The Cola Challenge: What Makes Medicine Distribution Different?

You’ve probably heard it; if you can get a Coke in any village in Africa, why can’t you get medicines?

Well, you can’t actually. Anyone who has traveled 100 kilometers down rutted, washed out roads to a village in the middle of a savanna knows that getting a Coke is never a sure thing. Getting a cold Coke is very unlikely. And getting the exact type of Cola you want—Diet Cherry Coke, please—well, forget about it.

But let’s say you are more likely to get some sort of carbonated beverage than you are antibiotics, measles vaccines, malaria medicine, or contraceptives. Why is that?

Well, it comes down to the differences between the supply chains; the resources, the sophistication, the commitment, and the return on investment of getting products to people.

Let’s look at those differences.

For consumer products like Cola beverages, profit drives the supply chain; someone makes money at every step, including the shopkeeper who sells colas to her customers. Everyone has some financial incentive to make sure the beverage gets to a retail outlet, and their return on investment is experienced every time money and products change hands.

In low income countries, most people can’t afford to buy medicine, and private pharmacies are concentrated in urban areas. So, it’s usually up to the government to make sure that medicines reach clinics in the most distant villages and the poorest urban neighborhoods. Medicines are provided free or at subsidized prices. It’s a mission driven supply chain with little financial incentive and a very intangible return on investment, except to the consumer.

What else is different? Well, any cola beverage can quench one’s thirst, and while a consumer might have a taste preference, they certainly don’t suffer when their choice isn’t available. But medicines are very specific to the needs of the consumer, who generally has little say in what medicine to get in order to treat their condition. Hundreds of different health products are required to treat or prevent the vast array of conditions that might arise.

Consider this. What if my doctor prescribes Orange Fanta to treat my malaria, but all I can find is Diet Pepsi, which everyone knows is for arthritis? That’s the reality with medicines; the exact medicine must be kept in full supply. And in the right condition.

Let’s say that my Orange Fanta must be kept cold at two degrees Celsius from the bottling plant to the shop where I buy it, otherwise it spoils. That’s the reality with vaccines and certain medicines. Colas don’t need to be cold, even if that’s what people prefer. Vaccines and some medicines must remain cold, or they won’t work, and that cold chain equipment—refrigerated trucks, cold rooms, refrigerators—is expensive to buy and maintain.  

One final point; who pays to get those beverages and medicines the last few kilometers down that rutted road, and who suffers if they don’t arrive? For beverages, it’s the shopkeeper who pays for the last mile. She buys her cases and takes the risk of transporting them on the back of a motorcycle or bike from the local distributor to the shop. If they get damaged, that’s not the distributor’s problem; they’ve already sold the goods and made their profit. Only the shopkeeper suffers, since she has nothing to sell. And her customers might be disappointed, but they can still quench their thirst with clean water and not suffer a bit.

But paying for the distribution of medicines to the last mile is often the responsibility of governments that already have too few resources and too many demands. It is very costly to distribute hundreds of health products routinely to thousands of far flung villages, many without power to operate refrigerators. And who suffers if the medicines don’t arrive in the right condition? The consumers. Patients who are ill, parents who cannot vaccinate their children, men and women who cannot use contraceptives to plan their family size.

So, do we have anything to learn from the Cola supply chain? Certainly. Governments and others working to distribute health commodities can learn a lot from the private sector, which excels at finding innovative ways to reduce cost, improve efficiencies, plan effectively, create incentives, and motivate people. The more we learn from and embrace these aspects of the private sector, the better we can quench the thirst of people everywhere for a healthy and disease-free life.

6 responses to “The Cola Challenge: What Makes Medicine Distribution Different?”

  1. What an excellent post! Like you, I agree that we can all learn a great deal from private sector practices and innovations — but also like you, the equivalency between a soda supply chain and one that manages vaccines is limited. Thank you for your thoughts!

  2. I totally agree with Chris. However, I would like we take into account another factor: the size of the market! A private pharmacist will not open a pharmacy in a village unless the size of the population enables him to sell enough drugs to break even. In most of small villages that condition cannot be fulfilled and, therefore, no private pharmacy is opened there. Private shopkeepers open shops in small villages because they sell many products in addition to coke: sugar, bread, kerosene, salt, rice, etc. Each product is sold in small quantities, but all together they enable the shopkeeper to break even!
    Pharmacies sell only drugs and cannot break even in small villages. However, drugs must still reach populations leaving there, and the public health sector has no choice but managing to achieve that whatever the cost is. Public health sector does that by establishing their own supply systems (even if in some places like in Senegal they outsource transport to private 3PLs). But public health sector could also ask private pharmacies to perform that distribution for them. To that end, I would suggest some discussions take place between MoHs and private pharmacists to explore the ways and conditions that would enable private pharmacists to distribute essential drugs to all villages. Why not?

  3. Very well said Chris, I know there are other factors for considerations e.g. product packaging, environmental conditions, governance, Out of stock effects etc.

    This analysis can be used as guide for more discussion,

    Thank you for sharing.

  4. Thank you Chris for the enlightenment. Yes it is true that we can learn a lot from the private sector to meet the national health objectives. My question is how can we do this?

  5. Mission driven, not profit driven. There’sa a point. You might have also have said that at the end of that long, rutted road, far from the urban centers, the consuming of Coca Cola may be restricted to the people who can afford to pay for Coca Cola’s delightful refreshment. It’s a luxury good. Ethically, we try not to restrict dispensing of essential medicines by ability to pay.

    Smart shopkeepers may also offset their losses (or risk of loss) within the retail price, so I feel like that burden could be shared between the shopkeeper and the consumer.

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