A New York Times op-ed last year highlighted the global disparity in access to quality medication. For people in developing countries, counterfeit drugs are a huge problem. In fact, a more recent Washington Post piece refers to the problem of unreliable pharmaceuticals as a global pandemic, amounting to an estimated $75 billion market annually. The Center for Disease Control (CDC) estimates that up to 30% of drugs sold in low-income countries are fake, expired or damaged, compared to 1% in more industrialized nations.
In East Africa, the problem goes deeper. For many reasons—including stock outs and long lines for the public healthcare system—people often go to local private sector pharmacies when seeking treatment. However, medications sold from these outlets are even more questionable, because no suppliers offer tested and certified medications for the private sector. Counterfeits and substandard drugs account for an estimated 20% to 45% of the total, which can lead to dangerous antibiotic drug resistance.
But Miti Health, founded in 2013 and based in Nairobi, Kenya, aims to change this market failure with a two-pronged approach. They arm private sector pharmacies with software tools to weed out fake medications and simultaneously interrupt the supply chain in East Africa to eradicate poor quality medications before they reach the pharmacies.
"When people in Kenya visit the pharmacy, there is a one in three chance they’ll get a substandard drug," says Miti Health managing director Jennifer Stutsman. "You are gambling every time you go in. People won’t come back if they don’t get better."
This is bad for both the business of the pharmacy and the health of clients. Miti Health saw the need for a new system of verification, so this past summer they invited 15 pharmacies in Kenya to participate in a pilot program to test their software.
Miti Health’s software, compatible with android phones and tablets, helps pharmacies track their orders to verify who sells them good medication. Furthermore, the platform improves the pharmacy’s business operations by tracking medicine stocks, streamlining reorders, and providing better customer demand forecasting through access to market data and disease prevalence in the region. The software costs $10 per month for pharmacists, covering full implementation and support. Previously, the shops used paper and pencil—if anything at all—to track orders and manage their businesses.
"Pharmacists know they need better systems, but because they’re running out of money or nobody has approached them, they haven’t made that investment," says Stutsman. "We approach pharmacists with our management tools and help them understand how it benefits them. We want to have the biggest influence we can in the supply chain."
To infiltrate the supply chain at large, Miti Health partners with key actors in the healthcare ecosystem—including drug manufacturers, nonprofits, governments and suppliers—to create mechanisms that halt poor quality drugs before they reach the pharmacists. In the next year, Miti Health plans to expand to over one hundred pharmacies in East Africa, with the goal of serving around 150,000 patients.
Using the global standard for medication quality testing, Global Pharma Health Fund’s GPHF-Minilab system, Miti Health randomly samples and tests medication batches as they come in from manufacturers, helping them determine the consistently high-quality suppliers. Some customers pay a per-test rate to validate the medicines they purchase, and grant funding helps support larger-scale random testing conducted by a Miti Health lab technician.
When people in Kenya visit the pharmacy, there is a one in three chance they’ll get a substandard drug.
Then, before delivering the medication to pharmacists, Miti Health provides certification and includes branding materials to make it clear to pharmacists and patients that they can trust it.
Stutsman started out as a pre-med student at the University of Pennsylvania then switched to public health policy because she thought she could have greater impact. "All the pieces of the ecosystem are necessary and have their own role," says Stutsman. "But being able to provide someone with a product with real immediate value to them is rewarding."