Kyle Poplin

Don’t Forget Hygiene: Health care delivery in sub-Saharan Africa is complicated, but simple things still matter

Dr. Patrick Lukulay is uniquely qualified to discuss health care in sub-Saharan Africa.

Currently vice president of the U.S. Pharmacopeial Convention’s Global Health Impact Programs and program director for the USAID-funded Promoting the Quality of Medicines program, Lukulay was born in Sierra Leone to a polygamous chief, and grew up there with 25 brothers and sisters working in the rice fields and walking to school barefoot.

He eventually earned a bachelor’s degree from the University of Sierra Leone, a master’s in analytical chemistry from the University of Aberdeen in Scotland and a Ph.D. in analytical chemistry from Michigan State University. His professional interests include partnering with other stakeholders to improve drug quality in developing countries. The author of several publications, he recently wrote a book, “The Executive in You: My Journey from the African Village to Corporate America.”

We recently asked him to discuss health care past and present in Africa.

Kyle Poplin: What are some of the key changes that have been made in health care delivery in sub-Saharan Africa in your lifetime? What are some of the key changes that need to be made going forward?

Dr. Patrick Lukulay: Health care delivery has been enhanced significantly from donor input and investments in health care. Private donors such as the Bill and Melinda Gates Foundation and international partners have changed health care in developing countries over the past decade. The focus has been on providing commodities much more so than building institutional capacity or human resource capacity. As we look ahead in the next decade health care delivery should focus on building institutions and developing local talents to ensure sustainability through country ownership and leadership.

(Left: Dr. Patrick Lukulay)

KP: There’s been much discussion about strengthening drug supply chains in an effort to end preventable diseases in developing countries. How have for-profit drug firms helped in that area, and what more can they do?

PL: The provision of commodities such as medicines and diagnostic tools does not guarantee a positive health outcome. The pharmaceutical services needed to ensure rational use as well as the checks, balances and controls needed to ensure that the products are of good quality, safe and efficacious, are equally and vitally important. Ensuring that the supply chain is secure and not prone to the introduction of counterfeit and substandard products is critically important to ensuring that the medicines are beneficial. For-profit companies have introduced track and trace technologies to detect fraudulent products in the supply chain and have introduced pedigree to track product throughout the supply chain. More work should be done to introduce reliable medicine retail facilities with proper storage and distribution in developing countries. The retail market is very fragmented in developing countries and staffs dealing in dispensing of medicines are poorly trained and lack adequate facilities to stock and distribute medicines.

KP: What are the key barriers to getting pharmaceuticals in the hands of the people who need them?

PL: The key barriers include availability, price and accessibility. People continue to live in remote areas that are not easily accessible and when the medicines are available, price, not quality, is the overriding factor in making decisions about what medicine to buy. Some government policies which allow high tariffs on medicines also negatively impact the price of essential medicines. Other factors include corruption in the procurement process where funds are not used prudently to buy quality-assured medicines.

KP: How can information and communication technology change health care access in the developing world?

PL: By sensitizing patients about proper health-seeking behaviors, and regulatory agencies can share information on best practices and intelligence in securing their respective supply chains. Through information, education and communication, consumers can be empowered to make informed choices about health-seeking behavior.

KP: Are there any drugs on the horizon that might have a big impact on health care worldwide?

PL: New therapies for HIV/AIDS treatment, including the use of a tenofovir-based, fixed-dose combination, is having a big impact.

KP: In your experience, what are the questions that aren’t being asked and solutions that aren’t being sought in health care delivery at the BoP?

PL: The area that has been ignored in health care delivery, in my opinion, is the role of hygiene in preventing diseases in developing countries. I have seen millions of dollars spent to provide cures for infectious diseases but little attention paid to cleaning the environment. Curing malaria without improving the conditions where people live will only lead to continuous infection and continuous cure.

Health Care
public health