Continuous Improvement Is Not Enough - Julius Mugwagwa

4 March 2016

The health of citizens in any country depends on the availability of safe, effective and affordable medicines. A recent book to which I contributed, Making Medicines in Africa (Mackintosh et al, 2015), explored pharmaceutical production in sub-Saharan Africa and the central role it plays in tackling Africa's acute health care needs. Yet, while acknowledging this critical role of pharmaceuticals or medicines in health care, the contributors to the book acknowledge that a successful pharmaceutical industry alone does not guarantee good health care. India, for example, has managed to grow a highly successful pharmaceutical industry in recent times, but sadly, many of its people still remain without access to competent care. In the book, I therefore argue that a sustainable and agile constellation of 'technological, industrial, intellectual, financial, health system organisation and research-related capabilities is needed, together with competent pharmaceutical production, for the African subcontinent to generate the resources to tackle the health needs and demands of its population'.

Shifting the debate away from whether African countries can manufacture medicines, the book presents and analyses evidence that in fact pharmaceutical manufacturing has been happening in many African countries for a long time – in spite of the many challenges that confront the pharmaceutical industry globally. These include the persistence of manufacturing operations which are said to be inefficient and costly, a slow rate of introduction of modern engineering process design principles, new measurement and control technologies, and knowledge management systems. For African countries and other low- and middle-income countries, the problems are exacerbated by two main problems which we highlight in the book: firstly, how to sustain their pharmaceutical industry capabilities in a competitive global space; and secondly, how the skills and competences built up by pharmaceutical manufacturers and distributors can feed into better health care access for African populations. The long history of manufacturing in some countries has meant that extensive and deep investment in infrastructure and skills has already been made. Now, diminishing flows of resources into the industry and limited adaptability of infrastructure has in many cases led to erosion of the competitiveness of African pharmaceutical companies in the face of supplies of similar products from Indian companies or multinational companies from the Global North.

There has been significant impetus towards strengthening the pharmaceutical industry in Africa, which has seen many efforts coming to the fore, among them the African Union's Pharmaceutical Manufacturing Plan for Africa (African Union, 2007), along with those of some UN agencies and bilateral donors. In an effort to address some of the challenges embedded in the pharmaceutical industry in particular, or those facing the industry more broadly, regardless of location, appreciable effort has been put towards drawing lessons from the Indian – as well as the Brazilian and Chinese – experience. Representatives of individual African pharmaceutical companies, as well as members of pharmaceutical industry associations, have made visits to India, China and Brazil to familiarise themselves with current trends and practices on modern pharmaceutical production, with the objective of copying and adapting or adopting models for use in their own countries. It’s a catch up model!

Lesson-drawing is good, but my contribution argues that lesson drawing should not only be geared for 'catch-up' or continuous improvement, but for coming up with innovative manufacturing systems which are agile, inclusive, sustainable and able to meet the demands and needs of users in a timely and low-cost manner while, desirably, charting a new capability pathway for African companies. A large majority of the existing pharmaceutical manufacturing facilities in Africa have fallen so far behind pre-defined manufacturing and quality oversight protocols for most products that trying to optimise them without changing the fundamental design of the manufacturing process will be costly in terms of both time and resources. Innovative manufacturing will mean replacing routine production operations with new production designs and operations, and this in turn entails significant investment of resources. Competitor companies will be reluctant to impart such lessons because they are themselves in a continuous search for the competitive edge. Equally importantly, African pharmaceutical companies need to invest in capacities for corrective and preventative action. A considerable part of the reason they find themselves in the position they are now is that – up to now – there has been a lack of timely preventative or corrective action to cushion existing investments and capabilities.

Dr Julius Mugwagwa is a Lecturer in Innovation Policy & Governance with the OU's Development Policy and Practice group. He is currently implementing a project investigating innovations in health spending in South Africa and Zimbabwe, with funding from the UK's Economic and Social Research Council.