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U.S. Group Helps Developing Countries Improve Access to Medicines

Donna Young

El Salvador, Ghana, and Tanzania have been chosen to participate in a public–private program aimed at improving residents' access to and use of medicines and vaccines.

The program, known as Strategies for Enhancing Access to Medicines (SEAM), was established by Boston-based nonprofit Management Sciences for Health (MSH) with funding from the Bill & Melinda Gates Foundation.

In collaboration with the governments of the three developing countries and some nongovernmental organizations, MSH is using a $29.9 million Gates Foundation grant to develop effective ways to procure, store, manage, and dispense drug products and vaccines.

Keith W. Johnson, a pharmacist and deputy director of strategic drug management information for MSH’s Center for Pharmaceutical Management, said the program will serve as a model that can be replicated in other developing nations.

MSH pharmacists and logistics experts have been sent to the three countries to provide technical assistance and train local health care and government agency workers, Johnson said. MSH physicians and nurses, he said, will later join the SEAM trainers.

But the governments and local agencies in those countries are responsible for implementing the program.

"It’s very important that they hire and use local staff to do the work," he said. "We provide the training and expertise, but they must do the work themselves."

The countries selected for the program, Johnson said, had to show that they had a stable government, community support, and opportunities for collaborations with other initiatives and that the program could be sustained.

Ghana and Tanzania. SEAM trainers are working with Ghana’s government to find ways to make medicines more affordable.

Of Ghana’s 19.3 million residents, according to MSH, 40 percent earn less than the local minimum wage. This becomes particularly problematic when a resident gets sick. For example, an adult in Ghana who earns the minimum wage and has pneumonia must now pay the equivalent of two days’ wages to obtain the recommended treatment at a private pharmacy.

The SEAM program is providing support in Ghana and Tanzania to help establish a network of government-monitored, privately operated drug-dispensing outlets in underserved rural areas.

Most drug-dispensing outlets in Ghana and Tanzania, especially those in rural areas, are considered nonpharmacies and, as such, are authorized to sell only nonprescription drug products, Johnson said. MSH is working with the governments, professional societies, and universities in those countries, he said, to define the dispensing outlets’ roles and expand their authorization for selling drug products.

The publicly operated health clinics and outlets in Tanzania provide medicines free to residents. But, according to MSH, those facilities often lack sufficient supplies, forcing patients to buy highly priced pharmaceutical products from privately owned drug shops known as duka la dawas.

Government-managed drug supplies have the capacity to meet the health care needs of only 65–70 percent of Tanzania’s 33.7 million people, according to MSH. SEAM program trainers are advising Tanzania’s Ministry of Health on the selection of pharmaceutical product wholesalers to act as alternative suppliers.

The trainers are also helping Tanzania’s health ministry to establish a quality assurance program for pharmaceutical products. SEAM investigators found that 11 percent of drug product samples collected from public facilities and 13 percent from private pharmacies failed tests of quality.

El Salvador. In El Salvador, MSH is aiding the government to establish a pharmaceutical supply system using one commercial wholesaler. This wholesaler will work with a network of 30 hospitals and 130 outpatient clinics that serve half of the country’s 6.3 million residents.

The strategy of using one wholesaler for the network of health facilities, according to MSH, will help the government control pharmaceutical costs and simultaneously maintain an adequate supply of high-quality drug products.

El Salvador purchases pharmaceutical products at prices higher than the international median, according to MSH. Inefficient decentralized procurement and poor management of drug supplies, SEAM investigators found, have made it difficult for the country’s public health-care facilities to maintain a sufficient stock of essential medicines.

The SEAM program is also helping the three nations’ health ministries to design, develop, and disseminate health care manuals, training materials, and software.

Elsewhere in the world. Johnson said MSH has helped other countries to develop successful drug-procurement processes. Through MSH's work in the Caribbean, for example, nine countries learned how to pool their resources to leverage buying power. These countries now obtain drug products at lower prices than they did when each bought alone.

Afghanistan was one of the first countries where MSH provided training and technical assistance, Johnson said.

The organization recently announced that it is returning to Afghanistan to use a $5 million U.S. Agency for International Development grant to assist the country’s interim government in surveying and expanding basic health services to women and children.