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Pharmacy Must Welcome Innovation –Abimbola Adebakin

Abimbola Adebakin is the CEO of Advantage Health Africa, a company with a focus on the African Healthcare System. In this interview with PharmaTimes WAIRE EMONEFE, she talks about her work, sheds light on CPN Nexus and shares her thought on ‘Innovative Disruption’ in the Pharmaceutical Industry.

What is Advantage Health Africa about?
Advantage Health Africa seeks to find solutions to some problems we have identified in the health sector. We found that there are many gaps in the health sector, so we want to bring ‘advantages’ to the health sector.
Our focus is on African healthcare system as a whole. We have started with the Pharmaceutical vertical, and we picked the community end of that vertical for starters. As we begin to scale up we see ourselves being relevant with the clinics, diagnostics and nursing, etc.
However, our major focus lies in the fact that right now the landscape of Africa has a lot of small businesses that are not doing so well serving our health needs. If we can strengthen those businesses to do better and improve their performance, ultimately they will be able to serve the health needs of the populace better. So, we are positioned to improve the performance of those who then improve the healthcare of the people.

At the last PSN National Conference, the theme was centred on innovation. What are your thoughts on this?
Disruption and innovation are here to stay. We have no choice. The people that we serve are being served by other sectors that are disruptive and innovation is constantly taking place in other things that their lives revolve around. So, we don’t have a choice in healthcare but to improve. Almost every health care intervention ends with a medicine being exchanged; giving a medication or something similar to solve a health problem.
Pharmacy is positioned right there within healthcare and we have problems. We have problems with quality, access and affordability. Hence, we must disrupt healthcare to address those three problems. So, for me when we bring out innovation, it’s not just for innovation sake. We must find the root of the problem that is causing access to be an issue. What problems are causing quality to be such a ‘big deal’ in Nigeria? What are the issues around affordability? Why are medicines, and great healthcare outside the reach of the majority?
In my opinion, the gap is so wide that it can’t be solved in a traditional manner. We also can’t grow the scale that we need to meet the deficit that we have in place using organic growth. Here’s an example, ideally, in Nigeria with our population of about 200 million people, we should have at least 200,000 licensed pharmacies. This is in Nigeria alone; now guess what we should have across Africa, over a million. At present, the pharmacies in Nigeria are less than 5,000. How do we want to grow 5,000 to 200,000 organically? We cannot. If we mandate every pharmacy right now to grow 10 times, we still have less than 50,000 and we are aiming for 200,000. That is a huge gap.
Therefore, we must find innovative ways to bridge the gap otherwise Nigerians will continue to be under-served by licensed pharmacies. The result of this will be a vacuum, and nature abhors vacuum. So somebody else will fill it. Now, if someone else is filling this gap and they are providing care that is not up to the right standard, and that is what people have access to, what they can afford and what they trust as quality, then we are out of the game.
So, pharmacy has to welcome innovation and we must bring in all the needed disruption to things that have made us so comfortable over the years to think that we have got it right, because we haven’t gotten it right yet. We are going to get it right but we must embrace change.

Abimbola Adebakin

What is the relationship between CPN Nexus and Advantage Health Africa?
In 2010, I tried to examine what the problems in the health sector were, and one area I saw was access to genuine medicines. I also saw that the supply chain across Nigeria was a mess. I realised that if we were able to bridge some gaps and sort out the point where the mess is happening, pharmacists would be able to guarantee the genuineness of medicines and when it goes out and is faulty, we can guarantee recall. Today, we know that we can’t guarantee recall. If a medicine goes out, we can’t get back 40% of that medicine because they have gone into informal channels that are not transparent. So, I tried then to put pharmacists together so that we do group purchasing because then I thought that was the problem, and we could tackle from that angle. I got 55 pharmacies within that network and we were called Advantage Health network. However, for some reasons, there was a lack of continuity on my part, I abandoned the idea.
I went to work as a managing consultant and came back to the industry in January of 2017, I realised the problem was still there. In Nigeria, over 95% of pharmacies are in one’s and two’s. You don’t have seriously large chains. In some other countries, we have large chains and few independent pharmacies. But the reverse is the case here in Nigeria. Looking at those individual pharmacies, their buying power is low. Their bargaining power is equally low. Their visibility is low. So, I still saw the need for aggregation – where we come together like a broom, we stop being broom sticks that can be easily broken, instead we are hardly broken. That is the philosophy behind CPN Nexus. So, early in 2017, we started aggregating again as Advantage Health.
However, from what I have learnt in my recent roles in business consulting and entrepreneurship development, partnership is important. So, I identified a credible partner that we needed to join forces with and that was the Association of Community Pharmacists of Nigeria (ACPN). I met with the officials and they loved the idea. They had also been looking for how to improve practice and business for pharmacies. So, this model that I brought came at a time when they were also thinking of doing something collectively. So, we agreed in Sept/Oct 2017 to jointly form a not-for-profit company called Community Pharmacists Network Nigeria, aka CPN Nexus.

We have spoken about CPN Nexus, what can you say about My-medicines.com?
I said earlier that Advantage Health Africa sees problems and we try to find a solution. We are looking at 3 cardinal areas which are quality, affordability and access. Many of the things we do are between pharmacies or manufacturers to pharmacies, basically, business-to-business (B2B).
But we saw that there was also need to bridge the gap between business and consumers (B2C). The people around us in Nigeria are having poor access to medicines. So, we saw that if we can find where medicines exist and find where it is needed, we can bridge the gap and bring a solution. We were the first to launch an aggregated platform of supply of medicines so that when you raise a request, we can crowd-source, and using block chain technology, we make sure you get your medicines at an affordable price anywhere in Nigeria. Scale and last mile delivery was very important to us in starting my-medicines.com. That is why we don’t carry inventory of our own – licensed pharmacies form our suppliers; hence they see my-medicines.com as a shared platform.
We have positioned as a health-tech solutions provider that finds (locates) genuine and affordable medicines, and makes sure it gets to consumers. We have had significant progress, delivery times, reach across the country, partnerships, team formation, our corporate governance, a tech investor that is now ensuring that our technology solution is at advanced stages.

Finally ma, in your opinion, do you think that the pharmaceutical industry has what it takes to move into that innovative sphere – looking at the challenges in the country?
I will answer this question by asking and answering 3 things: Is it possible? Yes, it is possible. Is it difficult? Yes, it is difficult. Are we ready? We are getting ready. It is possible because I have seen other industries go through an evolution when they became uncomfortable with where they were.
They didn’t quite know what to do. When I was away from the pharma industry I project managed formation of an ATM consortium. We had to get banks to work together to begin the explosion of ATMs. Prior to that time, the use of ATMs were thought to be elitist. They were only seen in Ikoyi and VI, and we thought that ATMs were not needed in Ikoyi and VI because the man there could afford to send his driver to the bank.
The inconvenience of banking over the counter was felt more by people in middle to low class and they were largely unbanked because many of the banks didn’t have branches in the Agege and Dopemu areas of Lagos. That was +15 years ago. Now we can see the explosion, the needed infrastructure evolved. A switching company called InterSwitch came in; ATMs were becoming more popular; technology was introduced in banking transactions; and mobile technology came in. The change has happened, but look back 20 years and it was a different landscape. So, we moved from an uncomfortable position to a more comfortable position. The banks are still not stopping. FinTech is disrupting banking as it is today.
So, I see HealthTech disrupting pharmacy care as we have today in the next 10-15 years. So I’ve given myself a 10 year window to address these issues comprehensively.
Are we ready for a different practice? Certainly not 100%; but we are getting there.
At Advantage Health Africa, we have been pleasantly surprised by how members of the CPN Nexus have embraced this concept. We currently have over 920 members in this network. When we put that against the fact that the largest chain of pharmacies in Nigeria is less than 60 branches across the country, it’s huge. What we have here is a virtual network of independent pharmacies that are saying they want to work together. Our target is 1000 pharmacies by December 2018. So, once again, are we ready? We are not yet ready, but we are getting ready. We have also been impressed with the willingness of ACPN and the leadership of other technical arms to embrace new things. How do we practicalise this? Those are the solutions we are churning out at AHA and other service providers are beginning to see the alignment within the ecosystem.
To address the issue of power, for instance, we recently released a product called Digi-Solar. We went looking for funding and one of the reasons why we got the funding was because we had a huge number of members that could be off takers. The Bank of Industry (BOI) is willing to fund solar power for pharmacies plus digital instruments that they can use for diagnostics. Once you use these instruments for diagnostics, the money you make from it will pay for the solar. This is a practical solution. But can we come up with this solution alone, with 2 branches or 5 branches? Not likely. That’s the power of numbers – you are bringing solutions on a bigger scale so people are listening to you. I’m looking for a situation where those that serve other industries and dedicate their lives to it come into the pharma sector. I want people to see that when they face the Pharma-Sector, they will have “market’.
We also need to have a behaviour change. Pharmacists need to be more confident of themselves. The readiness for change comes from confidence. The confidence that even if we fail at least we tried. So, we should step out of what we are used to and try. If you fail, don’t bother because when you fail, you don’t go back to where you were, you pivot when you get up and move forward. If you fail alone, it is worse than when you fail together. If you fail together somebody can rise up and say “let’s start again”.
So, this model of aggregation is a means to an end. A means to finding practical solutions to what we lack and need together, and we have a lot of support right now.

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