Interview: Ange Désiré Yapi
What are some of the challenges facing the universal health care system in Côte d’Ivoire?
ANGE DESIRE YAPI: The supply chain of pharmaceutical products in Côte d’Ivoire is secured from the conception of the product up to the initial phase of distribution, meaning to university, district and regional health centres. However, given the use of independent distribution channels, interactions further down the chain, to end consumers for example, are not visible to the authorities. These informal distribution channels – often made up of individuals or pharmacists – do not have the capacity or the know-how to transport certain medicines, resulting in either bottlenecks or the mismanagement of products. The concept of contractualising the process is being looked at as an interesting solution to the need for professional intervention within this segment.
Closely associated with this is the traceability of products. In order to make the health care system efficient, regulations must enforce systematic reporting at the different levels of the supply chain to ensure that the correct products and doses are supplied at the right time and place. Data on consumption habits is virtually non-existent, preventing us from creating models to assess the real needs of patients across the country.
Another challenge concerns the cost of pharmaceuticals, and thus their accessibility to the least well-off segments of society. To this end, we are working on three things: the timely payment of invoices from clients – primarily the state – which last year took up to 192 days instead of the agreed 90 days, resulting in the need to seek pre-financing mechanisms through financial institutions; an adapted procurement process, which makes use of competition in the global marketplace to purchase quality products at the best price; and the adequate management of our stocks, so as to reduce the instances of rush order transactions.
By securing these channels, we will also be fighting the use of counterfeit products. These negatively impact the state by depriving it of taxes, as well as operators, in that they take over an important share of the market, and most importantly the health of patients. Of course, coercive measures can be taken against this parallel market, but the proper implementation of the universal health care system will bring a natural end to it by providing better and cheaper access to quality drugs. Today we are at a crossroads where we need to invest in these mechanisms to develop efficient strategies and adequately finance and support the needs of the population.
What role are new technologies playing in the development of the health care system?
YAPI: Technology has a big role to play in overcoming the obstacles mentioned. The roll out of a single identification number for every patient and product will allow the tracing of users and medications, and engender the use of paperless documentation. At Nouvelle-PSP we are making use of enterprise resource planning solutions to minimise human interactions and provide valuable inputs for planning and predictive modelling, which are key to efficient stock management and control mechanisms. The use of these technologies, coupled with our decentralisation strategy, will provide additional clarity on consumer behaviours and market trends, and allow for a better understanding of patient needs.
The health care system has two types of data: clinical data and logistical data. The former is used by the Ministry of Health, which harnesses clinical information from the country’s public health facilities. The private sector, however, is yet to be integrated. On the logistical side, the electronic supply chain management system is still being perfected to allow authorities to create predictive models via the integration of both clinical and logistical data.
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