Christa Cepuch, a pharmacist and health rights activist, has no doubt about the issue: essential medicines are basic and should be readily accessible at an affordable price.
But the reality is different as Min Abbo’s story illustrates. Min Abbo, 60, almost lost her life when she was afflicted with a severe bout of diarrhoea and vomiting. Her daughter, Miliosi Abbo, was contacted by relatives in the village that her mother was very sick and likely to pass on any time.
She had been hanging precariously between life and death for three weeks. Miliosi asked for time off from her housemaid job in Kampala to check on her mother in Tororo district. But she was shocked when she got there: her mother looked like an eight-year-old child.
Min Abbo could not afford the Shs 2,000 needed for the journey to the nearest health centre, not to mention the Shs 15, 000 the health centre would ask for before she’s treated.
Accessing drugs such as those that treat diarrhoea is integral to the World Health Organisation’s mission. The organisation wants to see that essential medicines are easily available. Yet, only a fraction of people living in Low Developed Countries (LDCs) are able to access medicines.
And while they are very poor, these countries buy the medicines expensively. For instance, a world medicine price index reveals that prices in Uganda are three to five times higher than international prices. This means that on average, 55% of Uganda’s household expenditures are on medicine – a big percentage considering that most live in poverty.
Cepuch notes that even though Uganda’s health budget was increased from Shs 101bn in the 2010/2011 to Shs 204bn in 2011/2012, this only translates into Shs 6,000 for each of the 33 million Ugandans per year.
The amount, according to the budget framework paper, is set to increase to Shs 280bn in three years. But while the government has demonstrated some commitment to health, Cepuch observes that the high population growth and inflation rates negate such efforts.
Pharmaceutical companies protect monopoly over their medicines through a complex regime of patents. Once these patents are registered, newly invented medicines are protected for 20 years.
Uganda is party to the Trade Related Aspects of Intellectual Property Rights Agreement (TRIPS) – a piece of international legislation governing intellectual property, which includes innovations such as new medicines.
The inventors are given monopoly as patent holders and no one can manufacture the same drug until the patent expires. Yet, these patented drugs are often sold at astronomical prices only a few rich countries and individuals can afford.
The TRIPS, however, has flexibilities developing countries can take advantage of to ensure that patent holders are not protected at the expense of human life. For example, LDCs, with respect to medicines, do not have to comply with the patents until 2016.
This is meant to give them a chance to develop their pharmaceutical industry. In cases of extreme emergency, national urgency and under other circumstances, or for the protection of public health, a government may issue a compulsory licence to other manufactures to make medicines without the consent of the patent holder.
Alternatively, such medicines can be imported from countries where the patent holder’s rights do not apply and the same medicine is sold cheaper.
Countries like Brazil, China and India are trail blazers in the manufacture of generic drugs. Cepuch explains that generics are exactly the same as the originator drugs manufactured by patent holders and they work in the exact same way and have the exact same effect.
However, the public often insists on the more expensive originator drug. For example, Hajji Mustafa Kakaire whose wife is suffering from cancer says he would never allow her to take drugs from India. Rather, he insists that she takes medicine from Germany. He refers to the drugs from India as “fake.”
Yet most drugs in the country are generic. ARV prices fell dramatically from what they were in the 1980s because of generic manufactures. The public mistakes generic medicines to mean the same thing as counterfeit and/or substandard.
Cepuch acknowledges that these terms are “confusing and meant to confuse.” She explains that generic drugs are not substandard or counterfeit. Substandard refers to drugs that may be legally on the market but are of poor quality due to factors like poor handling, storage or manufacturing errors, while counterfeit refer to drugs illegally on the market or those that infringe on patents.
While counterfeit and substandard drugs pause dangers, generic drugs are safe.
Ray of hope
In Uganda, Quality Chemicals Industry in Luzira, locally manufactures generic drugs, shining a ray of hope on the ailing pharmaceutical industry in LDCs. The only one of its kind in East Africa, George Baguma, director of marketing, says they aim at producing quality affordable medicines for the local people.
Thus, he says, the ideal retail price for Coartem, a malaria drug which they manufacture and whose active ingredients are available locally, should be Shs 2,000. The drug is sold at Shs 800 to wholesalers.
But in pharmacies around Kampala, a dose of Coartem from Quality Chemicals goes for Shs 10,000. Originator Coartem from Switzerland is about Shs 18,000. Baguma emphasizes that at public health facilities, these drugs should be given out free.
Florence Nakachwa, assistant registrar at the Uganda National Drug Authority, says they are mandated to ensure that medicines on the market are available, genuine and safe.
They, however, do not have control over the market prices. In fact there is currently nobody that regulates these prices. Pharmacies and medical units take advantage of Uganda’s liaisez faire trade policies to price the drugs as they please.