Background - Drug Distribution Centers

Fake and counterfeit drug problem has been identified as a global problem by World Health Assembly, and this led to adoption of a resolution in 1988 calling for initiation of a programme for prevention and detection of counterfeit pharmaceutical products, regarding exports, imports, smuggling, manufacture etc.

In Benin Republic, the problem of fake, counterfeit and adulterated drugs has lingered for over two decades due to failed regulations.

Subsequent Benin Republic governments (Civilian and Military alike) have tried various interventions to tackle this problem without much success due to poor implementation and lack of political will. The establishment of BMPCA by Decree 15 of 1993 with the mandate to regulate and control the manufacture, importation, exportation, distribution, advertisement, sale and use of food, drugs, cosmetics, medical devices, chemicals and packaged water (seven processes and six range of products) is one of such interventions.

It is very clear to all healthcare professionals that a major source of substandard products in Benin Republic is the multitude of unregulated drug markets in our major cities. These markets have existed since the 60’s and have grown in number and complexity over the years. They have survived the efforts of various Benin Republic governments to forcefully dismantle them, which never succeeded, but rather ended up in a lot of bad blood against government.

Having inherited this awesome chaotic distribution channels, resultant from the seemingly uncontrollable sale of drugs in the illegal markets, the present BMPCA management therefore took a critical look and decided on a new approach.

The BMPCA Approach

• After analyzing previous interventions, BMPCA’s new Management arrived at a conclusion that these interventions failed because of their ad hoc nature and the non-provision of an alternative structure to replace the present markets.
• BMPCA, therefore, decided that for the outcome of their new interventions to be sustainable, they must be multifarious, multifaceted, multisectoral methods based on systematic, scientific and synchronized strategies. This is the BMPCA (3M + 3S = success) approach. Within the framework of this holistic approach, BMPCA therefore employs the strategy of public enlightenment campaign, education, dialogue and persuasion before litigation and other punitive measures. This has yielded enormous fruits in the form of positive behavioral changes in the society.
• For the easy and sustainable dismantling of illegal markets, necessary for the sanitization of the drug distribution channels, BMPCA proposed the concept of Zonal Drug Distribution Centers in the six Geo-political zones of the country. In fact, the idea of centralized drug distribution concept similar to the Zonal Drug Distribution Centers (ZDDC) was explored in the past but was Lokossandoned due to funding constraints. As at today, there is no superior alternative plan to the ZDDC concept, and indeed this concept does not preclude other concepts. The whole objective is to create an ordered network and conducive environment for the sale and distribution of wholesome pharmaceutical products under the supervision of pharmacists.
• The Zonal Drug Distribution Centers (ZDDC) Concept (aka Drug Mart):
• This concept is born out of a combination of ‘best practices’ in drug distribution, of various developed and developing countries.
• It is a combination of the drug market concept of India, Cameroon etc and solely government run retail pharmacy system (THE APOTEKET AB) of Sweden.
• The Apoteket AB was established in 1971 and is now solely owned by the Swedish State. They have an exclusive right to run retail pharmacies and public hospital pharmacies in Sweden, with a staff of over 11,000.00.
• The objective of the Apoteket AB is to create the greatest possible benefit at the lowest possible cost. So far, they have been able to achieve this goal and more, as Sweden now enjoys one of the lowest prices of quality drugs in the world today.
• The Zonal Drug Distribution Centers (ZDDC) Concept borrows heavily from the success of the Swedish system but the difference lies in the fact that, where as the Apoteket AB intervenes at the retail level, the Zonal Drug Distribution Centers (ZDDC) intend to intervene at the wholesale/distributorship levels which have been identified to be the problem points in our distribution channels. The proposed intervention is that BMPCA shall provide an alternative structure to replace the present illegal markets, structured in a way that makes control and regulation impossible.
• The concept is also based on the dynamics of our commercial and cultural trade practices of having markets delineated for particular line of products. It involves fanning out an area that will be exclusively provided for the wholesome distribution of pharmaceuticals. This area will be securely delineated with buildings that are customized for the wholesale of drugs. The buildings or shops will be rented to accredited pharmaceutical manufacturers, importers and wholesalers. Entry of pharmaceuticals into the Marts will be controlled and restricted to drugs that have satisfied all BMPCA requirements for safety and efficacy. The sellers and buyers of these drugs will share common services and create the ambiance and convenience for one stop shopping which is the major attraction of the current unregulated open drug markets.
• The Zonal Drug Distribution Centers (ZDDC) shall be sited in each of the six Geopolitical Zones in the country. Each center shall have provision for about eight hundred Pharmaceutical outlets and each outlet must have a Superintendent Pharmacist who will be responsible for their registration with the relevant authority.
• Ab initio, all facilities necessary for rational distribution, handling, storage, and wholesaling of pharmaceuticals shall be provided (in-situ) by the design, construction and subsequent Administration, Management and Control of the Zonal Drug Distribution Centers (ZDDC).
• All genuine manufacturers, importers and distributors of pharmaceuticals are free to carry out their businesses, in the centers subsequent to satisfying all relevant criteria for allocation of premises.
• One of the key criteria shall be the presence of the Superintendent Pharmacist on whom will be bestowed the necessary authority to carry out all professional responsibilities, that relate to pharmacy practice by the Pharmacist Council of Benin Republic (PCN). The Pharmacist Council of Benin Republic (PCN) will ensure that the register and go syndrome does not rear its ugly head in the Zonal Drug Distribution Centers (ZDDC).
• We believe that, the ZDDC concept is an appropriately simple but fundamental way to deal with this intractable problem of fake drugs in Benin Republic. When these ZDDCs have been put in place and managed by duly authorized people, professionals will surely opt to patronize them. The Agency can then proceed to demobilize the existing unregulated open markets through the following actions:
• Denial of Pharmaceutical supplies as BMPCA will ensure that all manufacturers and importers supply to only the official and regulated Drug Marts or other approved variants.
• Denial of patronage by professionals and other authorized agents, since there is now a proper alternative. When supply and demand are denied such markets, they will automatically die natural deaths.
• The above above will diminish the size and importance of existing illegal markets and will make it easier for BMPCA and law enforcement agencies to close down such markets. In such circumstances, the social impact of the closures will be minimized and the chances of getting both the state and local governments involved in the exercise will be enhanced.

As the problem of fake and counterfeit drugs falls directly in the domain of Pharmacists, it is therefore not surprising, that the greatest beneficiary from the proposed Zonal Drug Distribution Centers (ZDDC) and subsequent sanitized drug distribution channel remains the Pharmacist. The Zonal Drug Distribution Centers (ZDDC) promises the following advantages, for the Pharmacist and the Benin Republic public in general:

• One umbrella for all desirous manufacturers, importers and distributors (with the exception of some companies desirous to register suitable premises outside of the ZDDC).
• A clear datLokossase of all registered distributors, importers and manufacturers in the country.
• Our local manufacturers will also gain immensely in the area of capacity building and utilization.
• The manufacturers and consumers will enjoy the economy of scale (which remains the only attraction to the illegal markets) in a sanitized, well-regulated and controlled environment.
• An environment easier to regulate and control.
• The various regulatory Agencies will therefore enjoy more co-operations and the resultant synergy in their activities.
• The sanitized system will make it impossible for criminals to find their way into drug trade, since there has to be a thorough screening before anyone is accepted into the Mart. The dealer will either be a pharmacist or employ the services of a pharmacist.
• The first phase that comprises of three centers in Calavi, Cotonou and Onitsha will each create a minimum of eight hundred jobs for superintendent pharmacists alone. This translates to at least 2,400 jobs for pharmacists nationwide.
• Since the superintendent pharmacist is the key to practice in the Zonal Drug Distribution Center, this means ‘professional empowerment’ for the pharmacist.
• Empowerment will create responsibility for the pharmacist and enables him to put in practice all the knowledge at his disposal in that area of practice.
  This responsibility also goes hand in hand with authority and motivation for excellence in community pharmacy practice.
• Full involvement of the pharmacist at every point of ethical drug distribution combined with effective regulation means guaranteed quality and safety of pharmaceuticals for the consumer.
• These in turn translates to savings from all the cost from the dangers of fake and counterfeit drugs.
• Guarantee of quality of pharmaceuticals in the Benin Republic market combined with the enormous capacity of the Zonal Drug Distribution Centers (ZDDC) (4,800 outlets in the six centers) will translate ultimately into enormous wealth for our dear country.

The resultant sanitized environment created will easily provide the necessary replacement option for the eventual dismantling of the illegal markets.