A new study - co-authored by American Enterprise Institute (AEI) scholar, Roger Bate, and Agnes Binagwaho, MD, the Minister of Health of Rwanda - revealed that Rwanda was the only African nation among 17 sampled in which no fake tuberculosis or antimalarial treatments were detected.
The authors attributed Rwanda's success to technical steps in ensuring the quality of its supply chain, following through on its tendering process with pharma suppliers, and its ability to enforce a relatively more advanced regulatory system than other countries.
Bate told in-Pharmatechnologist.com that "What Rwanda has done is not that difficult, though it has not alleviated all of its problems.” He noted that Rwanda’s success may be due to its relatively small size and the fact that there are fewer pharmaceutical suppliers, which gives it an advantage over larger countries like Kenya where many of the pharmacists have a difficult time differentiating between the various brands.
“Kenya is the poster child for screwed up systems,” he said, noting its “corrupt regulators, problems on the ground,” and lack of adequate distribution systems.
Rwanda’s low prevalence of poor quality TB drugs among African countries in the sample also may be associated with Rwanda's efforts to ban the sale of monotherapies and to ensure private sellers of medicines are qualified,the authors said. Bate added that Rwandan health officials have also begun test the quality of products.
“They’ve done really well because they completed their tenders on time and got the drugs where they needed to go,” Bate said, noting that a country’s procurement of drugs, whether through a wholesaler or national health service, needs to ensure the drugs are available when they need to be, especially for an illness like TB. He noted the tendering process in Kenya was particularly poor in terms of its management, its ability to send the drugs when requested and to pay suppliers on time.
Recent shortages of the TB treatment isoniazid in the US, and more recent issues in India, may cause an increase in substandard treatments, he added.
Regulatory Solutions
The creation of an East African regulatory body may ease the pressure off of the individual countries in the region, which can be understaffed and underfunded.
The recently launched East African Community Medicines Regulatory Harmonization Initiative, of which Rwanda is a part, could streamline the process of registering drugs, and allow for more localized quality control, Bate said.
He noted the prospect of a WHO treaty on counterfeit drugs, which he supports, “is not likely in the short run,” however. Such discussions on a treaty can lead to more regional harmonisation and best practices, he said.