been left depending on middlemen. Those involved with the importation of drugs have, for several years, been enjoying brisk business — selling the imported medicines at more than 100 percent profit.

Despite the huge profit margins, their prices remained cheaper compared to those of local products. The brokers import from countries like South Africa and largely Asian states such as India.

Realising how capitalistic the middlemen system was, government and quasi-government companies have devised plans of moderating financial stress on the low income consumer.

Over 400 pharmacies in Zimbabwe have been accredited to sell anti-retroviral (ARVs) drugs under a private-public partnership deal.

Under the initiative, National Aids Council (Nac) procures ARVs in bulk and distributes them through National Pharmaceutical Company (NatPharm) to retail pharmacies, which have agreed to stick to a minimal agreed mark-up on the life-saving drugs.

Owing to the use of a shortened distribution chain, treatment costs plummeted by over 50 percent on average. A fixed dose of Tenofovir, Lamivudine and Efavirenz, which used to be sold at $51 now costs $19, while atazanavir and ritonavir are now retailing at $38 from $63.

The arrangement is helping decongest the overwhelmed public sector system for HIV management as well as help patients who are yet to be comfortable with people knowing their status.

Retail Pharmacists Association (RPA) chairperson Portifa Mwendera said the retail arrangement makes the commodity affordable and helps de-congest the national programme.

“Currently, RPA has 413 retail pharmacy units spread throughout the country with the obvious concentration around urban centres quite apparent. The arrangement has made availability better and the prices reasonable,” Mwendera recently told the Daily News.

Recently, Zimbabwe’s largest medical insurance company, Premier Medical Aid Society (Psmas), brokered a manufacturing deal with a reputable Indian firm, Catchet Pharmaceuticals, which will help bring down prices of a third generation antibiotic called Ceftriaxone.

Under the arrangement, being handled by Psmas’s  subsidiary Premier Service Medical Investments (PSMI), they bankroll the manufacturing of the drug while the Mumbai based firm puts a marginal mark-up — an arrangement which also tumbled the cost by half.

The toll order manufacturing deal also allows for the reduction of drug prices by eliminating the middlemen.

PSMI group business development and customer relations manager Nhamo Murandu, recently said the distribution chain has been too long and wide.

“Too many middlemen were making the injectable drug expensive,” he said.

The struggling quasi-government entity, which services about 870 000 of the 1,3 million medically insured Zimbabweans, is likely to save millions which Murandu believes can be used to improve service quality.

“At least we will become more liquid and be able to buy more drugs and cover the current shortages plus, from it we may also hope to open more outlets and bring service to the people”.

“We tried to do toll manufacturing with our local companies but prices remained high because of high manufacturing costs in Zimbabwe. We continue to be innovative as we make sure we deliver affordable healthcare to Zimbabwe,” he said.

While Zimbabwe waits for levelling of the uneven local drug industry playing field and stabilisation of the economy, such arrangements are critical in improving access to treatment at a time government cannot guarantee constitutional provisions pertaining to health rights.

The majority of Zimbabweans are living far below the poverty datum line. According to the latest Finscope report, over 75 percent of the country’s 7 million adult population are living on an average of $200 per month.

Currently, medically-insured Zimbabweans have had to fork-out more money to cover insurance policy shortfalls induced by such avoidable costs


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