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Revisiting the issue of access to medicines in Africa: Challenges and recommendations

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Public Health Challenges
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Background Access to safe, effective, affordable, and quality medicines is an essential component of the right to health and is also one of the targets in the global development agenda. In this review article, we extensively discuss the challenges and issues surrounding access to medicines in the African region as well as provides recommendations for ensuring medicines security on the continent. Methods We conducted narrative review with the use of data reported in published literature, reports, and grey literature available in African countries on topics pertaining access to medicines. The authors also snowballed further data to gather information for this review and narrative synthesis was conducted. Results Africa faces a double burden of infectious and non‐communicable diseases and the need for effective universal access to medicines cannot be deemphasized. However, access to medicines on the continent is not without issues and challenges. Some of which are the high burden of infectious diseases and non‐infectious diseases, limited pharmaceutical industries and high costs of raw materials, overdependence on countries abroad for medicines, poor supply chain systems, lack of government investment in the pharmaceutical sector, unfavourable manufacturing conditions, limited health workforce, lack of sustainable health financing mechanisms, lack of infrastructures and technical know‐how, low investment on research and development, and circulation of fake and counterfeit medicines among others. Conclusion This review reifies that access to medicines in Africa faces numerous challenges and it emphasizes the urgent need to address these issues as the continent geared towards strengthening its health systems for universal health coverage.
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Received: 23 February 2022 Accepted: 5 May 2022
DOI: 10.1002/puh2.9
REVIEW ARTICLE
Revisiting the issue of access to medicines in Africa: Challenges
and recommendations
Yusuff Adebayo Adebisi1,2Ifechukwu Benedict Nwogu3Aishat Jumoke Alaran1
Abubakar Olaitan Badmos4Adeboye Olakunle Bamgboye5
Basirat Oluwadamilola Rufai2Osaretin Christabel Okonji6Malik O. Malik2
John Oluwafemi Teibo7Samah Faisal Abdalla8Don Eliseo Lucero-Prisno III9
Mohamed Samai10 Wuraola Akande-Sholabi2
1Global Health Focus Africa, Abuja, Nigeria
2Department of Clinical Pharmacy and Pharmacy
Administration, Faculty of Pharmacy, University
of Ibadan, Ibadan, Nigeria
3The Comparative Health Outcomes, Policy and
Economics (CHOICE) Institute, School of
Pharmacy, University of Washington, Seattle,
Washington, USA
4National Primary Healthcare Development
Agency, Abuja, Nigeria
5Faculty of Pharmacy, Obafemi Awolowo
University, Ile-Ife, Nigeria
6School of Pharmacy, University of the Western
Cape, Cape Town, South Africa
7Department of Biochemistry and Immunology,
Ribeirão Preto Medical School, University of São
Paulo, Ribeirão Preto, SP, Brazil
8Faculty of Medicine, University of Khartoum,
Sudan
9Department of Global Health and Development,
London School of Hygiene and Tropical Medicine
and Health, United Kingdom
10Department of Pharmacology and Therapeutics,
College of Medicine and Allied Health Sciences,
University of Sierra Leone, Freetown, Sierra
Leone
Correspondence
Yusuff Adebayo Adebisi, Global Health Focus,
Abuja, Nigeria.
Email: adebisi.adebayo@ghfocus.org;
adebisiyusuff23@yahoo.com
Abstract
Background: Access to safe, effective, affordable, and quality medicines is an
essential component of the right to health and is also one of the targets in the global
development agenda. In this review article, we extensively discuss the challenges
and issues surrounding access to medicines in the African region as well as provides
recommendations for ensuring medicines security on the continent.
Methods: We conducted narrative review with the use of data reported in pub-
lished literature, reports, and grey literature available in African countries on topics
pertaining access to medicines. The authors also snowballed further data to gather
information for this review and narrative synthesis was conducted.
Results: Africa faces a double burden of infectious and non-communicable diseases
and the need for effective universal access to medicines cannot be deemphasized.
However, access to medicines on the continent is not without issues and chal-
lenges. Some of which are the high burden of infectious diseases and non-infectious
diseases, limited pharmaceutical industries and high costs of raw materials, overde-
pendence on countries abroad for medicines, poor supply chain systems, lack of
government investment in the pharmaceutical sector, unfavourable manufacturing
conditions, limited health workforce, lack of sustainable health financing mecha-
nisms, lack of infrastructures and technical know-how, low investment on research
and development, and circulation of fake and counterfeit medicines among others.
Conclusion: This review reifies that access to medicines in Africa faces numerous
challenges and it emphasizes the urgent need to address these issues as the continent
geared towards strengthening its health systems for universal health coverage.
KEYWORDS
access to medicines, Africa, public health, Universal Health Coverage
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original
work is properly cited.
© 2022 The Authors. Public Health Challenges published by John Wiley & Sons Ltd.
Public Health Chall. 2022;1:e9. wileyonlinelibrary.com/journal/puh2 1of13
https://doi.org/10.1002/puh2.9
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BACKGROUND
The need to have access to safe and effective medicines is so important that it has been designated as a basic human right by the
World Health Organization [1]. The relevance has been given further weight by its inclusion in the Sustainable Development
Goals (SDGs) target 3.b [2]. Efforts to ensure access to medicines are mainly driven by an ethical imperative: people should not
be denied access to life-saving or health-promoting interventions for unfair reasons, including economic or social causes [3].
Within the African context, certain limitations exist concerning their access to basic medicines [4, 5]. Many people living in
Africa have a problem with accessing medicines and this undoubtedly contributes to the poor health metrics of most countries
in the region [6]. Healthcare expenditures in many parts of Africa fall below what is required to achieve Universal Health
Coverage (UHC) and many people have to resort to out-of-pocket payments for medicines [7]. The African region also has
the highest burden of communicable diseases (like tuberculosis, HIV/AIDS, malaria) [8] and a significantly high burden of
non-communicable diseases such as diabetes and heart diseases [9]. These facts, therefore, suggest that access to medicines is
a vital issue to discuss concerning UHC attainment in a continent with weak health systems [10, 11].
Access to medicines has been defined by the United Nations as ‘percentage of the population who have access to a minimum
list of 20 essential medicines, which are continuously available and affordable at a health facility or medicines outlet, within
1 h walk from the patient’s home’ [12]. This definition takes into consideration the basic components of access to medicines,
that is, accessibility, affordability, availability, and acceptability [13]. Access to medicines takes into account the effectiveness
of the supply chain with respect to supply location and location of the end-user [13]. Considering that many parts of Africa
are still classified as rural or semi-urban areas, the efficiency of medicines supply could be influenced by geographical barriers,
cultural barriers, and shortage of qualified medical personnel [14].
The African sub-region relies heavily on the importation of medicines and raw materials for the manufacture of their med-
ications [15, 16]. This could spell serious trouble for rural areas since they are typically the last to get access to any imported
medicines or manufactured medicines due to their inaccessibility. This also means that changes to supply chain logistics or
policies affecting the importation of the drugs or raw materials could cause scarcity and make medicines inaccessible. The
acceptability of medicines correlates with patients’ familiarity with medicines [14] and this has implications for a region that
is constantly receiving medicines from multiple sources internationally. Patients may refuse certain forms of treatment because
they are unfamiliar, or due to religious and cultural reasons [17]. Similarly, drug distributors and importers (including commu-
nity pharmacies) may refuse to import or stock certain drugs if they believe that their target population would not accept them.
This could place a limit on the number of drugs that can be accessed by people in such an area. Availability of drugs borders on
supply chain logistics with respect to demand and supply [13].
Despite acknowledging the need for affordable and accessible treatments, there is little evidence to demonstrate that African
governments are intensely working on ensuring access of medicines to citizens. The affordability of medicines is another vital
part of access to medicines and it correlates well with the prices of drugs and the income of end-users. This paper elucidates
the challenges further, and issues surrounding access to medicines in the African region as well as provides recommendations
for ensuring medicine security on the continent.
METHODS
The methodological approach utilized in this narrative review is similar to what was used in some previous studies [18, 19]. We
conducted narrative review with the inclusion of relevant papers published up to March 2022 and in English Language. Data
reported in this study were gotten from published literature in African countries on topics pertaining access to medicines. The
authors also snowballed further data to gather information for this review by reviewing the references of the included papers
and narrative synthesis was conducted with theme of discussion identified across studies. Our data sources included journal
articles from different e-bibliographic databases, including MEDLINE, PubMed Central, PubMed, and Google Scholar. The
search terms used include ‘Access to medicines’, ‘Medicine Access’, Africa’, ‘Issues’, ‘Challenges’ ‘Efforts’. We also included
the name of African countries in the search box to gather useful data and information (See Figure 1for the map of Africa). The
definition of access to medicines is seen across the literature in terms of medicines affordability, accessibility and availability.
The inclusion criteria include data sources that provide information regarding access to medicines in African countries and
were published in English and up to March 2022 while the exclusion criterion was any other data sources that do not provide
information regarding access to medicines in Africa. Four researchers (Y.A.A., I.B.N., A.J.A., A.O.B.) were involved in the
independent review of literature to gather data for this study. The collected articles were managed using Endnote Reference
Manager Software version X8 with a prior review of the title and abstract. In case of any duplication of references or disagree-
ment, a consensus was reached through discussion. Additionally, to ensure the quality of data and correctness of facts (check
and balance), the authors had a brainstorming session on this.
Supplementary data were also gathered from country reports, newsletters, commentaries, policy briefs and other reports as
well as direct google search as it was inferred that some of the relevant sources are not published in peer-reviewed academic
REVISITING THE ISSUE OF ACCESS TO MEDICINES IN AFRICA 3of13
FIGURE 1 A map showing the countries in Africa (maps.com)
journals because they are not empirical studies but policy papers. The extracted data were discussed narratively, with themes
identified, to explore the aim of the study.
Challenges facing access to medicine in Africa
We extensively discuss the challenges and issues associated to access to medicines in Africa.
High burden of infectious diseases and non-infectious diseases
Despite the feeble healthcare systems, African countries are challenged with a double burden of infectious diseases and non-
infectious diseases [20]. While communicable diseases still account for about two-thirds of deaths in Africa, age-specific
death rates among men and women from chronic non-communicable diseases are greater in sub-Saharan Africa than in any
region globally [21]. This has resulted in heavy demand for medicines for diseases treatment and prevention, making access to
medicines on the continent considerably difficult for some patients, especially among the marginalized and vulnerable groups.
This situation is worrisome and concerning in Africa because of the presence of limited pharmaceutical manufacturing capacity
to cater to the continent medicine’s needs [15]. In other words, the demand for medicines surpasses local drug manufacturing
capacity in Africa [22] and the pervasive double burden of diseases is one of the possible drivers.
More so, the emergence of the COVID-19 pandemic has resulted in a shortage of medicines across the continent due to the
global travel bans and lockdowns, which affect medicines manufacturing and importation [23, 24, 25]. The urgent need to have
access to medicines among the populace, due to the high diseases burden, is a potential route that can facilitate the circulation
of fake and counterfeit medicines on the continent and the presence of porous supply chain systems worsen this further. This
implies that, as the efforts to curb diseases incidence and prevalence intensify, there is a need to invest in solutions and efforts
aimed at ensuring uninterrupted access to effective, safe, quality, and affordable medicines. To achieve this, localization of drug
manufacturing in Africa is much-needed.
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Limited pharmaceutical industries and high costs of raw materials
The dearth of drug manufacturing industries in Africa vis-à-vis the exorbitant cost of raw materials constitutes a huge limitation
to the ease of access to drugs. It is disheartening that Africa accounts for only 3% of global production of drugs [26] despite
bearing 24% of the global burden of disease and accounting for 11% of the world’s population [27]. A 2019 McKinsey report
noted that, for the 1.1 billion people in Africa, there are only roughly 375 drug-producing industries, mostly in the northern
region [28]. Those in sub-Saharan Africa are clustered in nine out of 46 countries [28]. This is massively pale in comparison
with China and India where 10,000 and 5000 drug manufacturers, respectively, serve 1.1 billion people [28].
In 2005, a World Bank research identified that Nigeria, South Africa, Kenya, and Zimbabwe have the industrial capacity that
can be channelled to the production of medicines for domestic consumption or export [29]. However, they warned that if the
economic cost of creating local production capacity is high or the quality of products is subliminal, this potential is prone to
depleting [29]. The cost of production and the quality of drugs manufactured are hugely dependent on the availability of raw
materials, including active pharmaceutical ingredients (the primary components in the manufacture of drugs). In Africa, raw
materials and equipment needed for drug production are mostly imported, contributing significantly to the cost of production
[30]. Thus, industries are forced to rely heavily on imports and thereby incur excessive expenditures. This directly translates
to a severe reduction in both the quantity and quality of drugs produced. Additionally, this usually results in very small profit
margins, discouraging investment and hampering the growth of industries.
The growth of local pharmaceutical industries also relies heavily on the availability of infrastructures such as transportation
systems, communication networks, and constant power supply [31]. These are starkly unavailable in most resource-limited
settings of countries in Africa. Combined with its fragile economy and ridiculous level of sustained poverty, indigenous drug
production faces tedious constraints [30]. The consequences thereof are suffered by the populace who have extremely limited
access to essential and non-essential drugs. There is no better time than now to promote more local production of medicines by
private and government-owned pharma companies as well as industries that manufacture active pharmaceutical ingredients.
Overdependence on countries abroad for medicines
In most African countries, pharmaceutical imports comprise as much as 70–90% of drugs consumed [28]. This overwhelming
dependence on importation predisposes vulnerable citizens to shortages. This stems from two major reasons: firstly, there is
an immense paucity of in-country drug-producing industries and secondly, there is a wide distrust in locally made drugs. The
consequence, therefore, is an enormous demand for overseas drugs which cannot match the importable quantities. The resulting
shortages from lack of access to specific brands lead to deterioration of illness and an increase in mortality, signalling a poor
health index. Moreover, excessive dependence on imported drugs also enables a spike in the production of counterfeit drugs
which are often marketed as the original to unsuspecting consumers [32].
This jarring problem also signals ominous consequences on the economy of the Africa region. Overdependence on imported
drugs pushes the economy to the edge of trade deficits [27]. It increases the countries’ reliance on foreign political and economic
power and consequently triggers inflation, reduced domestic currency values, and interest ratesall of which are indicators of
the economic contraction and reduced standard of living.
Poor supply chains systems
The entire process of drug manufacturing in a different country, the exportation of the final formulation, packaging, and repack-
aging of the drugs, and eventual sale of the packaged products can be complex. An efficient distribution system is, therefore,
needed to ensure drug quality and ease of access. Despite the increased investment in the procurement of drugs, their availability
in Africa remains extremely low. Inefficient drug distribution can drive up costs and cause drug stock-out [33]. The lack of a
functioning drug supply chain has been observed to be one of the major causes of poor access to essential medicines. Evidence
shows that the supply chain system in Africa is largely weak and unsustainable, laden with lapses and a high incidence of
counterfeit drugs, amidst poor regulation [34].
The causes of poor performance of medicines logistics and supply chain systems were identified to include: uncoordinated
and unstandardized logistics systems, poor supply chain practices, poor forecasting and data management, stifling of local
drug manufacture, regulatory concerns, weak policy implementation, and lack of support for in-country medical logisticians
[33, 35, 36].
Lack of government investment in pharmaceutical sector
The prevailing government apathy and lack of political will encapsulated by a consistent lack of investment in healthcare
affect people’s access to drugs [37]. There is a massive shortage of incentives to promote local manufacture of medicines as is
REVISITING THE ISSUE OF ACCESS TO MEDICINES IN AFRICA 5of13
evidenced by inadequate funding of research and development, lack of provision of financial support to manufacturers, heavy
taxation levied against pharmaceutical industries, and overall inadequate healthcare budgetary allocations [30, 37].
Additionally, there is an inadequate implementation of existing policies such as the Primary Health Care policy in many
African regions [38]. This policy aimed at ensuring equity in access to quality healthcare services has suffered severe setbacks
due to poor implementation. The primary healthcare systems are rife with fragmented services, a weak referral system, and a
huge gap in access to basic healthcare. A vast number of health facilities are located in urban areas, leaving the residents of
rural areas with limited healthcare access and resulting in the inadequate spatial distribution of health services and products
[39].
Government healthcare financing in Africa is critically low [40]. There is abysmally poor coverage of insurance schemes
with a significant number of the population unable to access the services. Thus, there is a disturbingly high un-pooled source
of payment for medical services and products including out-of-pocket spending by the populace which accounts for as high as
70% of total health expenditure in the region [37]. Amidst enduring poverty, a worrisome percentage of people are unable to
access medicines and healthcare servicesa nightmare obstacle towards achieving Universal Health Coverage.
Unfavourable Manufacturing Conditions
Drug production in Africa is typically done using small plants with low capacity and output [30, 41]. In the context of solid
dosage forms, for instance, this limits the capacity to produce enough tablets to achieve economies of scale and lower overall
production costs. According to a report by McKinsey, African manufacturers need to produce at least half a billion tablets
per year to be cost-competitive with India [28]. However, the prevailing low manufacturing capabilities often lead to high
drug prices and discourages local drug production. Moreover, the utilization and efficiency of manufacturing plants are further
exacerbated by high electricity costs, frequent power interruptions, and other infrastructural issues such as poor transportation
and logistics systems [30]. Unsurprisingly, these unfriendly manufacturing conditions are likely to outweigh any intended
production-cost advantages of local drug manufacturing. As a result, the affordability of these medicines is adversely affected, as
the overhead costs are ultimately transferred to patients and end-users, obstructing access to affordable medicines. Additionally,
compared to European and Asian counterparts, African manufacturing facilities are generally small and lack the required
production equipment, with operations that fail to meet international standards [28].
Limitedhealthworkforce
Globally, the crisis of insufficient healthcare workers is most pronounced in Africa, particularly sub-Saharan Africa [42], thus
limiting access to medicines. The region accounts for 36 out of the 57 countries with a critical shortage of health workers, having
2.3 healthcare personnel per 1000 population, a far cry compared to 18.9 and 24.8 in Europe and the Americas, respectively [43].
Expectedly, this has remarkable consequences on healthcare delivery, including access to medicines. The inadequate number
of trained health professionals makes it increasingly difficult for medical interventions, such as medicines and vaccines, to be
readily available, accessible, and effectively administered by trained and competent personnel [42].
Likewise, the unprecedented exodus of doctors, pharmacists, nurses, and other healthcare workers to developed countries
also worsens the already frail health systems of African nations, further impairing access to medicines [44]. Furthermore, there
is evidence to show that this worrisome trend may further deteriorate if not addressed promptly and properly. A meta-analysis
revealed that the intention to leave among African nurses was approximately 52% [45], considerably higher compared to Israel
(9%) [46], Brazil (22.1%) [47], and Europe (33%) [48]. Given that nurses play a pivotal role in the healthcare system and are
primarily responsible for administering medications, this signals a huge impediment in access to medicines and other healthcare
services if left unchecked.
Lack of sustainable health financing mechanism
Many African countries lack proper health financing frameworks needed to achieve UHC, making access to affordable
medicines challenging. Despite the 2001 Abuja Declaration in which African leaders agreed to allocate at least 15% of the
general government expenditure to health, only five countries (Botswana, Togo, Madagascar, Rwanda, and Zambia) have kept
to the commitment [49]. Moreover, twenty-two (22) African countries do not meet the minimum health expenditure of $44 per
capita as defined by the High-Level Task Force on Innovative International Financing for Health Systems (HLTF), and only
three countries (Botswana, Rwanda, Zambia) have met both the Abuja Declaration and the HLFT requirements [49]. As a result,
accessing medicines in Africa presents a significant challenge and often leads to catastrophic health expenditure characterized
by high financial risks and huge out-of-pocket payments which account for over 40% of the total health expenditure in at least
20 countries across Africa [50].
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Considering health insurance cover and uptake is low across the continent, many people who need medicines are unable to
receive treatment due to the inability to pay. In Nigeria, for instance, only 5% of the population is covered by the National Health
Insurance Scheme (NHIS) funded by the government [51]. Given that the NHIS primarily covers persons employed by the
federal government, those in the private sector, the self-employed, and the unemployed which constitute the vast majority of the
population are uninsured and lack financial protection. Consequently, in trying to access medicines, many families experience
financial hardship, and are pushed below the poverty line [52]. Poor health financing equally represents a significant barrier in
optimizing health and treatment outcomes as the accompanying cost of getting medications makes it practically impossible for
low-income patients to have access to the care they need.
Lack of Infrastructure and technical know-how
The supply of medicines is mired by inadequate infrastructure in many countries in Africa and has in turn affected access to
medicines. A prime example is vaccine supply in Africa. A study shows that at least three in four African countries do not
have adequate systems in place to handle vaccine supply [53]. This results in frequent stock-outs, products getting expired and
some, damaged during storage and transit. Additionally, it has been shown that the most essential factors influencing efficient
inventory management and transport and distribution of medicines are human resource capacity and process management [35].
However, many are not able to access medicines in Africa mainly due to: low number of skilled personnel, logistics being
handled by untrained personnel, poor process management, poor transparency and communication levels, poor assessment of
performance level [35]. There is also a dearth of skilled local talents that have knowledge and expertise in drug research and
development, modern manufacturing techniques, and the use of sophisticated industrial tools and machines needed to boost
drug manufacturing [41].
Lack of effective pricing and price regulations
In the year 2007, the 55 members of the African Union endorsed the Pharmaceutical Manufacturing Plan for Africa, a non-
binding framework ‘to pursue, with the support of our partners, the local production of generic medicines on the continent’.
Despite this, the high prices of essential medicines continue to be a major challenge limiting access to care to a large proportion
of poor populations in Africa [54]. In countries such as Zambia, Nigeria, Senegal and Tunisia, frequently use generic drugs like
paracetamol can cost up to 30 times more than its price in the UK and USA [55]. Many African countries are also not able to
control and regulate the prices of medicines, and they are procuring essentials medicines at high prices than the internationally
recognized price [55, 56, 57]. For instance, imported medicines approved by the drug regulatory agency in Sudan were ten
times more costly than the internationally standard reference price [56]. The lack of effective pricing policies and regulations
has made prices in the private sector pharmacies to remain higher than international prices, thus making treatments for chronic
diseases unaffordable to many in developing countries [55].
The WHO has proposed several cost-containment measures to prevent the further rise of treatment costs including the reg-
ulation of mark-ups in the pharmaceutical supply chain, use of reference pricing, exemptions or reduction of tax for essential
medicines, promoting the use of generics, promoting price transparency, and also the use of health technology assessment to
notify pricing and reimbursement decisions [58]. However, the lack of supporting frameworks, technical capacity, relevant data
have hindered the effective implementation of these cost-containment strategies in most developing countries including Africa
[59]. Therefore, a regulatory mechanism should be established in African countries, where such systems are not in existence to
ensure prices of essential medicines are thoroughly monitored and controlled. Additionally, the use of cheap generic medicines
should continue to be encouraged.
Circulation of fake and counterfeit medicines
Another crucial challenge to be addressed is the increased circulation of fake and counterfeit medicines. Counterfeit or fake
medicines are medicines which are deliberately and fraudulently mislabelled with respect to identity and/or source [60]. A
WHO report stated that Africa alone accounts for 42% of globally detected cases of counterfeit and substandard medical
products [32]. Coupled with poor regulation policies and widespread corruption, fake drugs abound in markets, the harm from
which people suffer and die in dreadful numbers. The borders of the region are very porous leading to smuggling of fake,
substandard, counterfeit and falsified medicines. The increase in circulation of fake and counterfeit medicines in Africa has
posed a great challenge in accessing quality medicines and this has caused waste of funds by consumers, and loss of revenue to
pharmaceutical companies up to 40% [61]. To circumvent this challenge, more deliberate effort and attention need to be put in
curtailing the silent and devastating effects of fake and counterfeit medicines circulating in Africa.
REVISITING THE ISSUE OF ACCESS TO MEDICINES IN AFRICA 7of13
Patent issues and limited investment on research and development
Restrictions in access to patents and inability of local manufacturers, researchers and scientists to gain patents is a barrier
to accessing medicines in Africa. Pharmaceutical industries in many African countries are not optimally manufacturing new
medicines due to low investment in research and development. Disease burden is high in most African countries because of
inadequate funding for innovation [62]. Evidence has also shown that African governments struggle to fulfil their commitments
to research and development, such that only a few kinds of research are being carried out and the ones carried out are not put into
practice [30]. There is also low intra-African research collaboration due to low funding and incentives within the continent and
this encourages under-research of some diseases prevalent in Africa and ultimately affecting the production of new medicines
[63].
RECOMMENDATIONS
We discussed recommendations to improve access to medicines. See Table 1for current efforts and challenges-specific
recommendations.
Direct investment on the health systems
A key component of good health systems is uninterrupted access to effective, safe, quality, and affordable medicines [64]. While
efforts and investments are being made to curb the double burden of diseases on the continent, resources and financial investment
towards ensuring access to medicines need to be prioritized. Currently, most African countries have been falling short of the
2001 Abuja Declaration since its inception, where at least a minimum of 15% of the total budget should be allocated to health;
however, out-of-pocket payment remains the major means of financing health services including medicine purchases [37]. This
is a wake-up call for governments and national health authorities in Africa to ensure investment in the overall health systems as
well as strengthen health insurance systems on the continent.
Increased investment in herbal medicine research
Herbal medicines have stood the test of time since time immemorial. They are generally more accessible, more affordable, and
more acceptable to the local population. About 80% of the population in Africa use herbal medicines in one form or the other and
about 25% of drugs used worldwide are derived from herbs [65]. Although largely non-prescriptive, the sources of information
are always relatives, friends, or herbal specialists. The materials used are always easily accessible and inexpensive. The need
for standardization and complete commercial exploitation of the potential benefits from herbal and traditional medicines thus
becomes imperative [66]. Africa has demonstrated a growing interest in promoting and preserving the traditional knowledge on
the use of herbal medicines. This is active in Senegal and Dakar through the activities of non-Governmental organizations such
as the Association for the Promotion of Traditional Medicines (PROMETRA) [67]. The Centre for Plant Medicine Research
(CPMR) was established in 2010 in Ghana to promote, encourage and regulate scientific research knowledge and development
in the field of plant medicine [68]. The initiative of preserving the local culture and sharing of their knowledge to the global
health as a way of increasing the countries market share has taken root in Nigeria [69].
Despite this huge potential, there is low investment in traditional medicine across Africa, the safety and efficacy of herbal
products are unestablished, and scientific researches to discover new herbal products and technologies to harness them are
hushed in low tones. Therefore, it is expedient that governments and collaborating partners increase finances on herbal medicine;
policies that integrate herbal medicine into national health systems must be implemented and safeguarded; significant research
must be encouraged and devoted to herbal medicine including rapid genetic sequencing that offers vast resource for discovery
of newer agents.
Strengthening access to medicines through public-private partnerships
Public-Private Partnership is a key element to be considered in improving access to medicines in Africa. For instance, a
community-based distribution model of enhancing access to medicines [70] will require public-private partnership. The collab-
oration between governments institutions, private sectors, public health institutions and pharmaceutical companies can help to
strengthen research capacity and improve local manufacture [71]. This is worth exploring on the continent to improve access to
medicines.
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TABLE 1 Overview of the current efforts by African governments and other stakeholders and challenges-specific recommendations to strengthen access
to medicines in Africa
Challenges facing access to medicines in
Africa Current efforts Specific recommendations
High burden of infectious and non-infectious
diseases
Agencies involved in strengthening healthcare
system to effectively respond to diseases and
public health emergencies.
1. Improve disease surveillance, health
promotion and inter-sectoral collaboration
2. Poverty alleviation programmes
Limited pharmaceutical industries and high
costs of raw materials
National Medicines Regulatory Medicines
Authorities (NMRAs) focus on regulation of
medical products, rather than expanding and
strengthening pharmaceutical industries
1. African Medicines Agency (AMA) to
establish additional pharmaceutical
companies
2. Government should subsidize raw materials
including APIs.
3. Research on cost-effective and readily
available raw materials
4. Government grants to local drug
manufacturers.
Overdependence on countries abroad for
medicines
Despite recommendations from researchers, and
other stakeholders, government response and
political will in this regard is still limited.
1. Invest more in ensuring increase in the
presence of more pharmaceutical companies.
Private-public partnerships in this regards
would be beneficial.
2. The presence of the proposed AMA should
also be enhanced across the continent.
Poor supply chains systems Many African countries have its NMRAs with
the role of ensuring effective and efficient
drug supply chain systems. However, only
15% of the NMRAs have a legal mandate to
perform all critical regulatory functions [80].
1. Revitalization of all the NMRAs.
2. Invest in capacity building of medicines
regulatory officers.
3. Developing structural models to address any
local barriers, for example, corrupt practices.
4. Strengthening digitalization of supply chain
activities
Lack of government investment in
pharmaceutical sector
Stakeholders continue to advocate for more
investment from the government to revitalize
the pharmaceutical sector on the continent
[15, 23].
1. Recognition of the pharmaceutical sectors
with direct investment by the government.
2. Increase in political will
Unfavourable manufacturing conditions High electricity costs, frequent power
interruptions, and other infrastructural issues
such as poor transportation continue to persist
despite all the policy recommendations.
Invest in making the continent conducive for
pharmaceutical manufacturing, towards
attracting more international investors.
Limited health workforce 1. Community health workers (CHWs) and
patent medicines vendors have played active
role in improving access to medicines [81,
82].
2. Some countries have also invested in
improving access to medical, pharmacy and
health education across tertiary institutions.
1. Engage CHWs and patent medicines vendor
as well as upskilling them.
2. Specialized practical training in
pharmaceutical manufacturing, quality
assessment, process control, and the use of
modern equipment should be incorporated
into the core curriculum of pharmacy
schools.
3. Improve access to education through
educational grants
Lack of sustainable health financing mechanism Effort is seen in advancing health insurance
systems on the continent. However, there is
still a huge concern regarding coverage. For
example, the insurance coverage in Kenya is
19%, and Nigeria is 5%.
1. Strengthen health insurance systems.
2. Increase in budgetary allocation to health in
African countries
3. Revitalization of primary health care systems
remain pertinent.
Lack of infrastructure and technical know-how Even though more still needs to be done,
pharmaceutical companies, with limited
support from governments, are involved in
strengthening manufacturing capacity through
training, and international collaborations.
Invest directly in supporting manufacturing
industries through capacity building,
improved access to infrastructure, and
building local talents.
Lack of effective pricing and price regulations Even though it is recommended that African
countries should have agency aimed at
regulating medicines prices, most do not
perform the role.
Set up an initiative that is aimed at regulating
drug prices with evidence-based pillars in
making such decisions.
(Continues)
REVISITING THE ISSUE OF ACCESS TO MEDICINES IN AFRICA 9of13
TABLE 1 (Continued)
Challenges facing access to medicines in
Africa Current efforts Specific recommendations
Circulation of fake and counterfeit medicines The medicines regulatory landscape is
undergoing transformation with Nigeria,
Egypt, Tanzania and Ghana having NMRAs
operating at WHO maturity level 3. The
NMRA’s surveillance effort to reduce the
circulation of fake and counterfeit medicines
are, however, undermined.
1. Invest in strengthening medicines supply
chain systems.
2. Active and passive surveillance of drugs in
circulation should be enhanced.
3. Employing people-centred technological
innovation.
4. Close open drug market.
Patent issues and limited investment on research
and development
There is a growing discussions and actions on
the need to invest in herbal medicine research.
Struggle to protect patents persists and
advocacy action is still growing in this regard.
1. Massive investment in pharmaceutical
research.
2. Initiative should be enhanced to protect
African-based patents.
Abbreviations: AMA, African Medicines Agency; APIs, Active Pharmaceutical Ingredients; CHWs, Community Health Workers; NMRAs, National Medicines Regulatory Medicines
Authorities; WHO, World Health Organization.
Establishing effective pharmaceutical drug policies
Since most of the medicines used in Africa are imported, drug policies that target the improvement of local production of drugs
would greatly improve the access to medicines in the region. Historically, poor implementation of existing policies has led to a
shortage of essential medicines and will continue to do so unless deliberate interventions are made. Such interventions should
include strengthening the drug policies to support local expertise in the manufacture and quality control of drugs. Adequate
training and funding of drug regulatory agencies in the region should be put in place as they are critical to eliminating the
distribution of fake and counterfeited medicines. Collaboration between countries in the region to develop a system to limit the
free movement of fake and adulterated drugs would help to support local manufacturers. A robust system to enforce the policies
is equally important to ensure strict compliance. Smooth development and enforcement of drug policies have the potential to
bring the continent one step closer to achieving access to safe and quality medicines. In addition, harmonization of African
Medicines Agencies is also a very important step to address the anaemic access to medicines on the continent [72].
Establishing more in-continent pharmaceutical companies
There is currently an increasing interest among African and international policy makers, researchers, and some donors and
suppliers, to improve local African pharmaceutical supply by supporting new and existing pharmaceutical companies. This
is much-needed to improve the continent’s capacity to produce medicines for its populace. Investing in establishing more in-
continent pharmaceutical companies will improve access to medicines which is crucial to attain universal health coverage in
Africa [73].
Investment in industrial pharmacy education and capacity building on the continent
A commitment to investment in industrial pharmacy education can help to bridge gaps in access to medicines in Africa through
development of human resources and advocacy [74, 75]. Specialized practical training in pharmaceutical manufacturing, qual-
ity assessment, process control, and the use of modern equipment should be incorporated into the core curriculum of pharmacy
schools to stimulate interest in industrial pharmacy, improve local manufacturing capacity and galvanize renewed actions
towards making medicines more available, accessible, and affordable to Africans. Additionally, African-based pharma and
biotech companies should make strides to improve existing systems and structures, particularly in research and development,
in order to meet the ever-growing healthcare needs of the teeming African population.
Evidence-based adaptation of WHO essential medicines lists for local use
The World Health Organization publishes Model List of Essential Medicines, which is updated every 2 years since 1977 when
it was first published [76]. The list contains the medications which are considered to be most effective and safe to meet the
most important needs in a health system. Even though many African countries frequently use the list to help develop their own
10 of 13 ADEBISI ET AL.
local lists of essential medicines, often times the locally adapted essential lists are not evidence-based [77]. We recommend
that African countries should engage in active research to understand the local medicines need of their population and adapt or
modify the essential medicines lists based on this.
Rapid ratification of the proposed African medicines agency treaty
The African Medicines Agency’s (AMA), which is a component of the African Union Model Law, has a vision to ensure that
all Africans have access to quality-assured, efficacious, safe and affordable medical products, that meet globally recognised
standards, for major diseases or prioritized conditions [72, 78]. Ultimately, instead of having 55 National Medicines Regula-
tory Agencies (NMRAs) on the African continent, each with its own regulatory requirements, the AMA intends, among other
goals, to result in streamlined regulatory processes in order to enable the timely evaluation and subsequent registration of med-
ical products [79]. The African Medicines Regulatory Harmonization initiative is the foundation for the establishment of the
African Medicines Agency [72]. To date, 17 member states of the African Union (Algeria, Benin, Burkina Faso, Cameroon,
Chad, Gabon, Ghana, Guinea, Mali, Mauritius, Namibia, Niger, Rwanda, Seychelles, Sierra Leone, Tunisia and Zimbabwe)
have ratified the Treaty for the Establishment of the African Medicines Agency and deposited the legal instrument of ratifi-
cation to the Commission [78]. In total, 26 member states (Algeria, Benin, Burundi, Cameroon, Chad, Cote d’Ivoire, Egypt,
Gabon, Ghana, Guinea, Madagascar, Mali, Mauritius, Morocco, Niger, Rwanda, Republic of Congo, Saharawi Arab Demo-
cratic Republic, Senegal, Seychelles, Sierra Leone, Tanzania, Togo, Tunisia, Uganda and Zimbabwe) have signed the treaty
[78]. We urge African countries to sign and ratify the Treaty for the Establishment of the African Medicines Agency in the
interest of public health, safety and security. In addition to this, sustainable financing mechanism and political commitment
across African countries to ensure the success of AMA is pertinent.
CONCLUSION
Without reliable access to medicine systems, the healthcare system is incomplete and good health and well-being cannot be
guaranteed. It is clear that access to medicines in Africa faces numerous challenges and it is pertinent for the continent to
address these issues as it is geared towards strengthening its health systems for universal health coverage. We call on African
governments and national health authorities to prioritize efforts and initiatives to strengthen access to medicines using tailor-
made mechanisms and country-compatible strategies.
ACKNOWLEDGEMENTS
The authors are grateful to the critical comments of the reviewers. There is no funding in the development for this paper.
CONFLICT OF INTEREST
The authors declare no competing interests.
ETHICS STATEMENT
There is no need for ethical approval.
AUTHOR CONTRIBUTIONS
Yusuff Adebayo Adebisi conceptualized the idea of the paper. A data gathering and a drafting group was composed of Yusuff
Adebayo Adebisi, Ifechukwu Benedict Nwogu, Aishat Jumoke Alaran, Abubakar Olaitan Badmos, Adeboye Olakunle Bamg-
boye, Basirat Oluwadamilola Rufai, Osaretin Christabel Okonji, Malik O. Malik, John Oluwafemi Teibo, and Samah Faisal
Abdalla. All authors contributed in the analysis of the data and the revision iterations. Final rewriting and revision were done by
Yusuff Adebayo Adebisi, Don Eliseo Lucero-Prisno III, Mohamed Samai, and Wuraola Akande-Sholabi. All co-authors agreed
to the final draft of the paper.
DATA AVAILABILITY STATEMENT
This is a review article and all sources used were duly cited.
ORCID
Yusuff Adebayo Adebisi https://orcid.org/0000-0002-2381-0984
Ifechukwu Benedict Nwogu https://orcid.org/0000-0001-9845-9327
Aishat Jumoke Alaran https://orcid.org/0000-0001-8443-8701
Abubakar Olaitan Badmos https://orcid.org/0000-0002-7762-7018
REVISITING THE ISSUE OF ACCESS TO MEDICINES IN AFRICA 11 of 13
Osaretin Christabel Okonji https://orcid.org/0000-0002-1511-2094
John Oluwafemi Teibo https://orcid.org/0000-0002-0833-4828
Don Eliseo Lucero-Prisno III https://orcid.org/0000-0002-2179-6365
Mohamed Samai https://orcid.org/0000-0002-1427-9482
Wuraola Akande-Sholabi https://orcid.org/0000-0003- 0869-1726
REFERENCES
1. World Health Organization International Health Conference, New York; 1946. https://www.who.int/about/who-we- are/constitution. Accessed: 20
February 2022.
2. World Health Organization. Towards Access 2030: WHO Essential Medicines and Health Products Strategic Framework 2016–2030. Geneva: World
Health Organization; 2017. https://www.who.int/medicines/publications/Towards_Access_2030_Final.pdf. Accessed: 20 February 2022.
3. World Health Organization. Ten years in public health, 2007–2017: report by Dr Margaret Chan, Director-General, World Health Organization. World
Health Organization. 2017. https://apps.who.int/iris/handle/10665/255355. Accessed: 20 February 2022.
4. Niëns LM, Cameron A, Van de Poel E, Ewen M, Brouwer WB, Laing R. Quantifying the impoverishing effects of purchasing medicines: a cross-country
comparison of the affordability of medicines in the developing world. PLoS Med. 2010;7(8):e1000333.
5. Auta A, Bala ET, Shalkur D. Generic medicine substitution: a cross-sectional survey of the perception of pharmacists in North-Central, Nigeria. Med
Princ Pract. 2014;23(1):53-58.
6. Phaege T. Dying from lack of medicines. Africa Renewal. 2017;30(3):24-25. Available online at: https://www.un-ilibrary.org/content/journals/25179829/
30/3/27. Accessed: 20 February 2022.
7. Novignon J, Olakojo SA, Nonvignon J. The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence
from panel data analysis. Health Econ Rev. 2012;2(1):1-8.
8. Narayan, K., Donnenfeld, Z. Envisioning a healthy future: Africa’s shifting burden of disease. 2016. https://media.africaportal.org/documents/african_
futures18.pdf. Accessed: 20 February 2022.
9. Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet Glob Health. 2019;7(10):e1295-e1296.
10. Johns Hopkins Center for Health Security. Global Health Security Index. 2020. https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-
Health-Security- Index.pdf. Accessed: 20 February 2022.
11. Lucero-Prisno DE 3rd, Adebisi YA, Lin X. Current efforts and challenges facing responses to 2019-nCoV in Africa. Glob Health Res Policy. 2020;5:21.
12. United Nations Development Group (2003) Indicators for Monitoring the Millennium Development Goals. United Nations, New York, 2003.
13. Centre for Pharmaceutical Management (2003). Defining and Measuring Access to Essential Drugs, Vaccines, and Health Commodities: Report of the
WHO-MSH consultative meeting. Ferney-Voltaire, France, December 11–13, 2000.
14. Obuaku IC. Rural-urban differentials in access to essential medicines: Evidence from three Northern Nigerian States. JIAATS- J Adv Res Med Health Sci.
2017;3:7.
15. Akande-Sholabi W, Adebisi YA. The impact of COVID-19 pandemic on medicine security in Africa: Nigeria as a case study. PanAfrMedJ.
2020;35(Suppl 2):73.
16. Beargie SM, Higgins CR, Evans DR, Laing SK, Erim D, Ozawa S. The economic impact of substandard and falsified antimalarial medications in Nigeria.
PLoS One. 2019;14(8):e0217910.
17. Ophori EA, Tula MY, Azih AV, Okojie R, Ikpo PE. Current trends of immunization in Nigeria: prospect and challenges. Trop Med Health. 2014;42(2):67-
75.
18. Adebisi YA, Rabe A, Lucero-Prisno Iii DE. COVID-19 surveillance systems in African countries. Health Promot Perspect. 2021;11(4):382-392.
19. Van Minh H, Pocock NS, Chaiyakunapruk N, et al. Progress toward universal health coverage in ASEAN. Glob Health Action. 2014;7:25856.
20. de-Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global.
Global Health. 2010;6:5.
21. Young F, Critchley JA, Johnstone LK, Unwin NC. A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and
diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization. Global Health. 2009;5:9.
22. Mujinja PG, Mackintosh M, Justin-Temu M, Wuyts M. Local production of pharmaceuticals in Africa and access to essential medicines: ‘urban bias’ in
access to imported medicines in Tanzania and its policy implications. Global Health. 2014;10:12.
23. Akande-Sholabi W, Adebisi YA, Bello A, Ilesanmi OS. COVID-19 in Nigeria: is the pharmaceutical sector spared? Public Health Pract (Oxf).
2020;1:100044.
24. Faiva E, Hashim HT, Ramadhan MA, Musa SK, Bchara J, Tuama YD, Adebisi YA, Kadhim MH, Essar MY, Ahmad S, Lucero-Prisno DE 3rd. Drug
supply shortage in Nigeria during COVID-19: efforts and challenges. J Pharm Policy Pract. 2021;14(1):17.
25. Uwizeyimana T, Hashim HT, Kabakambira JD, Mujyarugamba JC, Dushime J, Ntacyabukura B, Ndayizeye R, Adebisi YA, Lucero-Prisno DE 3rd. Drug
supply situation in Rwanda during COVID-19: issues, efforts and challenges. J Pharm Policy Pract. 2021;14(1):12.
26. Bright B, Babalola CP, Sam-Agudu NA, Onyeaghala AA, Olatunji A, Aduh U, Sobande PO, Crowell TA, Tebeje YK, Phillip S, Ndembi N, Folayan MO.
COVID-19 preparedness: capacity to manufacture vaccines, therapeutics and diagnostics in sub-Saharan Africa. Global Health. 2021;17(1):24.
27. Ahen F, Salo-Ahen HMO. Governing pharmaceutical innovations in Africa: inclusive models for accelerating access to quality medicines. Cogent Med.
2018;5:1500196.
28. McKinsey. Should sub-Saharan Africa make its own drugs? 2019. https://www.mckinsey.com/industries/public-and- social-sector/our-insights/should-
sub-saharan- africa-make-its- own-drugs. Accessed: 20 February 2022.
29. WorldBank. Local Production of Pharmaceuticals : Industrial Policy and Access to Medicines, An Overview of Key Concepts, Issues and Opportunities
for Future Research. https://openknowledge.worldbank.org/handle/10986/13723. Accessed: 20 February 2022.
30. Ekeigwe AA. Drug manufacturing and access to medicines: the West African story. A literature review of challenges and proposed remediation. AAPS
Open. 2019;5(1):3.
31. Tannoury M, Attieh Z. The influence of emerging markets on the pharmaceutical industry. Curr Ther Res Clin Exp. 2017;86:19-22.
32. WHO (2017) 1 in 10 medical products in developing countries is substandard or falsified. Geneva, Switzerland. https://www.who.int/news/item/28-11-
2017-1-in-10- medical-products-in- developing-countries-is- substandard-or-falsified. Accessed: 20 February 2022.
12 of 13 ADEBISI ET AL.
33. Committee on Understanding the Global Public Health Implications of Substandard, Falsified, and Counterfeit Medical Products; Board on Global
Health; Institute of Medicine; Buckley GJ, Gostin LO, editors. Countering the Problem of Falsified and Substandard Drugs. Washington (DC): National
Academies Press (US); 2013. https://www.ncbi.nlm.nih.gov/books/NBK202530/. Accessed: 20 February 2022.
34. Vledder M, Friedman J, Sjöblom M, Brown T, Yadav P. Improving supply chain for essential drugs in low-income countries: results from a large scale
randomized experiment in Zambia. Health Syst Reform. 2019;5(2):158-177.
35. Anna S. Analysis of challenges of medical supply chains in sub-Saharan Africa regarding inventory management and transport and distribution. Master’s
Thesis. https://iaphl.org/wp-content/uploads/2016/05/Medical-Supply-Chain-Challenges.Masterthesis.ASchoepperle.pdf. Accessed: 20 February 2022.
36. Chukwu OA, Chukwu U, Lemoha C. Poor performance of medicines logistics and supply chain systems in a developing country context: lessons from
Nigeria. J Pharmaceut Health Services Res. 2018;9(4):289-291.
37. Adebisi YA, Umah JO, Olaoye OC, Alaran AJ, Sina-Odunsi AB. Assessment of health budgetary allocation and expenditure toward achieving universal
health coverage in Nigeria. Int J Health Life Sci. 2020;6(2).
38. World Health Organization. A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development
Goals. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2018 (WHO/HIS/SDS/2018.X). http://www.who.int/
docs/default-source/primary-health/vision.pdf?sfvrsn=c3119034_2. Accessed: 20 February 2022.
39. Druetz T. Integrated primary health care in low- and middle-income countries: a double challenge. BMC Med Ethics. 2018;19(Suppl 1):48.
40. World Health Organization. Public Financing for Health in Africa: from Abuja to the SDGs. https://www.afro.who.int/publications/public-financing-
health-africa- abuja-sdgs. Accessed on: 20 February 2022.
41. African Union. PHARMACEUTICAL MANUFACTURING PLAN FOR AFRICA. https://au.int/sites/default/files/pages/32895-file-pmpa_business_
plan.pdf. Accessed: 20 February 2022.
42. Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int J Environ Res Public
Health. 2007;4(2):93-100.
43. World Health Organization: Working Together for Health -The World Health Report 2006 (2006). Available at: https://www.who.int/whr/2006/whr06_en.
pdf. Accessed: 20 February 2022.
44. Ogilvie L, Mill JE, Astle B, Fanning A, Opare M. The exodus of health professionals from sub-Saharan Africa: balancing human rights and societal needs
in the twenty-first century. Nurs Inq. 2007;14(2):114-124.
45. Ayalew E, Workineh Y, Semachew A, Woldgiorgies T, Kerie S, Gedamu H, Zeleke B. Nurses’ intention to leave their job in sub-Saharan Africa: a
systematic review and meta-analysis. Heliyon. 2021;7(6):e07382.
46. Dekeyser Ganz F, Toren O. Israeli nurse practice environment characteristics, retention, and job satisfaction. Isr J Health Policy Res. 2014;3(1):7.
47. de Oliveira DR, Griep RH, Portela LF, Rotenberg L. Intention to leave profession, psychosocial environment and self-rated health among registered nurses
from large hospitals in Brazil: a cross-sectional study. BMC Health Serv Res. 2017;17(1):21.
48. Dall’Ora C, Griffiths P, Ball J, Simon M, Aiken LH. Association of 12 h shifts and nurses’ job satisfaction, burnout and intention to leave: findings from
a cross-sectional study of 12 European countries. BMJ Open. 2015;5(9):e008331.
49. Piabuo SM, Tieguhong JC. Health expenditure and economic growth - a review of the literature and an analysis between the economic community for
central African states (CEMAC) and selected African countries. Health Econ Rev. 2017;7(1):23.
50. World Health Organization: State Of Health Financing In The African Region’ 2013. https://www.afro.who.int/sites/default/files/2017- 06/state-of-health-
financing-afro.pdf. Accessed: 20 February 2022.
51. Alawode GO, Adewole DA. Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative
study among sub-national level actors, healthcare and insurance providers. BMC Public Health. 2021;21(1):124.
52. Wagstaff A, Flores G, Smitz MF, Hsu J, Chepynoga K, Eozenou P. Progress on impoverishing health spending in 122 countries: a retrospective
observational study. Lancet Glob Health. 2018;6(2):e180-e192.
53. GAVI. Progress Reports. https://www.gavi.org/programmes-impact/our-impact/progress-reports. Accessed: 20 February 2022.
54. WHO. Access to medicines: making market forces serve the poor. health 2007–2017. World Health Organization; 2017. Available at: https://www.who.
int/publications/10-year-review/chapter-medicines.pdf. Accessed: 20 February 2022.
55. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries:a
secondary analysis. Lancet. 2009;373(9659):240-249.
56. Lucero-Prisno III DE, Elhadi YA, Modber MA, Musa MB, Mohammed SE, Hassan KF, Dafallah A, Lin X, Ahmadi A, Adeyemi S, Ekpenyong A. Drug
shortage crisis in Sudan in times of COVID-19. Public Health in Practice. 2020;1:100060.
57. Ewen M, Kaplan W, Gedif T, Justin-Temu M, Vialle-Valentin C, Mirza Z, Regeer B, Zweekhorst M, Laing R. Prices and availability of locally produced
and imported medicines in Ethiopia and Tanzania. J Pharm Policy Pract. 2017;10:7.
58. WHO guideline on country pharmaceutical pricing policies, second ed. Geneva: World Health Organization; 2020. https://apps.who.int/iris/rest/
bitstreams/1309649/retrieve. Accessed: 20 February 2022.
59. Kirua RB, Temu MJ, Mori AT. Prices of medicines for the management of pain, diabetes and cardiovascular diseases in private pharmacies and the
national health insurance in Tanzania. Int J Equity Health. 2020;19(1):203.
60. World Health Organization. Counterfeit Drugs. 1992. Available from: http://www.apps.who.int/iris/bitstream/10665/58358/1/WHO_DMP_CFD_92.pdf.
Accessed: 20 February 2022.
61. Seiter A. Health and economic consequences of counterfeit drugs. Clin Pharmacol Ther. 2009;85(6):576-578.
62. Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, Van Damme W. Access to medicines from a health system perspective. Health Policy
Plan. 2013;28(7):692-704.
63. Nwaka S, Ilunga TB, Da Silva JS, Rial Verde E, Hackley D, De Vré R, Mboya-Okeyo T, Ridley RG. Developing ANDI: a novel approach to health
product R&D in Africa. PLoS Med. 2010;7(6):e1000293.
64. Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, Gyansa-Lutterodt M, Jing S, Luiza VL, Mbindyo RM, Möller H, Moucheraud
C, Pécoul B, Rägo L, Rashidian A, Ross-Degnan D, Stephens PN, Teerawattananon Y, ’t Hoen EF, Wagner AK, Yadav P, Reich MR. Essential medicines
for universal health coverage. Lancet. 2017;389(10067):403-476.
65. Wachtel-Galor S, Benzie IFF. Herbal Medicine: An Introduction to Its History, Usage, Regulation, Current Trends, and Research Needs. In: Benzie IFF,
Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd ed. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 1.
66. Fokunang CN, Ndikum V, Tabi OY, Jiofack RB, Ngameni B, Guedje NM, Tembe-Fokunang EA, Tomkins P, Barkwan S, Kechia F, Asongalem E,
Ngoupayou J, Torimiro NJ, Gonsu KH, Sielinou V, Ngadjui BT, Angwafor F 3rd, Nkongmeneck A, Abena OM, Ngogang J, Asonganyi T, Colizzi V,
REVISITING THE ISSUE OF ACCESS TO MEDICINES IN AFRICA 13 of 13
Lohoue J, Kamsu-Kom. Traditional medicine: past, present and future research and development prospects and integration in the National Health System
of Cameroon. Afr J Tradit Complement Altern Med. 2011;8(3):284-295.
67. Kasilo OMJ, Wambebe C, Nikiema JB, Nabyonga-Orem J. Towards universal health coverage: advancing the development and use of traditional medicines
in Africa. BMJ Glob Health. 2019;4(Suppl 9):e001517.
68. Appiah KS, Oppong CP, Mardani HK, Omari RA, Kpabitey S, Amoatey CA, Onwona-Agyeman S, Oikawa Y, Katsura K, Fujii Y. Medicinal plants used
in the Ejisu-Juaben Municipality, Southern Ghana: an ethnobotanical study. Medicines (Basel). 2018;6(1):1.
69. Falodun A. Herbal medicine in Africa-distribution, standardization and prospects. Res J Phytochem. 2010;4(3):154-161.
70. Magadzire BP, Marchal B, Ward K. Novel models to improve access to medicines for chronic diseases in South Africa: an analysis of stakeholder
perspectives on community-based distribution models. J Pharm Policy Pract. 20161;9:28.
71. Vogler S, Zimmermann N, Babar ZU, Busse R, Espin J, Mantel-Teeuwisse AK, Panteli D, Suleman F, Wirtz VJ. Addressing the medicines access
challenge through balance, evidence, collaboration and transparency: key take-away lessons of the 4th PPRI Conference. J Pharm Policy Pract.
2021;14(1):18.
72. Ncube BM, Dube A, Ward K. Establishment of the African Medicines Agency: progress, challenges and regulatory readiness. J Pharm Policy Pract.
2021;14(1):29.
73. Orubu ESF, Ching C, Zaman MH, Wirtz VJ. Tackling the blind spot of poor-quality medicines in Universal Health Coverage. J Pharm Policy Pract.
2020;13:40.
74. Brown A, Atif M, Hasselberg E, Steele P, Wright C, Babar ZUD. Human resources health supply chains and access to essential medicines. J Pharm
Policy Pract. 2014;7(Suppl 1):I2.
75. Ravinetto R, Vandenbergh D, Macé C, Pouget C, Renchon B, Rigal J, Schiavetti B, Caudron JM. Fighting poor-quality medicines in low- and middle-
income countries: the importance of advocacy and pedagogy. J Pharm Policy Pract. 2016;9:36.
76. Laing R, Waning B, Gray A, Ford N, ’t Hoen E. 25 years of the WHO essential medicines lists: progress and challenges. Lancet. 2003;361(9370):1723-
1729.
77. Peacocke EF, Myhre SL, Foss HS, Gopinathan U. National adaptation and implementation of WHO Model List of Essential Medicines: a qualitative
evidence synthesis. PLoS Med. 2022;19(3):e1003944.
78. African Union. African Medicines Agency. Link: https://au.int/en/pressreleases/20211109/treaty-establishment-african- medicines-agency-ama- enters-
force. Accessed: April 3, 2022.
79. Chattu VK, Dave VB, Reddy KS, et al. Advancing African medicines agency through global health diplomacy for an equitable Pan-African universal
health coverage: a scoping review. Int J Environ Res Public Health. 2021;18(22):11758.
80. Ndomondo-Sigonda M, Miot J, Naidoo S, Dodoo A, Kaale E. Medicines regulation in Africa: current state and opportunities. Pharmaceut Med.
2017;31(6):383-397.
81. Liu J, Prach LM, Treleaven E, et al. The role of drug vendors in improving basic health-care services in Nigeria. Bull World Health Organ. 2016;94(4):267-
275.
82. Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and functions of community health workers in primary care. Ann Fam Med. 2018;16(3):240-245.
How to cite this article: Adebisi YA, Nwogu IB, Alaran AJ, et al. Revisiting the issue of access to medicines in
Africa: Challenges and recommendations. Public Health Chall. 2022;1:e9. https://doi.org/10.1002/puh2.9
... The AU required a minimum of 15 member states to ratify the AMA Treaty before it could be implemented. By contributing to the continental socioeconomic development agenda, AMA is expected to be a key driver in removing technical trade barriers among the regional countries [14,[17][18][19]. This study describes the factors that enabled the establishment of the AMA, as well as the successes, challenges, and perceived benefits of its establishment. ...
... On October 5, 2021, Cameroon became the 15th country to deposit its ratification instrument. Consequently, the AMA Treaty came into force on November 1, 2021 [19]. As of October 2023, 37 of the 55 member states had signed the treaty (Figure 3). ...
... Since Rwanda's initial signing of the treaty on June 12, 2019, the progress has been noteworthy, culminating in the treaty coming into force on November 1, 2021, after Cameroon deposited its ratification instrument as the 15th country on October 5, 2021. By October 2023, 37 out of 55 member states had signed the treaty, showcasing widespread support for this crucial initiative [18,19]. ...
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In response to the situation of the African healthcare system, the African Medicines Agency (AMA) was established by the African Union (AU) to regulate access to medicines and support the local manufacture of medications. This study aimed to describe the factors that enabled the establishment of the African Medicines Agency and its successes, challenges, and perceived benefits. We reviewed data sources that explored the progress and challenges of the African Medicines Agency and Medicines Regulation in Africa. The SPIDER framework was used to organise the research focus and to extract the keywords for the literature search. The study data were obtained from PubMed Central, ScienceDirect, and Google Scholar. Out of 249 studies screened, 19 were selected for this narrative review. Critical successes observed in the agency's establishment include the appointment of a Special Envoy, the selection of its headquarters, and the signing of its treaty by 37 member states. However, it is hindered by poor political commitment, differences in risk‐benefits interpretation and organizational structure, weak legal and regulatory frameworks, inadequate financial mechanisms, and inadequate political and policy leadership in some member states. The value of AMA in achieving optimal health outcomes and its other benefits must be considered despite the challenges being encountered. Therefore, all member states should adopt the best procedures in signing and ratifying the treaty and implementing associated commitments to improve efficiency and accountability in African medicine regulation.
... African pharmaceutical industry is dominated by privately owned small companies and few major manufacturers [6]. The local production output of the African pharmaceutical industry is 25-30% of pharmaceuticals and below one-tenth of medical supplies available on the African market [7]. Over time, the industry has seen significant improvements in the processing, formulation, and manufacturing of pharmaceutical products from small-scale production using simple hand-operated tools to large-scale production using commercial machinery [8,9]. ...
... Africa's pharmaceutical industry is critical to improving public health outcomes, promoting economic development, and lowering the continent's reliance on imports [7,16]. Despite significant challenges such as budgetary limitations, inadequate infrastructure, skilled labor shortages, and regulatory limitations, the industry has ample growth opportunities due to the rising demand for pharmaceuticals. ...
... Africa imports 95% of its medications and 99% of its vaccines [16,17], relying heavily on international support. Many African nations have inadequate pharmaceutical manufacturing and regulatory frameworks, limiting access to quality, safe, effective, and affordable medical products [7]. Domestic manufacturing capabilities are limited, and the industry heavily depends on imports from China and India. ...
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Emerging technologies present a transformative potential for pharmaceutical process design and optimization, particularly within Africa's evolving pharmaceutical industries. The purpose of this review is to explore the impact of emerging digital technologies, including Artificial Intelligence (AI), Machine Learning (ML), the Internet of Things (IoT), and Robotics, on pharmaceutical process design and optimization within the African context. Data was collected through a comprehensive literature review of scholarly articles, industry reports, and case studies. By analyzing recent advancements and case studies, this review identifies key areas where technology is reshaping the production processes for pharmaceutical product development. It highlights the benefits, including increased efficiency, improved accuracy, and minimized waste. However, the review also emphasizes significant challenges, including infrastructural limitations, regulatory barriers, and disparities in access to technology that can hinder the adoption of these emerging technologies in Africa. An assessment of their impact on manufacturing efficiency, drug production costs, drug quality, and safety reveals their potential to enhance pharmaceutical manufacturing operations significantly. The findings suggest that while emerging technologies offer substantial opportunities for improving pharmaceutical processes and operations, their successful integration requires a strategic approach that involves stakeholder cooperation, infrastructure improvements, and targeted capacity enhancement initiatives within the continent's pharmaceutical industry. This review offers a broad overview of the current state of technological adoption in the pharmaceutical manufacturing sector in Africa and the impact of leveraging these emerging technologies to drive sustainable improvements in the pharmaceutical product development process.
... As the literature denotes, crucial to this will be investing in the Country's technology, infrastructure and human resource capacity, which can promote local production [40,42,43]. Additionally, incentivizing local production, such as through the establishment of a conducive legislative framework, increases local production [37,44]. These legislations can include price controls, tax relief for manufacturers and the overall establishment of good manufacturing practices (GMP) that attract local and international investments in production [41,42,44]. ...
... Additionally, incentivizing local production, such as through the establishment of a conducive legislative framework, increases local production [37,44]. These legislations can include price controls, tax relief for manufacturers and the overall establishment of good manufacturing practices (GMP) that attract local and international investments in production [41,42,44]. ...
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This study examines the impact of the COVID-19 pandemic on the availability of essential medicines in Kenya and suggests actionable measures to enhance the country’s preparedness for future pandemics. Utilising a cross-sectional qualitative design, the research combines a systematic review of the literature and 20 key informant interviews to provide a comprehensive analysis. The initial response to the pandemic involved resource reallocation, disrupting the procurement of essential medicines at national and county levels. Inefficiencies in these systems resulted in shortages and wastages of crucial medicines, exposing vulnerabilities in the health system. Furthermore, the study reveals regulatory policy weaknesses in Kenya, such as an inadequate legal framework for domestic pharmaceutical manufacturing and conflicting policies hindering medicine availability. The study recommends a multifaceted policy approach to ensure essential medicine availability during crises. Key recommendations include strengthening financial systems through increased government investments and innovative funding mechanisms, implementing price regulation policies, and enhancing the resilience of supply chain and procurement systems. Collaboration among various supply systems is essential to prevent stock-outs. Strengthening legislation and regulatory policies, increasing domestic pharmaceutical manufacturing capacity, and investing in health information systems are vital for sustained self-sufficiency and efficient service delivery. These comprehensive measures are essential to promote essential medicine availability, safeguard public health, and enhance resilience during crises.
... Moreover, there is a lack of harmonization between national and state-level regulations, leading to inconsistencies in implementation and oversight. Several gaps exist in the regulatory frameworks governing herbal medicine in Nigeria, with significant implications for public health and safety [24]. These include the absence of standardized training and certification requirements for herbal practitioners, which can lead to variations in practice and quality of care. ...
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Traditional medicine (TM) by World Health Organization (WHO) is the totality of knowledge, skills, and practices based on theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance and preservation of health, whether physical or mental. African traditional medicine is the holistic healthcare system specializing on divination, spiritualism, and herbalism. In Nigeria, most indigenes rely on TM to meet their primary healthcare needs. WHO’s strategy for TM is to promote TM integration and complementary and alternative medicine (CAM) into the healthcare systems of countries. Therefore, the aim of this study was to critically assess the regulatory framework for traditional medicinal practice in Nigeria. The research methodology was doctrinal approach, using expository and analytical research design. The main sources of data collection were literatures from physical library and e-library. This research found, among others, that there is need to have a working national framework for the safe practice of TM in Nigeria. Thus, this research recommended, among others, a distinct national framework for the practice of TM in Nigeria which will also establish a functioning regulatory institution in various states, thereby ensuring proper regulation and enlightenment in this milieu.
... It is imperative that people are not denied life-saving medicines for economic and/or social reasons. The need for safe and effective medicines is also recognised as a basic human right by the World Health Organisation (WHO) [1]. Health care is fundamentally important because it affects our ability to pursue life goals, reduce pain and suffering, and prevent premature loss of life [2]. ...
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Background South Africa is composed of a two-tier healthcare system. One tier is a private healthcare system that is funded through medical insurance, and comprised of people who can afford to make monthly payments towards their medical insurance. Second tier is a government-funded public healthcare system, which covers the majority of the population. This study explored the perceived barriers and current strategies being utilised by the pharmaceutical industry to increase access to innovator medicines. Objectives The objectives of the study were to: (1) quantify and classify innovator medicines registered between 2010 and 2020 by the South African Health Products Regulatory Authority (SAHPRA); (2) identify barriers to accessing innovator medicines in South Africa through interviews with market access managers from innovator companies; and (3) explore the current market access strategies used by the pharmaceutical industry. Design This study employed a quantitative and qualitative methodology. Whereby the former involved the extraction of a list of innovator medicines from the regulator database, and the latter involved 9 semi structured interviews. Purposive sampling was conducted through pharmaceutical association member companies. The interviews included seven market access managers and two medicine managers from one of the payers in South Africa. Thematic analysis was used to interpret the data collected from the study. Results According to the regulator database during the review period, 238 innovator medicines were registered. Only 14.77% were available in the public sector in the form of tenders, whereas in the private sector (based on the products having a SEP), 76.92% were available. From the interviews six themes emerged: reimbursement of medicines, types of reimbursement, partnerships, technology, legislative challenges, and other factors (e.g., real-world evidence). Conclusion Access to innovator medicines in South Africa is a challenge, as the price of these therapies is high. Therefore, various stakeholders in the health sector must collaborate to identify and implement solutions that are locally relevant. The government needs to proactively update policies that would allow for alternative reimbursement methods to be explored.
... But this scenario is not yet valid for most SSA countries, where subsistence rural farmers prevail, and food purchases are not yet influenced by a health concern, such as managing fat and cholesterol, salt and sugar, reducing risk of a disease, defying the aging process, or following doctor's orders. In reality, some 80% of the SSA population attend traditional doctors and access to imported pharmaceuticals in SSA faces numerous challenges [178,179]. ...
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Food fortification with micronutrients was initially justified in developed countries by a lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands, soil fatigue is not predominant, and communities consume mostly home-grown, organic, non-processed crops. Sub-Saharan food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability, and self-sufficiency, the main SSA setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction and women’s education are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize, if not entirely, eliminate deficiencies. Compulsory mass fortification of foods in Sub-Saharan Africa (SSA) with single micronutrients is, however, controversial since they work in synergy among each other and with the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal, and unjust food distribution, interrelated with political, social, cultural, or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programs, just food fortification cannot solve the composite of all these elements. Further, compulsory fortification is excessive, unproductive, and likely harmful to human health, while many challenges remain in assessing the quality of available premixes. Furthermore, aiming at dietary diversification is the best approach of increasing trace element intake from commonly accessible and easily available food sources.
... But this scenario is not yet valid for most SSA countries, where subsistence rural farmers prevail, and food purchases are not yet influenced by a health concern, such as managing fat and cholesterol, salt and sugar, reducing risk of a disease, defying the aging process, or following doctor's orders. In reality, some 80% of the SSA population attend traditional doctors and access to imported pharmaceuticals in Africa faces numerous challenges [176,177]. ...
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Food fortification with micronutrients was initially justified in developed countries by lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands soil fatigue is not predominant and communities consume mostly home-grown organic non-processed crops. African food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability and self-sufficiency, the main African setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction, and women's education, are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize if not entirely eliminate deficiencies. Mass fortification in Sub-Saharan Africa with single micronutrients is however controversial working in synergy among each other and the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal and unjust food distribution, interrelated with political, social, cultural or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programmes, just food fortification cannot solve the composite of these elements. Further, compulsory fortification is excessive, unproductive and likely harmful to human health, while many challenges remain in accessing quality of premixes. However, aiming at dietary diversification is the best approach of increasing trace elements intake from commonly accessible and easily available food sources.
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Pharmaceutical care in rural and underserved communities faces significant challenges, including limited access to healthcare services, geographic isolation, and infrastructure deficiencies. This review explores innovative strategies to optimize patient care delivery and expand access to essential medications in these areas. It highlights the potential of telepharmacy and digital health solutions in bridging the gap between patients and pharmacists, ensuring timely consultations, and enhancing medication adherence. Additionally, community-based healthcare initiatives and pharmacist-led interventions are examined as practical solutions for improving care delivery at the grassroots level. The review further discusses necessary policy reforms and incentives that can support healthcare professionals in underserved regions, along with long-term strategies such as localized drug production and international collaboration to sustain improvements in global healthcare access. By integrating these approaches, healthcare disparities can be reduced, leading to improved outcomes for vulnerable populations worldwide. Keywords: Telepharmacy, Rural Healthcare. Medication Access, Pharmacist-led Interventions, Policy Reforms.
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Africa has a double burden of communicable and non-communicable diseases that account for 26 % of the global disease burden. Pharmaceutical medicines are a critical component in treating these diseases,...
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This chapter overviews the challenges in pharmaceutical supply chains (PSCs) in Low- and Middle-Income Countries (LMICs), with a focus on Sierra Leone. Furthermore, it describes how traditional supply chain optimization strategies can be used to improve performance of PSCs in Sierra Leone. Finally, it describes the significant potential for using machine learning in this framework for effective demand forecasting. We highlight challenges such as limited data availability, the need to ensure equitable distribution, as well as the potential for transfer learning to address some of these challenges.
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Background The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. Methods and findings We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Supporting the Use of Research Evidence (SURE) framework, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. Conclusions This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. Protocol registry PROSPERO CRD42018104112
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Background: Surveillance forms the basis for response to disease outbreaks, including COVID-19. Herein, we identified the COVID-19 surveillance systems and the associated challenges in 13 African countries. Methods: We conducted a comprehensive narrative review of peer-reviewed literature published between January 2020 and April 2021 in PubMed, Medline, PubMed Central, and Google Scholar using predetermined search terms. Relevant studies from the search and other data sources on COVID-19 surveillance strategies and associated challenges in 13 African countries (Mauritius, Algeria, Nigeria, Angola, Cote d’Ivoire, the Democratic Republic of the Congo, Ghana, Ethiopia, South Africa, Kenya, Zambia, Tanzania, and Uganda) were identified and reviewed. Results: Our findings revealed that the selected African countries have ramped up COVID-19 surveillance ranging from immediate case notification, virological surveillance, hospital-based surveillance to mortality surveillance among others. Despite this, there exist variations in the level of implementation of the surveillance systems across countries. Integrated Disease Surveillance and Response (IDSR) strategy is also being leveraged in some African countries, but the implementation across countries remains uneven. Our study also revealed various challenges facing surveillance which included shortage of skilled human resources resulting in poor data management, weak health systems, complexities of ethical considerations, diagnostic insufficiency, the burden of co-epidemic surveillance, and geographical barriers, among others. Conclusion: With the variations in the level of implementation of COVID-19 surveillance strategies seen across countries, it is pertinent to ensure proper coordination of the surveillance activities in the African countries and address all the challenges facing COVID-19 surveillance using tailored strategies.
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The African continent is home to 15% of the world's population and suffers from a disease burden of more than 25% globally. In this COVID-19 era, the high burden and mortality are further worsened due to inequities, inequalities such as inadequate health systems, scarce financial and human resources, as well as unavailability of inexpensive medicines of good quality, safety, and efficacy. The Universal Health Coverage ensures that people have access to high-quality essential health services, secure, reliable, and affordable essential medicines and vaccines, as well as financial security. This paper aimed at addressing the critical need for a continental African Medicines Agency (AMA) in addressing the inequities and the role of global health diplomacy in building consensus to support the ratification of the Treaty of AMA. A literature review was done in Scopus, Web of Science, MEDLINE/PubMed, and Google Scholar search engine to identify the critical literature in the context of study objectives. All the articles published after 2015 till 2021 in the context of AMA were included. African Health Strategy 2016-2030 highlighted the importance of an African regulatory mechanism for medicines and medical products. Through global health diplomacy (GHD), the African Union and its partners can negotiate and cooperate in providing infrastructural, administrative, and regulatory support for establishing the AMA. The paper emphasizes the South-South cooperation and highlights the contributions of India and China in the Citation: Chattu, V.K.; Dave, V.B.; Reddy, K.S.; Singh, B.; Sahiledengle, B.; Heyi, D.Z.; Nattey, C.; Atlaw, D.; Jackson, K.; Khatib, Z.; et al. Advancing African Medicines Agency through Global Health
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Introduction: Nurses' intention to leave their job is a worldwide concern. Internal and external brain drain factors are the main reason for nurses' intention to leave their job. So far, in Sub Sahara Africa, several observational studies have been done on nurses' intention to leave their job. However, a comprehensive review that would have a lot of evidence for designing an intervention is lacking. Hence, this study aimed to the pooled status of nurses' intention to leave their job. Methods: In the current meta-analysis, the target variables were searched from different electronic databases. These electronic databases are Pub Med, Google Scholar, Science Direct, African Index Medicus, African Journal Online, EMB ASE, and the Cochran Library. To determine the pooled proportion of intention to leave their job in Sub- Saharan Africa, all the necessary data was extracted by using a standardized data extraction format. We analyzed the data by using Stata 15 statistical software. Heterogeneity between the primary studies assessed by Cochran Q and I-square tests. A random-effect model computes to estimate the pooled nurses' intention to leave their job. Result: We included fifteen full-text studies in the current meta-analysis. The findings of this meta-analysis revealed that the pooled proportion of nurses' intention to leave their job in sub-Saharan Africa was 50.74% (95% CI; 41.33, 60.14; I2 ¼ 95.80%). The subgroup analysis showed that the highest pooled proportion of intention to leave their job (58.03% (95% CI: 47.93, 68.12)) in East Africa. The lowest pooled estimation to leave their job among nurses showed that South Africa (33.04% (95%CI: 20.45, 45.63)). Conclusion: In the current study, there was a high proportion of nurses indentation to leave their job. Nurses' intention to leave their job also varied from region to region in the study area. Therefore, health managers and stakeholders focus on design sufficient development and career opportunities, positive working atmosphere, and secure their autonomy.
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Insufficient access to quality, safe, efficacious and affordable medical products in Africa has posed a significant challenge to public health for decades. In part, this is attributed to weak or absent policies and regulatory systems, a lack of competent regulatory professionals in National Medicines Regulatory Authorities (NMRAs) and ineffective regional collaborations among NMRAs. In response to national regulatory challenges in Africa, a number of regional harmonisation efforts were introduced through the African Medicines Regulatory Harmonisation (AMRH) initiative to, among others, expedite market authorisation of medical products and to facilitate the alignment of national legislative frameworks with the AU Model Law on Medical Products Regulation. The goals of the model law include to increase collaboration across countries and to facilitate the overall regional harmonisation process. The AMRH initiative is proposed to serve as the foundation for the establishment of the African Medicines Agency (AMA). The AMA will, as one of its mandates, coordinate the regional harmonisation systems that are enabled by AU Model Law domestication and implementation. In this paper, we review the key entities involved in regional and continental harmonisation of medicines regulation, the milestones achieved in establishing the AMA as well as the implementation targets and anticipated challenges related to the AU Model Law domestication and the AMA’s establishment. This review shows that implementation targets for the AU Model Law have not been fully met, and the AMA treaty has not been ratified by the minimum required number of countries for its establishment. In spite of the challenges, the AU Model Law and the AMA hold promise to address gaps and inconsistencies in national regulatory legislation as well as to ensure effective medicines regulation by galvanising technical support, regulatory expertise and resources at a continental level. Furthermore, this review provides recommendations for future research.
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Objective The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises. Main body Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization’s COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19. Conclusion Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.
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The 4th PPRI Conference, held in Vienna in October 2019, addressed issues related to equitable and affordable access to medicines. A multi-stakeholder audience from around the globe discussed solutions and best practice models for current challenges such as high-priced medicines, limitations of current pricing and reimbursement policies and tight budgets for health technologies. A multi-faceted approach (so-called balance, evidence, collaboration and transparency/BECT strategy) was also discussed. This includes an improved balance of different interests and policy areas, generation of relevant evidence, collaboration between countries and stakeholders, and transparency, and was considered as the most promising pathway for the future.
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The COVID-19 pandemic has resulted in massive disruptions in global supply chains. Nigeria is particularly vulnerable with respect to pharmaceuticals since there is reduced local production and about 70% of the drug supply is imported creating a huge supply-demand disparity particularly in times like COVID-19. Nigeria is in need of huge quantities of quality-assured health commodities to effectively respond to the pandemic. Significant shortages of other essential medicines and medical products across the country could be imminent. Drug scarcity in Nigeria during the COVID-19 pandemic period is because of several accumulated factors, majorly as a result of global lock-down, decreased manufacturing, unaddressed regulatory affairs, poor access to resources by the population, lack of buffer stocks, security instability, and poor funding of the healthcare system. This situation if left unattended, could cause serious drawbacks to the health of the populace as well as the quality of life of Nigerians amid the COVID-19 Pandemic. Appropriate measures should be directed to ensure ethical processes on drug production, importation, pricing, and distribution to avoid such events during unavoidable scenarios, like the COVID-19 pandemic and other public health emergencies.