Seven out of 10 times, that prescription drug you buy from a registered pharmacy in Uganda is most likely imported and quite often expensive.
With no National Health Insurance system in place to cushion these costs, many Ugandans, if not most, cannot afford to get seriously sick. But if they do, it is not surprising either that many, especially in the rural areas, will first resort to herbal medicines.
Building local capacity is seen as the best solution. Going by the recent surge in new investments, the outlook is promising for the domestic pharmaceutical manufacturing sector, so much so that the list of foreign customers is getting longer for certain products.
Uganda’s pharmaceutical market is presently valued at about $350 million annually and dominated by Asian imports, particularly from India and China. Local manufacturers account for a relatively small percentage of all drugs sold, but this figure is steadily rising.
There is a National Pharmaceutical Services Strategic Plan (NPSSP) which envisions the growth and self-sustenance of the national pharmaceutical services with the ultimate goal of providing the highest standard of health for Ugandans.
The current five year NPSSP plan which ends this year, also emphasizes boosting domestic local manufacture of medicines and health supplies including innovations in herbal medicine to increase access to quality Essential Medicines and Health Supplies and underpin the Buy Uganda Build Uganda (BUBU) policy.
Those who are horrified at the use of public funds to help set up the billion dollar-plus Deo-Pharma manufacturing complex in Matugga, should also realize that in the long run, depending on foreign suppliers does carry considerable risk.
Under prevailing circumstances, Uganda will always be vulnerable to global supply chain disruptions and as the Covid-19 pandemic clearly showed us, charity does indeed begin at home.
“When Covid-19 hit, every country prioritized its own needs and supply chains. We must strengthen local manufacturing to be self-reliant,” Benjamin Kiiza, the Chief Executive Officer of Piston Medical Limited said earlier this year.
The company recently opened a new plant for the production of intravenous fluids and essential drugs with ambitions to expand market penetration across Africa.
Deo Pharma founder, Dr. Matthias Magoola, wants to establish a globally recognized pharmaceutical company, producing a diverse range of vaccines and affordable medicines to combat widespread diseases.
With some hyperbole, the company describes itself as Africa’s most ambitious biopharmaceutical complex, designed to meet and exceed global standards, and built to serve both local needs and global markets.
Boasting is not a crime, although living up to expectations can prove to be daunting. For one thing, Africa is not a country. To navigate the regulatory landscape in a neighbouring country, let alone 54 of them, can pose momentous headaches. Then there is the question of logistics, poor infrastructure and fighting off counterfeiters. Nevertheless the opportunities are plentiful.
Africa’s total pharmaceutical import bill is currently at just over $20 billion and still rising as the continent’s populace becomes more urbanized. However, what is more striking is that there are roughly 380 factories predominantly in Nigeria, North Africa and South Africa to cater for 1.3 billion people. This is a situation foreign suppliers have been exploiting for decades.
Last month, the Pharmaceuticals Export Promotion Council of India reported that African countries still account for 83.2% of India’s total pharmaceutical exports worth close to $4 billion in 2023.
UN Trade and Development (UNCTAD) says Africa must invest in local pharmaceutical production to improve access to medicines, reduce reliance on imports and build stronger, more resilient health systems.
UNTAD thinks expanding local production in Africa can improve availability, affordability, safety and the stability of supply, especially for critical drugs like vaccines and antibiotics.
The key is achieving scale, increasing plant utilization (currently 30% to 60% in many countries) and improving infrastructure and regulatory systems. Secondly, policymakers must offer transparent incentives that balance production-facilitating measures such as tax breaks with market-shaping tools like preferential procurement.
In May, Quality Chemical Industries Limited (Qcil) announced that Stanbic Bank is availing the company with a $36 million debt facility to pay for an expansion programme. Specifically, the construction of a second World Health Organization (WHO) certified manufacturing plant.
The Qcil Chief Executive Officer, Ajay Kumar Pal said, “The new factory represents a significant investment in our mission to expand access to critical medicines by manufacturing in Africa, for Africa. It will enable us to introduce specialised production for TB treatment, making Qcil the only TB medicine manufacturer in the region.”
According to Dr. Adrian Ddungu, the Secretary General of the Uganda Pharmaceutical Manufacturers Association, “There is an increase in the number of products being made by local industries and this is helping to ensure sustainability and availability. With adequate infrastructure and partnerships, the pharmaceutical sector has the potential to contribute up to two percent of Uganda’s GDP.”
Regionally, Kenya is the manufacturing hub. However, in the not so distant future, Uganda can gain an edge once the new oil refinery is up and running. This is because the manufacturing of a wide range of pharmaceuticals relies on petrochemicals as raw materials.
These raw materials, technically known as Active Pharmaceutical Ingredients or APIs are mostly sourced from abroad. So even making drugs locally instead of importing finished products only carries a degree of self-sufficiency.
However, it would boost self-sufficiency and spotlight Uganda’s rich biodiversity, if the government were to actively encourage our pharmaceutical manufacturers to integrate herbal medicines into producing modern pharmaceutical products.
This means combining traditional knowledge of medicinal plants with modern scientific methods to develop new and improved drugs. WHO says about 40% of modern pharmaceutical products widely used today are derived from traditional knowledge. Aspirin is a classic example of the collaboration between tradition and modernity.
What would move the process along, is the need to nurture talent, the ‘scientists’ that President Yoweri Museveni loves to talk about and investing in technology, notably AI to turn ideas into marketable products.
Admittedly, research and development is costly and Uganda’s regulatory regime must be top notch to inspire international confidence. But the rewards in terms of developing a homegrown supply chain, adding new income streams for rural communities and ensuring affordability, would be immense.
Last year, the Ministry of Health invited the WHO’s Regulation and Prequalification Department to Uganda as part of a long process, started in 2019, to achieve Maturity Level 3 status. ML3 means having a regulatory agency that is stable, well-functioning and integrated.
Health minister, Dr Jane Ruth Aceng said, “Strengthening our regulatory framework is crucial for improving access to quality medicines and achieving sustainable health outcomes.”
Dr Medard Bitekyerezo, the Chairman of Uganda’s regulatory body, the National Drug Authority (NDA) said. “We are focused on building a robust system that meets international standards and ensures the safety and efficacy of medical products for all Ugandans.”
According to an official statement, achieving ML3 will strengthen NDA’s capacity to regulate medical products effectively, improve access to quality medicines, and position Uganda as a leader in the local production of medicines, vaccines, and medical devices.
“By building local capacity, Uganda can ensure a steady supply of affordable, quality-assured medicines for all,” Dr Kasonde Mwinga, the WHO Representative to Uganda said.
Credit should go to Uganda’s pharmaceutical manufacturers for their appreciation of the Big Picture. They are putting their money where their mouth is and willing to take the risk. It shows they are embracing the competitive challenge in the one of the world’s toughest businesses.
