August 20, 2021

How Ethiopia’s $1 billion pharmaceutical market at risk

City: Bahir DarHealth

The country's over-the-counter medicines are concentrated in health centers and hospitals. Benishangul Gumuz region has the highest prevalence of all.

Avatar: Ayele Addis
By Ayele Addis

Ayele Addis is an award winner Journalist, Journalism, Trainer, Researcher, and Media & Communication Development Consultancy for Thomson Reuters' Foundation, Africa News Channel, Amhara Media, and Journalists Association. Ethiopian Mass Media Action (EMMA News), ARMA Media Production.Woldia University and Bahir Dar University and founder of Journal of Ethiopian Media and Communications.

How Ethiopia’s $1 billion pharmaceutical market at risk

Ethiopia’s pharmaceutical market grew by 15% last year to nearly $1 billion. The local market has been growing steadily at an average of 25% per year by 2020. With a population of more than 102 million, increased access to health services, and a growing middle-class, demand is projected to grow exponentially and reach 3.6 billion by 2030. Ethiopia currently imports 85% of its pharmaceutical needs, a huge demand that is yet to be fulfilled by local manufacturing.

On a separate level, Ethiopia is also grappling with the trafficking of substandard and falsified medicines, plus the delivery of other medical products under counterfeit. The country's over-the-counter medicines are concentrated in health centers and hospitals. According to the World Health Organization (WHO) and a Ministry of Health assessment, a  survey disclosed that the Benishangul Gumuz region has the highest prevalence of over-the-counter drugs. The prevalence of expired drugs varied in the six regions between 3% in Tigray to 38% in Benishangul−Gumuz showing very significant variations. This means that, in relative terms, the quality of drugs is best in Tigray but least in Benishangul−Gumuz.        

The WHO has identified 100 cases of a drug overdose. According to the study, 10.5 percent of drugs in Ethiopia have substandard or counterfeit drugs. The national presence of expired drugs was 8% in health facilities, 2% in regional drug stores, and 3% in private drug retail outlets. Although the results are alarming, the significant variation between health facilities and regions calls for further investigation.

Solomon Tsamealew, a private pharmacist in Bahir Dar. says that the government does not have a competent system to monitor the quality of medicines in his area. The delivery and handling of medicines are not monitored at every pharmacy. Pharmacist Senait Al-Taseb, for her part, says there is a good chance that expired drugs are being reused. She told Addis Zeybe that it was as simple as changing cartons and changing paper and that they could be distributed internally in smuggled drugs. 

"It is very easy to sell low-quality medicine in our country," said Yabebal Tilahun. “Because there is no control, it can be imported and sold. No one examines the quality of the medicine, but the person who gives it. The wholesale drug dealer also sells: It does not investigate. If you have any doubts, we will take you to the Central Laboratory and we will investigate.” 

Pharmacist Getnet Teshale. Who lived in Bahir Dar, Ethiopia said the effects of mislabelled drugs on their users could lead to serious physical and mental health problems. He says the cost varies based on the brand of the medicine is a headache for the patient. This is even more so due to the low monitoring and control of various types of drugs entering the country. The importation of counterfeit medicines has increased and spread in the market. The assessment of the pharmaceutical sector in Ethiopia shows that the national percentages of expired drugs were 8.2% in public health care facilities (PHCFs), 2% in regional drug stores (RDSs), and 3% in private drug retail outlets (PDROs). In relative terms, the quality of drugs appears to be best in regional drug stores and least in public health care facilities. 

The prevalence of expired drugs varied in the Ethiopian six regions - between three percent in Tigray regional state to 38% in Benishangul−Gumuz regional state.  This implies that the quality of drugs is best in Tigray regional state but least in Benishangul−Gumuz regional state.

The researchers show that the quality of drugs is relatively best in health stations but least in hospitals. 

These problems put the $1 billion Ethiopian pharmaceutical market at risk, with about 10% to 5% of all pharmaceutical products sold being falsified. “The annual pharmaceutical market in Ethiopia is estimated to be increasing US$ 400 to US$ 500 million and growing at an impressive rate of 25% per annum”, reported the Pharmaceuticals Fund and Supplies Agency. According to the 2015 Ethiopian national strategy and plan of action for pharmaceutical manufacturing development, there are approximately 200 importers of pharmaceutical products and medical consumables in Ethiopia. The local industry comprises 22 pharmaceutical and medical suppliers and manufacturers, with nine involved directly in the manufacture of pharmaceutical products. Most of the manufacturers operate below their capacities and supply only about 20% of the local market. The latest figures compare to  2014 when local pharmaceutical companies supplied products to the value of US$ 44.2 million. Local manufacturers have limited product portfolios and are thought to be able to supply only 90 of the more than 380 products on the national essential medicines list. Around 35–40% of their total output is supplied to the private sector at a price premium of 10%. The ownership of the companies is diverse and ranges from two large companies to smaller entities that are joint ventures between Ethiopian entrepreneurs and foreign investors from China, India, Jordan, Saudi Arabia, Sudan, and the United Arab Emirates.

The public sector, through the Pharmaceuticals Fund and Supplies Agency (PFSA), procures almost 70% of all the medicines consumed in Ethiopia, but there is still significant out-of-pocket expenditure on health, estimated at 46% by the Ethiopian Food, Medicines, Healthcare Administration and Control Authority (FMHACA). PFSA procurement increased from US$ 27 million in 2007 to US$ 310 million in 2014.

Despite support from the Ethiopian Government, the Ethiopian pharmaceutical industry faces significant challenges, including human resource capacity constraints, limited access to foreign.  currency, and raw material procurement difficulties. 

Until now, there has been no coherent national vision, strategy, or plan to develop the pharmaceutical industry in the long term. According to the Office of the Federal Auditor General (OFAG) of Ethiopia 2020, an evolving pharmaceutical industry is up against numerous challenges, including supply chain disruptions, counterfeits and illegal trade in pharmaceuticals, a lack of foreign currency, a heavy reliance on imports for manufacturing inputs and insufficient regulatory capacity. 

Currently, the Ethiopian population is also facing a significant unmet need for essential medicines. The national auditor highlighted: limited access to health care facilities, lack of adequate personnel, pharmaceutical management and expertise to address the medical needs, and poor infrastructure where most facilities do not have the proper facilities to handle the medical challenges.