About 1 in 10 medicines in developing countries is of poor quality. With its Be-cause Health Charter on Quality of Medicines, Belgium made a commitment in 2008 to strive for quality medicines. Nevertheless, there is still room for improvement.
Belgium presents itself as a pioneer when it comes to promoting the quality of medicines. In 2017, competent minister Alexander De Croo signed a commitment declaration on this subject, putting access to quality medicines once again forward as a priority. Belgium has been focusing on this for 10 years, with the Be-cause Health Charter guaranteeing that humanitarian and development programmes deliver high-quality products. To mark this anniversary, the FPS Foreign Affairs invited several experts to a one-day conference in November 2018 to evaluate and optimise the Belgian initiatives. Experts from Niger and Madagascar shared their experiences with Glo.be.
From Madagascar to Niger
Tahina Andrianjafy is director of SALAMA (Centrale d’ Achats de Médicaments Essentiels et de Matériel Médical de Madagascar), which was founded in 1996 and is responsible for the control of medicines and medical equipment in Madagascar. To this end, it cooperates with NGOs and international organisations, such as the EU.
Andrianjafy says that Madagascar's health care system faces many challenges: 'After a period of political instability around 2010, the budget for health care decreased. Currently, the budget is about 8 percent of the GNP, whereas international standards determine that it should be 15 percent. People's purchasing power is also problematic. They cannot afford health care.'
Barira Dan Nouhou, who works for the Nigerien Medicines Regulatory Authority, points at some other critical issues. ‘Niger is currently working on a coherent national health policy, a process in which we encounter numerous obstacles. Many poor quality products enter Niger illegally because we are unable to fully control our borders. Moreover, the distribution chain, namely all of the distributors who bring medicines to customers, is highly fragmented, which makes control difficult. We also need support for the technical inspection of the products as we do not have any experience in this regard.'
Both Andrianjafy and Dan Nouhou praise the Belgian initiative. ‘I am delighted that they have taken this initiative', says Dan Nouhou, 'they really commit themselves to guaranteeing the quality of the products in their partner countries.'
Many poor quality products enter Niger illegally because we are unable to fully control our borders. Moreover, the distribution chain is highly fragmented, which makes control difficult.
Room for improvement
It is certain that good work has been done in the past 10 years. Nevertheless, there is still room for improvement. Hans Hogerzeil, professor of 'Global health' at the University of Groningen, confirms the problems Andrianjafy and Dan Nouhou mentioned.
‘On average, many developing countries spend far too little on medicines. According to a study from the Lancet Commission, countries should spend at least 13 dollars per person per year on necessary medicines. But many countries fail to achieve this. Besides, the quality guarantee remains too uncertain in those countries. Poor quality medicines cost society a lot of money, reduce people's confidence in health care and contribute to antibiotic resistance,' says Hogerzeil.
Poor quality medicines cost society a lot of money, reduce people's confidence in health care and contribute to antibiotic resistance.
To solve the problems, Hogerzeil makes a number of recommendations: 'Donor countries must provide technical assistance to developing countries. They are also advised not to donate amortised medical equipment. They should pay more attention to the needs of the people on the ground and supply products that are in accordance with local legislation. And, of course, further financial support remains indispensable.’
Yet Hogerzeil does not see any benefit in a war against falsified medicines. ‘It is much more useful to fully focus on quality assurance. If quality medicines are available at a reasonable price, people will automatically ignore inferior medicines.’
So despite the Belgian initiative of the past 10 years, much remains to be done. Or as Minister of Development Cooperation Alexander De Croo concluded in his opening speech: 'We need to get engaged.’
For further information: Why counterfeit medicines are unacceptable
The Belgian commitment declaration on quality medicines
With this commitment, Belgium was the first donor country to commit itself to guaranteeing the quality of medicines at the level of cooperation with other governments, both in its development cooperation and in its humanitarian programmes. The implementing partners (the Belgian development agency Enabel, medical NGOs, BIO) also ensure that only reliable medicines are used, although this is not always feasible.
At the international level too our country is an advocate for quality medicines within the European Union and the World Health Organisation, among others. Moreover, our country has a law that obliges pharmaceutical companies to produce medicines of guaranteed quality, even if they are intended for export. Not all EU Member States have already achieved this.