Interview: Oumar Kébé
What are your expectations for the roll-out of universal health coverage in Côte d’Ivoire?
OUMAR KÉBÉ: The hope is that, with this new scheme, access to health care and medicines will increase and a larger share of the population will be able to get the treatments they need. However, the question of funding still remains. Who is going to pay for the health care system? The state can help jump-start the process but should not be involved in the long run, otherwise it will be unsustainable. A system based on solidarity, with a monthly contribution, would most likely be an effective solution. Solidarity is key because some people will never be able to pay their contribution and have access to decent treatments unless society takes care of them.
How can the consumption of generics be increased?
KÉBÉ: While general access to medicines is increasing, a large share of the population is still left behind, with limited access to basic treatments. Not only is purchasing power low, but geographical remoteness makes supplying drugs a challenge. Given poverty levels, manufacturers must supply cheaper medicines, yet at the same quality as branded medicines. Hence there is no choice but to use generics, especially for chronic diseases like cancer, diabetes and hypertension. Though infectious diseases are prevalent, chronic diseases are rising fast in sub-Saharan Africa, and will likely surpass infectious ones in the next 10 years. This means that many people will need to take medication for the rest of their lives. Drug-makers need to adapt to these new pathologies and supply products accordingly.
In terms of consumption, francophone African countries usually prefer branded medicines to generics. In Côte d’Ivoire, for instance, generics make up only 30% of medicine consumption. Although generics are of equal quality to branded medicines – using the same molecules – they suffer from a perception problem due to a lack of information. Some health professionals and patients have doubts about generics, but more and more people see them as a reliable alternative.
To what extent do counterfeit drugs impact the pharmaceutical industry?
KÉBÉ: As with many underground activities, it is hard to quantify the impact this has on the real economy. Some health professionals claim that counterfeit medicines make up 20-30% of total consumption. I find those estimates to be too high. One needs to distinguish between counterfeit drugs and illegal importation of real ones – another scourge in West Africa.
With this distinction in mind, an estimate of 10% would be more appropriate. Counterfeit drugs are a serious public health issue as they can be harmful to consumers. When damage is caused, it also hurts the credibility of health professionals, and people start losing faith in certain treatments. All the same, in francophone Africa it is hard to find counterfeit products in pharmacies – the network and distribution channels are well-regulated, and it is hard to find a breach. Illegal importations are another challenge: from the moment the distribution channel is unregulated, there is no traceability. To address this, in Côte d’Ivoire every medicine must be registered in order to be sold.
What more can be done to prevent the outbreak of highly contagious diseases in French West Africa?
KÉBÉ: Governments are working with the World Health Organisation to harmonise health policies within ECOWAS. Greater convergence is needed, but one cannot deny the improved harmonisation of pharmaceutical laws and regulations. If a country has an unreliable system that is not convergent with others, it not only weakens itself but affects all of its neighbouring countries. In the long term, additional and better health infrastructure will be needed to help prevent diseases like Ebola, which can quickly become pandemic. In terms of infrastructure, Côte d’Ivoire hosts a large amount of unregistered clinics; further controls should be put in place to make sure that standards are respected. Illegal imports are another challenge. The distribution channel is illegal and to address that only registered medicines should be sold.
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