Côte d’Ivoire — the world’s largest cocoa producer has beautiful landscapes that attract thousands of yearly visitors. It is also a breeding ground for the distribution of counterfeit and illicit drugs. Though the use of counterfeit medicines carries many risks, many Ivorians still seek them out. The growing need for counterfeit pain relief in Côte d’Ivoire has resulted in the expansion of a new sector dominated by adolescents and those in need of a different form of relief.

The Dilemma

In sub-Saharan Africa, counterfeit drugs run rampant, but in Côte d’Ivoire, they run everything. Pharmacies produce only 30% of the drugs circulated in Côte d’Ivoire while the other 70% are counterfeits. Overall, about 42% of the world’s counterfeit drugs were found in Africa, a continent whose inhabitants are the most susceptible to poverty. Since 1998, Côte d’Ivoire’s percentage of counterfeit drug usage has increased by 50%, but the rate of health care availability has remained stagnant.
A 2020 World Bank report found that 33% of Ivorians did not live in close proximity to a hospital or clinic. In two regions, this percentage exceeded 50%. Health care specialists mainly work in major, more developed cities and government spending typically goes for the more developed parts of Côte d’Ivoire. Furthermore, many Ivorians do not have health insurance to aid payments towards their medical bills. As a result, they are at risk of adopting high health expenditures— 74% of it due to their overspending on medications, according to a World Bank report.

Availability

Non-branded or generic medications cost seven times higher than the international standard. Brand-named medications cost 18 more than the international guidelines, according to the same report. The quantity and variety of available medications differ depending on the sector. Just 32% of drugs essential to Côte d’Ivoire’s population made their way into the public sector while 57% of essential drugs are available to the private sector— one that comprises 80% of wealthy Ivorians.

Getting medications after obtaining prescriptions is a time-consuming process. At times, drugs are not readily available for patients. Sometimes, restocking and transferring to neighboring pharmacies can take a while. Consequently, patients will purchase counterfeit drugs from local street vendors as it is a more convenient alternative.
Over a two-year span, law enforcement seized almost 400 tonnes of counterfeit pain relief in Côte d’Ivoire and pharmacies suffered a $173 million loss that was later attributed to the presence of counterfeits. Authentic medications will run the average Ivorian 10,000 CFA or $15. For most, this is too much to pay. Ivorians typically bring in $200 a month.

A Cheaper Alternative

Unlike pharmacies, counterfeit drug markets are open around the clock. Due to the unregulated nature of the informal sector, people in need of medications can purchase any quantity of their desired drug, according to a 2021 research article. A patient in need of just a few pills of their prescription can buy medications individually instead of buying them in a pack like most pharmacies require, further lowering their expenses. However, there are some who take advantage of the cheapness of the drugs and the illegality of counterfeits, buying them to fulfill an addiction, according to the same article. Others buy from counterfeit drug markets because they can’t find traditional forms of medicines in pharmacies, due to cultural or religious reasons.

Many street vendors sell counterfeit pain relief in Côte d’Ivoire to relieve themselves of poverty. Among them are children and teens who function similarly to cashiers, negotiating prices with customers and finding drugs that match a given description.
Counterfeit drugs present buyers with what they perceive to be a cheap alternative with good enough quality. In reality, these drugs are adulterated. Meaning an active pharmaceutical ingredient is present, but is coupled with inferior substance(s). The most common replacement for starchy components found in drugs is flour with water being the substitute for liquid components. Or the counterfeits consist of entirely different substances.
Taking poorly made counterfeits result in the annual deaths of more than 100,000 people in Africa. The cultivation of counterfeit drug products has allowed their effects to go undetected and has started to show signs of the fostering of antimicrobial resistance, according to a WHO study.

Encouraging A New Côte d’Ivoire

Ten years ago Côte d’Ivoire’s government launched a new initiative that provided affordable health care to millions. Unfortunately, it ended up downsizing after government spending exceeded the allocated amount, limiting coverage to women and children under the age of 6.
But in recent years, Côte d’Ivoire began with a universal health coverage plan that is said to broaden the scope of health care and increase its accessibility. The plan includes financial reforms, medical assistance schemes, larger medicinal access and an increased budget to ensure that every Ivorian receives quality health care.
Meditect is a social enterprise that aims to put an end to counterfeit drugs by increasing access to ones of quality. The app tracks the medicine supply from the time it hits the pharmacy to the time it reaches the street, ensuring that the drugs in circulation are authentic and of good quality. It directs patients to a nearby pharmacy that presents them with the best financial and medical options.

Currently, Meditect is available in three francophone countries in West Africa, providing services to the Senegalese, Cameroonian and Ivorian people. Its goal is to expand this initiative to more countries until no African country is facing the issue of the presence of counterfeits.

– Dorothy Quanteh
Photo: Unsplash