Dudzai Mureyi, Claudia Pagliari and Raluca Bunduchi

Laws and regulations restricting the advertising of medicines are essential for protecting the public from harms due to inappropriate, dangerous, or counterfeit products. However, such restrictions may themselves become a health hazard if they prevent consumers from efficiently accessing the medicines they need; an unintended consequence that is currently affecting community pharmacy in Zimbabwe.

Zimbabwe is a low-income country in Sub-Saharan Africa plagued by a protracted economic recession and a dilapidated health system. [1] Zimbabwe’s Central Bank have had to ration resources across several priority sectors of the economy, including healthcare. [2,3] This has severely undermined the sector’s ability to import medicines, leading to significant gaps in pharmacy stocks, which are hindering the provision of key services. For example, two of the largest referral hospitals in the country recently had to suspend elective surgeries due to lack of antibiotics, pethidine, injectable morphine, fentanyl, adrenaline, sodium bicarbonate, metoclopramide and endotracheal tubes of various sizes [4,5], while many rural clinics now lack even basic painkillers [6].

The problem is also widespread among community pharmacies dispensing prescribed and over-the-counter medicines, and stock availability can be patchy and unpredictable. As a result, patients often find themselves having to trudge from pharmacy to pharmacy until they eventually find one that can dispense the medicines they have been prescribed or, as anecdotes suggest, accept “the next best thing.”  Not only is this frustrating for consumers, it also has potential to make pharmacists unintentionally complicit in patient harm. Current advertising restrictions are compounding this problem because pharmacies lucky enough to hold certain medicines are legally prevented from promoting this fact, thus making it difficult for patients to make informed decisions. [7,8]

One of the challenges for health policymakers is the need to adapt strategies, regulations and laws to take account of local circumstances. In well served health systems with universal health coverage, such as the UK, preventing the advertising of medicines produces a net gain for consumers, since it avoids the predatory marketing of unnecessary, unsuitable, or unsafe drugs and helps to ensure that medicines are prescribed and dispensed by bona fide health professionals.

The situation in Zimbabwe today contrasts markedly with this ideal, however, and innovative approaches are needed to equitably and safely straddle the fine line between promoting services and protecting the public. These include regulatory innovations, to legally and safely adapt restrictions on the advertising of medicines for the Zimbabwean context, as well as digital and social innovations, which will enable more transparent, equitable, and accessible pharmacy information for consumers. Efforts to address each of these are underway, and have potential to act in harmony with other ‘good governance’ approaches, such as the use of mobile drug authentication tools, which are widely deployed in Africa to combat counterfeiting. [9,10] For example, in one innovative workaround known to the first author, community pharmacists have been using the secure social medium WhatsApp to enquire among their peers about available medicines, enabling them to advise their customers on which pharmacies to visit while avoiding direct advertising.

We welcome a dialogue with researchers, regulators, policymakers, and practitioners in resource-poor countries facing similar challenges and dilemmas, with a view to sharing ideas on innovative solutions for enabling equitable and safe consumer access to medicines.

Dudzai Mureyi is a pharmacist and digital health innovator from Zimbabwe with an MA in international health policy. She is currently undertaking a PhD in Global eHealth at the University of Edinburgh, supervised by the co-authors.

 

 

Claudia Pagliari is a Senior Lecturer at the University of Edinburgh Medical School, where she leads the Global eHealth programme. This project aligns with her work on health informatics and emerging eHealth innovations for addressing the challenges of low and middle income countries.

 

 

Raluca Bunduchi is a Senior Lecturer at the University of Edinburgh Business School, where she leads the Entrepreneurship and Innovation Group. This project aligns with her work on information systems and innovative practices in the healthcare sector.

Competing Interests: Using technology to mitigate the unintended effects of health information control policies is the focus of a PhD project by the first author, supervised by the co-authors in the Global eHealth group at the University of Edinburgh. The project involves a novel, professional crowd-sourcing innovation, aimed at increasing the transparency of pharmacy stock information to improve the accessibility of prescribed medicines.

References:

1. Meldrum A, (2008). Zimbabwe’s health-care system struggles on. The Lancet 371(9615); 1059-1060.
2. The Financial Gazette (2017). Drug Prices Soar. [WWW] Available from http://www.financialgazette.co.zw/drug-prices-soar/ Accessed on 11 April 2017.
3. The Daily News (2017). Slow Government Procurement Worsening Dugs Shortage. [WWW] Available from https://www.dailynews.co.zw/articles/2017/03/18/slow-govt-procurement-worsening-drugs-shortage Accessed on 11 April 2017.
4. Zimbabwe Drug Shortages – A National Crisis. AllAfrica.com Accessed on May 4^th 2017 http://allafrica.com/stories/201602040662.html
5. United Bulawayo Hospitals (2016). Internal memo: Cancellation of Elective Surgical Operations. [WWW] Available from http://www.africanews.com/2016/10/15/drug-shortage-hits-zimbabwe-hospitals-suspends-some-surgical-operations/ Accessed on 06 February 2017.
6. Harare Central Hospital (2016). Internal memo: Suspension of Elective Lists-Drug Shortages. Harare. [WWW] Available from https://zimnews.net/zimbabwe-suspends-surgeries-harare-hospital/ Accessed on 06 February 2017.
7. Parliament of Zimbabwe (2001) Medicines and Allied Substances Control Act [15:03]. Harare. Parliament of Zimbabwe.
8. Parliament of Zimbabwe (1989) Statutory instrument 232 Pharmaceutical Professional Conduct Regulations. Harare. Parliament of Zimbabwe.
9. The Herald (Sept 2016). Pharmacist seeks court order for private pharmacy stocks database http://www.herald.co.zw/pharmacist-seeks-court-order-for-private-pharmacy-stocks-database/ Accessed on 11 April 2017.
10. Digital technology for health sector governance in low and middle income countries: a scoping review. Holeman, I., Cookson, T. &Pagliari, C.Dec 2016 Journal of Global Health. 6, 2, 11