I usually start my articles with little comical anecdotes or overtures that make nice sagways for whatever issue I proceed to write about. Today, besides the fact that I neither have the newspaper space to allow nor the inclination to get into anecdotes, there is nothing comic about what I would like to write about today, from whichever perspective one looks at it.
Access to medicines has been severely compromised. Some pharmacies are closed under the pretext of ‘stock taking’ or issues with their computer systems. Those that are open are either insisting on USD cash as a method of payment, particularly for medicines procured using foreign currency, or charging prices considered by some to be astronomically high if they accept EcoCash and other electronic forms of payment or not accepting health insurance as method of payment. Those for whom money is not an issue, have not been spared the woes of medicine access, because some products are not easily available on Zimbabwean pharmacy shelves, no matter one’s method of payment.
The temptation to vilify pharmacies and pharmacists is irresistible at this stage. Pharmacists tend to be the faces associated with medicine access and medicine shortages, alike. They seem unempathetic and even unpatriotic – profiteering, or worse, denying life-saving medicines to people at a time when all hands are supposed to be on deck, rebuilding Zimbabwe. But let me assure you, they are not the bad guys. They’re just the unfortunate folks accessible to most. The tragedy of pharmacy is that it is both a life-preserving social service and a business. A private sector pharmacy has to remain financially viable in order to provide that life-preserving social service. That means that pharmacies are affected by the same fiscal and economic environments that affect other businesses that provide much less essential services and goods and are apt to respond in similar ways to those other businesses. This article is meant to give readers a sneak peak at behind the scenes. It’s meant to expose the things that the pharmacists of this country, myself included, have for the longest time been trying to do in the fight to improve efficient access to medicines for patients, particularly in the domain of advocacy, even before this medicine access crisis hit. We saw it coming three years ago in 2015, tried to launch interventions, and got persecuted. This article will reveal how.
The Bond note is not equal to the USD and this is a fundamental problem. Enough with the official pretence. More than half of the medicines consumed in this country are imported…obviously using foreign currency. The monetary policy presented last week, informed us that only 1% of foreign currency disbursements, is allocated to medicine importation. 1% of what little is available is apparently not enough and shortages are inevitable. In addition, when pharmaceutical wholesalers use foreign currency to import medicines, they may ask retailers for payment in the same, so tha they are able to replenish stocks. Accepting alternative payment forms from consumers on a 1:1 basis, whether that payment is in mobile or electronic money or as health insurance cover, means that retailers get to operate at an incredible loss and set themselves on the path to certain death as a business. So, shortages, and demands for USD payments for imported products or locally made products made using imported raw materials, will happen.
Having realised that medicines are going to be in short supply relative to what we are ordinarily used to, it is incumbent upon us, as a nation, to be more efficient in our affairs. It is prudent that we share information, so that finding a medicine that is in the market in less quantities than normal, is not tantamount to looking for a needle in a haystack. Which brings me to the real issue.
In 2015, I decided it would be a good idea to have an electronic tool that would assist patients to identify the exact pharmacies that had in stock, the medicines that they need at a given time. That way, even if one pharmacy in the whole country had the required medicine, a patient would be able to find this out in minutes. You see, pharmacies are not allowed to advertise medicines in this country. You can never find one posting a public notice that says: “Oi! We have xxx medicine here!” That, dear readers is illegal. So what that means is, when you need medicine, your best bet is to walk, trudging from pharmacy to pharmacy until you find one that will dispense your prescription. That, can take anything from minutes to weeks. When I decided, as a pharmacist, to launch an information service, legally, I approached the regulators of pharmacy practice in this country with a detailed description of the plan I had. I hoped that they would endorse it and thus signal to pharmacies around the country that the service I hoped to provide would not place them at risk of being in breach of medicine advertising regulations in Zimbabwe. Attached to this article are the letters of rejection that they sent back to me. Apparently, letting the public know where to find medicines during their time of need is ‘not in the public’s best interests’.
That did not sound right to me. So, in 2016, with the assistance of my lawyer, Professor Lovemore Madhuku, I approached the High Court of Zimbabwe to get a second opinion, with me as the Applicant and the regulators and the then Minister of Health & Child Care as the respondents. The High Court ruled, among other things, that my plan to improve efficiency in access to medicines was legal, fostered national development and by rejecting my proposal, regulators had neglected one of their constitutional duties. The summary of the High Court ruling is also attached to this article.
Before my lawyer had even had the chance to inform me of the High Court victory, the respondents had appealed the judgement to the Supreme Court. I am told that appealing to a higher court, is their constitutional right that can’t be denied them. I just don’t understand why that right is allowed to supersede everyone else’s right to efficient medicine access. We are currently waiting for the Supreme Court to hear the appeal on a date yet to be advised.
If what I intend to implement had been authorised in 2015 when I first requested for permission to do it, we would still be in a medicine shortage crisis, because efficiency does not magically solve the forex shortage we suffer from but finding the few medicines that are on the shelves anyway, would not be this much of a nightmare. So, no, pharmacists are not the bad guys. We are in all sincerity trying to do the best for our patients behind the scenes, including the relevant ministerial offices and petition for prioritisation of medicines on the list of items this country imports. The deputy health minister has been especially gracious; declaring that no pharmacist with a plan on how to improve access to medicines needs an appointment to see him. We are all flocking there. I am in fact, just coming from there myself. He had better brace himself.
As always, I am open to your views, comments and questions on this Whatsapp number: +263 783 228050 between the hours of 10 am and 1 pm. Like any other pharmacist, I am often privy to information that the lay public isn’t. If you text me a question, I will do my best to answer it free of charge. If the question is beyond me, I will also communicate this. Desist from purchasing medicines from places that are not health facilities and people that are not licensed to handle medicines. The consequences for your health may be dire.