Abstract
The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions.
Highlights
In international research and policy debates, health system strengthening and industrial development have been generally addressed within two separate silos (Mackintosh et al 2007, 2016)
When health–industry linkage in sub-Saharan Africa (SSA) has been raised, each silo has viewed the proposition with scepticism
Quantitative data were collected on availability and source of a set of tracer essential medicines, supplies and equipment on the day of the visit
Summary
In international research and policy debates, health system strengthening and industrial development have been generally addressed within two separate silos (Mackintosh et al 2007, 2016). Industrialists and researchers in Africa are increasingly exploring and promoting synergies between local industrial production of pharmaceuticals and medical supplies and improvement in coverage and quality of health care, especially for lowincome populations (Government of Uganda 2002; Republic of Ghana 2004; African Union 2007, 2012; Berger et al 2010; Government of Kenya 2010; EAC 2011; FDRE 2015; GebreMariam et al 2016; URT 2016). International organizations have responded: the World Health Organization (WHO) strategic framework for medicines and health products (WHO 2017a: 8, 12) recognizes the relevance of local manufacturing of quality medicines and health products for access, a view reflecting collaborative UN research and policy Linkages between health policy and industrial change in low and middle income country (LMIC) contexts more broadly are increasingly researched (Srinivas 2012; Shadlen and Massard da Fonseca 2013)
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