This Database at a Glance features analysis from Morgan K. Benson and Cynthia Charchi
Private pharmacies, drug stores, and drug sellers are often the first point of contact for healthcare in low- and middle-income countries. Many can provide increased accessibility and lower costs to consumers than broader healthcare institutions such as hospitals. (1) Despite these favorable characteristics, there continues to be a low availability of pharmacists in many low- and middle-income countries, as compared to those with higher incomes. (2)
Twelve programs profiled in the CHMI database are employing pharmacy chains as an emerging model to expand accessibility to reliable quality medicines for the poor. Despite the diversity of communities in which these programs work, these innovators aim to fulfill the same basic need—a replicable and consistent form of access to healthcare in their communities.
Trends Amongst Innovative Pharmacy Chains
Of the 88 programs in the CHMI database that employ franchise models, 8 are pharmaceutical franchises. This commercial retail model organizes private providers as owners of their own pharmacy kiosk or store into a network that delivers medicines and health products under a common brand, with a promise of quality assurance.
Unlike many franchises, Health Plus Outlets in the Philippines are owned by civil service organizations and operated by a Health Plus Coordinator. The Health Plus Coordinator is typically a health worker or nutrition scholar, ensuring that operations are facilitated by individuals who are familiar with its products. Their knowledge and expertise allows operational decision making to be disaggregated to a lower, on the ground, level. Health Plus Outlets are ideally stationed near a health facility to promote coordination with healthcare providers.
The 4 pharmacy chain programs not franchised are independently-run, such as Farmacias Similares, the largest pharmacy chain in Latin America. Farmacias Similares was founded in Mexico and has outlets in every major city of the country. Its name derives from the generic medicines it offers consumers, which are more affordable than their “similar” (rather, identical) brand-name counterparts.
Of the 1,243 health market programs profiled by CHMI to date, 193 are for-profit entities—about 15.5%. Amongst the cohort of pharmacy chains, this percentage jumps to 75% (9 of 12 programs). This trend towards a for-profit model follows the opportunity exhibited by a commercial retail model. These for-profit entities are however pro-poor targeting in their design, imbuing their profit mission with a social one.
For instance, MedPlus, a for-profit company, was founded to take the risk out of buying medicines for consumers and combat counterfeit medicines in India. Mi Farmacita Nacional, a for-profit pharmacy chain in Mexico, brings medicines to those most in need. Mi Farmacita Nacional now has 57 franchises in 15 Mexican states.
These programs have launched pharmacy chains in low- and middle-income countries in several regions, and some have scaled into new countries. After establishing a franchise network of Child and Family Wellness (CFW) drug shops in Kenya, The HealthStore Foundation signed a unique Public Private Partnership with the Ministry of Health of Rwanda to replicate their model and establish Health Posts as an entry level into the formal Rwandan public health system.
Pharmacy chains can build brand trust by regulating quality. Tiendas de la Salud (TISA) in Guatemala exclusively sells high quality generics manufactured locally, made available directly to the franchisee, with little risk of counterfeit product entering the supply chain.
Other Methods of Access
Pharmacy chains are not the only way CHMI innovators increase access to essential pharmaceuticals. Many chains of primary care clinics—such as Pathfinder in India or Sehat First in Pakistan—also provide pharmaceutical services. The Boat Clinics along the Brahmaputra River in Assam, India, provide a mobile form of access. Community health workers trained by Piramal Healthcare are provided with village-level pharmacy services, stocked with medicines to fill the basic prescriptions recommended by the health center with which they are linked through telemedicine.
A Growing Evidence Base
As these programs operate and expand, the evidence base of their models grows. There must be continued rigorous study of how pharmacy chains affect quality, pricing, regulation enforcement, and responsiveness to patient needs.
This is also, of course, only one step in the process of analyzing access to healthcare. Explore more CHMI posts for further study of the health market innovation space. For more on supply chain innovations that are enhancing how the medicines get to this delivery stage, see the CHMI Database at a Glance on Supply Chain Innovations. For more on how states and other stakeholders are ensuring drug quality, see the Database at a Glance on Licensing and Accreditation.
As we gather more data about the universe of health market innovations, we will continue to track trends and highlight new insights from our analysis. We invite you to do the same by downloading the CHMI Database and sharing your findings with us!
(1) Lowe RF, Montagu D. Legislation, regulation, and consolidation in the retail pharmacy sector in low income countries. Southern Med Review (2009) 2; 2:35-44.
(2) Chan XH, Wuliji T. Global Pharmacy Workforce and Migration Report: A Call for Action. International Pharmaceutical Federation (2006).
Photo: Juan Tista Toj, Tienda de la Salud pharmacist in Guatemala by Miguel Samper for Mercy Corps © 2013