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The IFC estimates that by 2030, developing countries will need up to $210 billion per year in new investment for health care assets to meet the growing healthcare demands of the Sustainable Development Goals (SDGs). This will require the current level of investment in healthcare in developing markets to triple. What may be almost as important as the money itself, however, is the prospective opportunity to catalyze the entrepreneurial spirit that is seeping its way into African markets. Here we look at how this entrepreneurialism is being leveraged in the pharmacy and supply chain space.

An initial analysis from the CGD Working Group on the Future of Global Health Procurement estimated the health commodity value chain (procurement + supply chain) in low- and lower-middle income countries to be $81 billion in 2015, and observed increasing fragmentation and higher out-of-pocket spending as countries propel towards middle-income status. As these countries are also transitioning away from aid, national payers, wholesale and retail pharmacies, and individuals paying out of pocket are asking how they can buy drugs and commodities to get a better deal and speed the procurement process.

While health donors are busy writing complex transition plans, start-up pharmacy disruptors are already collecting data, negotiating price deals, and broadening their remit to provide additional services that respond to market demands. Below we chronicle what we describe as the 4M’s—Maisha Meds, MedSource, mPharma, and mTIBA—and the impact we think they could have on the procurement and supply chain landscape in low-and middle-income countries (LMICs) in transition, and perhaps even in high-income country markets also struggling with spiraling drug costs.

Maisha Meds: The small private start-up pharmacy management platform

Originally set up to improve diagnosis and prescribing for pharmacies in Kisumu, Kenya, Maisha Meds faced a growing demand for pharmacy management, stock keeping, and supply chain tools. Two years on, Maisha Meds offers pharmacy owners a cloud-based android app which is a point of sale (POS) system that collects procurement and patient data; it also negotiates prices with manufacturers and coordinates deliveries with distributors.

The app appeals to pharmacists because it enables easy ordering and allows them to keep tabs on their stock, which can help prevent theft. Even though a tablet is a big buy for some small pharmacies, the software has expanded across Kenya and other countries. Maisha Meds is now exploring new partnerships and additional services, such as payment subsidies for the poorest patients.

The company’s differentiator is its android-based POS system that can operate in settings with or without traditional electrical grids. Further, the data that it generates could be a game changer for global health donors and pharmaceutical companies seeking to geographically map the demand for certain products, which could provide valuable inputs for differentiating prices in different markets.

MedSource: The commercial group purchasing organization spun off a major USAID contractor

USAID contractor Management Sciences for Health (MSH) decided to leverage its already-established relationships and know-how in Kenya to launch MedSource last month, aimed at creating more opportunities for the private sector to deliver quality services. This window of opportunity existed because some LMIC consumers buy privately, a finding backed by our recent analysis.

A commercial operation, MedSource negotiates price/volume agreements on behalf of its members and provides pharmacies business management training and IT solutions, along with potential access to credit. This access to credit and other available financial instruments also de-risks sales for participating distributors. The company is already working to arrange framework agreements for medicine pricing for clients, including large networks of clinics, and to build its own POS system.

MedSource has the potential to bring down transaction costs in the way that most group purchasing organizations do, by consolidating purchasing power to drive down prices. However, it is unclear how much volume it can aggregate to do this; transaction savings could be offset by the service fee charged by MedSource, leading manufacturers go direct to pharmacies, hoping perhaps for better discounts.

mPharma: The venture capital-funded vendor-managed inventory system

Set up to tackle pharmacy stock-outs and high prices, Ghanaian-born mPharma is a vendor-managed inventory system for private pharmacies which standardizes data for improved forecasting; procures, warehouses, distributes, and supplies stock for its members; and offers quality improvement services under its retail pharmacy brand QualityRx.

mPharma operates a unique consignment model with a standardized drug formulary, whereby member pharmacies’ shelves are stocked with mPharma products. Under the model, members only pay for what they dispense and mPharma carries the liability for the stock through sharing out across pharmacies, as needed. With the aim of being profitable in the next three years, the current model is limited to urban markets where mPharma can consolidate its in-house warehousing and distribution networks.

Growth of such a model could be quite disruptive, especially if mPharma manages to carve out a market share for itself in an already-competitive manufacturing and distribution landscape. According to its founder, mPharma’s big aspiration is “to be the largest pharmacy retail infrastructure on the continent without building pharmacies, just like Airbnb is the largest hotel business in the world without building hotels.”

mTIBA: The mobile health savings account

Launched by PharmAccess, M-Pesa, Safaricom, and CarePay primarily as a mobile health savings account in Kenya, mTIBA also collects claims data on customer purchases and provides a credit facility from which pharmacies can borrow money to pay for expenses related to facilities, equipment, staff, pharmaceutical products, and procedures.

mTIBA enables patients to save, borrow, and share money to spend on health when they need to, and is made more robust by Safaricom’s intelligent segmentation, which allows for targeting of specific groups (e.g., smallholder farmers or slum dwellers). The savings account can also be used by public and private insurers to subsidise technologies and services in their benefits package, just like in this mTIBA partnership with the Kenyan National Health Insurance Fund to provide families in informal settlements access to SUPA Coverage.

While mTIBA is still a mobile health wallet and not currently in the procurement business, it offers a service that could complement the other three M’s if they were to scale.

Six of one, half dozen of the other? Not exactly

Put simply, the 4M’s are all innovative start-ups of varying sizes trying to improve access to medicines and bring down prices. We summarise some of the core characteristics in the table below.

The 4M’s

Organization Geography Pharmacy requires specific POS Pharmacy members restricted to exclusive ordering Owns stock for pharmacies Negotiates prices Warehousing/ distribution Provides patients credit or subsidies
Maisha Meds

Kenya, Tanzania, Nigeria, Egypt, Ghana

Yes No No Yes Coordinates Yes
MedSource Kenya No No No Yes Coordinates No
mPharma

Ghana, Nigeria, Zimbabwe

Yes Sometimes Yes Yes Owns distribution facilities/vehicles Yes
mTIBA

Kenya, Tanzania, Nigeria, Ghana

Accreditation required N/A N/A N/A N/A Yes

 
While there are obvious overlaps, each of the 4M’s was developed to meet different needs, and none of them represents a cookie-cutter solution. Rather, perhaps due to their presence on the ground working day-to-day with various stakeholders, the business models have nimbly adapted over time to adjust for the markets that they serve. Maisha Meds’ real-time POS system improves forecasting capacity and minimizes theft; MedSource uses financial instruments and credit to minimize the risk of non-payment, and as a result may be able to achieve lower prices; mPharma stocks pharmacy shelves, taking the onus off pharmacies to buy stock and theoretically minimizing stock outs; and mTIBA’s ringfenced health savings account on a mobile platform should give patients easier access to healthcare and payers more options for improving targeting and efficiency.

These organizations are small and new and will need to scale before any conclusions can be drawn on their effectiveness and impact on affordability and access. Further, they may be competing against each other as they grow. Interestingly, they do not neatly fit into existing donor programs, which is perhaps why there has not been more attention and investment in this space. The fees that they charge may not be enough to make them commercially viable—especially for those not yet backed by venture capital funding. This could be one opportunity for more private sector support, including impact investment, which can drive better baseline and impact assessments. Time and data will tell us more about what the 4M’s can achieve.

New reports and an exciting event that take this blog further

The 4M’s represent a tiny proportion of innovative supply chain start-ups in Africa, which we selected opportunistically based on our research for the Working Group on the Future of Global Health Procurement; this blog therefore should only serve to illustrate that pharmacy disruptors are on the rise and provide a couple of examples.

As timing would have it, the Bill and Melinda Gates Foundation released a much more systematic and comprehensive landscaping analysis today, which looks at 30 different archetypes of innovative distribution models popping up across sub-Saharan Africa. The analysis includes more detail and offers a framework to evaluate and compare companies’ projected impact on targeted consumers based on measures of availability, quality, cost, geographic access, and scale.

Stayed tuned, as colleagues at the Gates Foundation will soon host a seminar at CGD on the findings of their landscape analysis, and our forthcoming Working Group report will detail a much broader set of procurement challenges.

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Disclaimer

CGD blog posts reflect the views of the authors drawing on prior research and experience in their areas of expertise. CGD does not take institutional positions.