Imperial marches into Africa - building a drug supply chain

Africa's dire need for pharmaceuticals is well-documented, but so are logistical problems involved in transporting sensitive drugs across long distances in the continent's tropical climate and harsh terrain. Dr Nicola Davies spoke to Johannesburg-based Imperial Holdings, who recently made a bold move to improve their logistics chain by acquiring the pharmaceutical and consumer healthcare supply chain of South Africa's RTT Group.


Different areas present their own individual challenges due to varying levels of infrastructure

PHD, the pharmaceutical distribution division of the RTT Group, is an innovative, multichannelled pharmaceutical distributor in Sub Saharan Africa. It has been warehousing and distributing pharmaceuticals for more than ten years and has become Africa's leading healthcare supply chain company.

The company distributes more than 1.7 million units each month, which equates to 324 tonnes of products a month. Their network stretches across many countries, transporting essential pharmaceuticals to Botswana, Zambia, Tanzania, Malawi and South Africa, to name a few.

They transport to more than 9,000 delivery points on behalf of around 30 manufacturers, serving various outlets such as hospitals, clinics, pharmacies and other end users. This impressive feat is not without its challenges, however.

Challenges of distributing drugs in Africa

As the complexity of susceptible pharmaceutical supplies increases, it is crucial to identify any distribution risks and challenges, as well as to generate solutions for them.

"RTT Health Sciences has developed a proven model that creates a strategic advantage for its clients."

According to Stephen Pitcher, former managing director of Cargo Planning & Distribution and a member of the Imperial Logistics Group: "There are a number of complications involved in delivering pharmaceuticals to remote areas." Access is one of the main challenges.

As Pitcher highlights: "We often had to deal with farm and rural deliveries where the patient resides in a shack in the hills. These deliveries had to be completed by farm labourers, using wheelbarrows, despite the delivery weighing more than 500kg at times."

However, technology has helped simplify the delivery of items in some ways.

According to Pitcher: "Farm deliveries, for example, often relied on incomplete addresses or faulty directions - a situation that has been rectified to a degree by the advent of GPS...a GPS in every home patient delivery vehicle [will] soon became essential for effective operations."

Home deliveries, hazardous terrain and counterfeits

With home deliveries, in particular, a number of extra difficulties emerge involving the patients themselves. According to Pitcher: "Patients were often not at home, despite delivery being arranged the day before - resulting in returns and re-delivery of goods - while if a home patient passed away their relatives would often just dump leftover stock in open fields, leading to time-consuming investigations to pinpoint the stock's point of origin."

Different areas present their own individual challenges due to varying levels of infrastructure. "The combination of rain and dirt roads causes numerous issues in not being able to reach patients in remote or rural settings," says Pitcher.

"With home deliveries, in particular, a number of extra difficulties emerge involving the patients themselves."

"Vehicles can become stuck in muddy conditions..." This led to an increased rate of accidents, until: "We eventually refused any deliveries on dirt roads in the former Transkei regions and certain areas of the Natal Midlands, because it was simply too dangerous for our delivery vehicles."

Pitcher also reveals that all private hospitals in South Africa have very small storerooms, stating that: "This has created the need for next day and same day deliveries throughout the country, which results in very expensive logistic distribution costs."

Another major headache is security and the infiltration of counterfeit products into the market. The World Health Organisation (WHO) emphasises the importance of a regulated cold chain supply network, while outlining the dangers of 'spurious, falsely-labelled, falsified or counterfeit' (SFFC) medicine.

It has warned that: "In many African countries a much higher percentage of the medicines on sale may be SFFC. People might also purchase medicines from non-regulated outlets if, as is often the case in the rural areas of developing countries, medicine supplies at regular health facilities do not meet demand."

The key challenge - temperature sensitive pharmaceuticals

During the last couple of years, there has been a strong growth in the sales of temperature sensitive pharmaceutical in Africa. Indeed, reports suggest that as many as seven of the top ten global pharmaceutical products will require cold chain handling by 2014.

As a consequence, the demand for pharmaceutical logistics services continues to grow at a rapid pace, with the market estimated to grow from US$6.6bn (£4.2bn) in 2011 to US$9.5bn (£6.1bn) in 2016.

"Reports suggest that as many as seven of the top ten global pharmaceutical products will require cold chain handling by 2014."

Therefore, the vital importance of maintaining a rigorous cold chain in the shipping and storage of susceptible pharmaceutical products is a continuing challenge. For example, there are potential financial and legal implications for a distributor to deal with.

One way in which this has been tackled is noted by Pitcher, who states that: "Thermo labile products are delivered in sealed insulated packaging, complete with Techni-Ice (similar to a freezer pack). Our patients did not always have a refrigerator in which to store the products, however, resulting in product claims that the cold chain had not been maintained."

The ethos of the RTT cold chain system is to ensure that everyone who receives essential medication is assured of receiving a drug that is fit for purpose. RTT Medical's cold chain warehouse and distribution facilities all have good distribution practice (GDP) compliant cold rooms of two to eight degrees Celsius, while their Quality Management System (QMS) is ISO 9001 certified to ensure the organisation meets the needs of their clients. Cold chain shipping is further controlled via environmental monitoring systems, QMS, validation / qualification and mapping.

A proven model for Africa

Despite the challenges of extending its footprint into Africa, RTT Health Sciences has developed a proven model that creates a strategic advantage for its clients.

"I think it is about growth, expansion, and delivering quality healthcare supply chain solutions in Africa on behalf of our clients. By making medicine affordable, safe and available in these countries, we can make a huge difference," Pitcher concludes. "The African market is starting to have feasibility for our client base so, more often, it is on the agenda; it is an optimistic growth area."


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