As we've said, the medicine vendors get all kinds of medicines,
things that they're not legally supposed to sell,
things that are no longer part of national policy or guidelines.
So, we want to know where,
how do these medicines shops and medicine vendors procure their medicine.
So, somehow, even though the shops are out in the periphery,
this is a very small shop in a rural market,
you can see the shelves don't have many things on them,
but that's the reality of business far out from the center of the towns.
So, the question is how do they get medicines way out there?
How does this procurement and supply system work?
How do they get the kind of drugs that they know that their clients will request?
Oftentime, the farther you go from a major town,
the fewer the drugs.
But also the cheaper the drugs,
and often like I said about the chloroquine syrup, the less appropriate.
I had mentioned the chloroquine syrup being available in shops.
Chloroquine has always been cheap.
And this is another reason why the customers like it.
It also has some secondary benefits in terms of
the ability of quinine to ease aches and pains that may come with malaria,
although it no longer is effective in destroying the parasite.
These are the types of drugs that would appeal to poor people.
The medicine vendors in these rural areas don't want to stock
very expensive things that they know may sit there
for a long time and the product doesn't move.
So, the business model at the periphery is such that you have,
possibly being less effective,
but cheaper medicines that the clients can afford.
Procurement for the village-level medicine shop comes from many levels.
We can see on the right-hand picture, a big warehouse,
where an NGO stocks all kinds of malaria medicines,
family planning products et cetera.
These are usually obtained by
large medicines shops or large pharmacy shops in the main city.
There are also wholesalers that do
sell a variety of medicines that are located in a large city.
So, somehow, whether it's from an NGO warehouse or wholesalers warehouse,
it gets to the larger medicine shops.
And from there, you see that the smaller shops,
either in the city or the smaller shops out in the countryside,
the owners will come in to these larger shops and buy what they need.
We have special programs that have been tested,
the affordable medicine for Malaria Project,
that was tried through the Global Fund,
that tested whether you could get cheap medicines into
the system that were the correct malaria medicine.
And these show that, generally,
even though the medicine shops might sell them for
more than the markup that was recommended,
they were still cheaper than things that could be
gotten through the commercial wholesalers.
So, some countries having done this pilot project to test this out are now trying to
incorporate this into their regular procurement system
using the grants they get from Global Fund and other donors.
One thing that's important in terms of marketing of special projects
like this is that they have a special marking on the packet,
that's a little green leaf,
so that people know that they're getting the appropriate quality product.
So, upgrading of the quality of the patent medicine sellers
so that they know which drugs to procure can be done.
For many years, programs throughout Africa have been
working on training and upgrading the quality of the medicine shops.
And a few years ago,
we did a review and looked at the different models.
There's a question of franchising,
where you develop a brand,
and shopkeepers who go through this training are recognized as part of this system.
As I mentioned, that was done in Tanzania.
The most common thing is training of medicine sellers.
The challenge there is that you may train one person in the shop,
because they can't close the shop down to go to the training,
but that person may not pass on the information to others in the shop.
Another approach is supervision,
where people from the Health Department from NGOs go out
to the shops and supervise and provide on-the-job,
learning, and then the process of branding.
We mentioned before, the AMFM drugs have the branded green leaf.
Some NGOs have signs
and things you can hang in your shop to show that you've been trained,
and combinations of these are used.
But, basically, the idea is that if you're going to do procurement,
you want to make sure that people in
these shops know what are the correct drugs and actually order those.
This is an example of both franchising and branding,
these CFW Shops in East Africa,
where you can see that the staff have been trained.
They have their uniform as it were.
After the training, they can buy from a special supplier,
special procurement, the correct drugs.
So, it's a whole system that's been built around
their training so that they're not just trained to provide better care,
but they're ensured a way of getting
the appropriate supplies through this franchising process.
You can see the little green leaf on the packets that are approved for
the Affordable Medicines Facility for malaria so that,
again, people can tell that they're getting the quality medicine,
and they know that medicines with this leaf should
cost less than the same product from a commercial source.
So, this is an important way of trying to ensure procurement and
supply out to the shops that are providing care for the community.
So, medicines vendors or medicine shops can
bring basic essential health supplies to the village level.
The issue of quality is raised,
and we've talked about the need for training,
the need for supervision,
possibly having some type of franchising,
possibly having some type of standard supply system.
And, finally, we've looked at the question of how can drugs be made
available in these communities that are
the correct drugs and at a price people can afford.
So, this is our challenge.
The resources out there with the medicine shops,
we just need to harness that,
train them and make sure that they have access to quality health commodities.
William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
