Innovative Private Pharmacy Distribution Channels: Implications on Medicine Quality in Zambia

Poor-quality medicines represent a profound public health risk, contributing to increased morbidity, mortality, and global health challenges such as antimicrobial resistance. The complexity of pharmaceutical supply chains, particularly in low- and middle-income countries (LMICs), may exacerbate inequalities in access to quality-assured medicines. The multiple stages of the supply chain, from the procurement of active pharmaceutical ingredients to the final distribution of medicines, present numerous points of entry for suspect medicines (substandard and falsified). This problem is particularly acute in rural areas where lengthy supply chains and multiple storage points increase the risk of medicine degradation. Added to which, the lack of access to medicines in public facilities can lead to out-of-pocket purchases from potentially unlicensed private facilities, where the quality of medicines is often questionable. In response to these challenges, entrepreneurs are leveraging innovative technologies and business models with the potential to enhance the availability, affordability, and quality of medicines. However, research on these innovations has primarily focused on their financial and business benefits, with no investigation of their impact on medicine quality. This PhD thesis investigated this gap by comparing quality of the commonly used antimalarial (sulfadoxine/pyrimethamine) and antibiotic (amoxicillin) available in pharmacies supplied by innovative pharmacy chains with those in independent pharmacies served by traditional supply chains. A mixed-method approach comprising standardised surveys, key informant interviews, and laboratory analyses of samples to assess their quality, was undertaken to appreciate if innovative supply chains provide better quality medicines in Zambia. The findings of this thesis revealed that no falsified medicines were detected in the SP and amoxicillin samples analysed. However, there were some inconsistencies in the content analysis, yet all samples conformed to the USP tolerance limits for bioavailability. Notably, no statistically significance difference was found in medicine quality between samples purchased from the innovative and traditional independent pharmacies. This research further revealed that innovative pharmacies, characterised by more streamlined supply chains, adopted digital record-keeping and better transportation practices. Nevertheless, gaps in professional training and storage practices, were evident in both types of pharmacies, indicating that innovation alone is not a panacea. However, this research underscores the potential advantages of incorporating innovative distribution channels to ensure the consistent delivery of good-quality medicines to patients. Merging these innovative strategies with established trust in traditional pharmacies could offer a novel approach to mitigating the challenges of poor-quality medicines in LMICs.