By Mara Hansen Staples, partner and co-founder of Impact for Health; Kariane St-Denis, associate at Impact for Health; Ann Allen, program officer in systems innovation at the Bill & Melinda Gates Foundation; Prashant Yadav, affiliate professor of technology and operations management at INSEAD and a senior fellow at the Center for Global Development.
Health care systems around the world are struggling with ways to deliver much-needed medical supplies for COVID-19. In emerging markets, health systems are strained to begin with and have very limited capacity to absorb the pandemic. In countries such as India, Nigeria, Kenya, and Ghana, a large fraction of the population seeks diagnosis and treatment in private pharmacies, chemist shops, and drug stores using their own money, paying out of pocket.
While country governments need to be the decisive stewards of medicine and health product distribution, a robust response to the coronavirus in emerging markets will need to leverage the reach, agility, and ingenuity of private sector organizations involved in health supplies. Of particular importance are social enterprises in the health sector that are leveraging new technology, data, and business model ingenuity to change the way essential medicines and health products are distributed.
Companies have already donated cash, supplies, and equipment, and set research capacity to developing diagnostics and vaccines. The World Economic Forum has launched a platform to better coordinate these efforts.
In normal times, these organizations utilize business models built around digital marketplaces, pay-as-you-go financing, vendor-managed inventory, direct-to-consumer delivery, and tech-enabled quality assurance to improve medicines’ affordability, availability, quality, and access. And now, many of these social enterprises are finding innovative ways to mitigate the impact of COVID-19 in the communities they serve and to limit medicine supply disruptions for their customers.
Based on discussion with over 18 innovative health product distribution companies working across sub-Saharan Africa, India, and Southeast Asia, we identified four key opportunities for innovations in product distribution that might help mitigate the harms of the pandemic.
1. Leverage telepharmacies and home or pickup-point delivery
E-commerce, telepharmacies, automated dispensers, and smart lockers are enabling direct distribution of medications to people across Africa and Asia. These models can support social distancing by reducing the need for in-person contact. Companies such as the Kenya-based MYDAWA, Ghana-based MedRx, and Rwanda-based Kasha are already reporting significant increases in orders for delivery of products — both those related to COVID-19 and those that are not.
Such models can also help shift dispensation of medicines for nonacute care away from health facilities that may become increasingly burdened with COVID-19 cases. In South Africa and Zambia, Right ePharmacy enables dispensation of chronic medications for stable patients in community settings, such as malls, through the use of ATMs and temperature-controlled lockers. Facilitating medication refills at these locations can reduce risks of nosocomial infection among patients with chronic diseases while preserving clinical capacities for acute needs.
2. Empower pharmacies and labs with information, the ability to triage, and capacity to test
Distributors to pharmacies and labs recognize the potential their customers hold to bolster the public health response. For example, mClinica — with its digital network of over 150,000 pharmacy professionals from 40,000 pharmacies in Southeast Asia — has been providing its members with official World Health Organization advisories to ensure pharmacists are equipped to communicate effectively with their communities. The company argues that with proper personal protective equipment and guidance, pharmacists could also play a role in helping triage patients for testing or self-quarantine.
Similarly, pharmacies in Kenya’s Livia Dawa network are partnering with the Mombasa county government to educate patients on how to receive care for COVID-19, directing them to telemedicine as the preferred entry point for screening. In Ghana and Nigeria, digital pharmacy supply platform mPharma is equipping private labs with polymerase chain reaction machines and test kits for COVID-19. Having distributed 100 PCR machines in April, the platform hopes to rapidly expand the program to Zambia and Zimbabwe.
3. Enable real-time visibility into product pricing and availability while maintaining stocks and delivery
Digital marketplaces that connect providers to medicine suppliers can offer rapid visibility into fluctuations in stock levels and prices. This data is essential for purchasing decisions by hospitals, clinics, pharmacies, and drug shops, and group purchasing platforms such as MedSource report increasing levels of communication with providers on price changes, real-time stock availability, and sourcing alternatives while attempting to discourage price gouging and the hoarding of products.
Marketplaces that aggregate supplier data in real time could also offer governments a novel view into product availability and pricing in private sector distribution channels. Aggregating supplier-level data across both the private and public sectors could help governments match supply and demand and optimize allocation of key coronavirus-related supplies.
In this vein, MedSource has offered the Kenyan government agency in charge of medicines distribution access on its platform pro bono — providing the government with real-time data on ordering patterns and stock-outs could help enable efficient allocations and response. And Maisha Meds, a platform offering point-of-sale data and sourcing for pharmacies, has launched a dashboard to track a range of key demand- and supply-side factors influencing product availability amid the pandemic.
While data is plentiful, marketplaces report struggling to secure sufficient inventory at affordable prices for their members, and reports suggest that requests for product quotes have risen 500%. In Nigeria, the pharmaceutical purchasing platform DrugStoc notes that hand sanitizers and face masks increased in price by over 1,000% in just one month, making it impossible for average customers to obtain them. Innovators pointed to the urgent need for funding to help secure inventory at this time. The organization macro-eyes, which uses AI for predictive supply-chain management, is working to understand demand for coronavirus-related medical products at health facilities in the public and private sectors.
Even when products are available, affordable, and high-quality, delivery systems are strained. Tusker — a service by Logistimo for last-mile transportation auctions and demand aggregation — has permission to continue facilitating delivery of medicines and fast-moving consumer goods in rural areas of India, and Zipline is using drones to deliver essential medicines and COVID-19 supplies, such personal protective equipment, across Ghana and Rwanda.
4. Strengthen mass authentication and quality assurance to reduce use of counterfeit products
Reports suggest the distribution of counterfeit medications is on the rise, filling gaps in the market caused by production delays in India and China. Innovators that provide quality-assurance services can help providers and consumers validate the authenticity of essential goods.
For example, the RxDelivered platform in Nigeria connects pharmacists and consumers to a network of licensed wholesalers and manufacturers, from which they batch-certify product quality prior to delivery. The company has reported a tenfold increase in week-on-week customers, which it attributes to a growing demand for authenticated masks and medication.
Mass authentication programs, run by PharmaSecure, Sproxil and mPedigree, enable providers and consumers to validate the authenticity of goods through call centers, QR codes, and more. Because these systems already operate at scale in many markets, there is significant potential to leverage the infrastructure to reduce use of counterfeit or substandard face masks, gloves, sanitizers, medicines, ventilators, and other consumer goods.
The context of COVID-19 intensifies the need to ensure that medical supplies, essential goods, and protective gear are distributed in the right quality, to the right places, and at the right time to make a critical difference. As health systems are stretched thin, social enterprises become a crucial partner for governments to mount an effective response.
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