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costs of medical goods – especially pharmaceuticals – being lost or stolen.

Description and Background

A major technology company have set out an early proposition for developing a system for the tracking shipments of pharmaceuticals through a combination of radio and satellite technologies. There would be transmitters inserted into the pharmaceutical containers and packages which could then be monitored to ensure that they reached their planned destination.

Issues Addressed

Pharmaceuticals and other material are needed to address Africa’s significant health needs. However, they are also valuable and easily transportable commodities which can be stolen and sold on the grey market. This theft not only increases the costs of security and providing replacement material; it also increases the perceived financial risks of providing assistance to Africa by donors. The tags could also be used to verify the authenticity of shipments as counterfeit drugs is also a very serious problem.

Satellite Use

Satellites would allow tracking of the materials across locations which were outside of the range of other telecommunications networks and could also provide detailed information of the surrounding areas into which the materials were moving.

Impact Pathway: Pharmaceuticals Tracking Objectives

 Reduce the levels of pharmaceuticals and other materials which are stolen and sold on the gray market.

Inputs

 Satellite monitoring capacity

 Tracking devices

 Security/investigative support

Activities

 Monitor selected cargoes to ensure that they reach their intended locations

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Impact Pathway: Pharmaceuticals Tracking Outputs

 Information on the status and location of pharmaceutical deliveries

Initial Outcomes

 Lower rates of pharmaceuticals being lost or stolen

 More people receiving the care that they need

Longer term Outcomes

 Increased confidence in the reliability of deliveries

Wider Outcomes

 Reduced goods and cash flow into the criminal markets

 Knock-on application to monitor other goods

Benefits

The main benefit is the greater certainty about the delivery and provenance of pharmaceuticals and other materials.

Costs

The initial costs cover the establishment of the appropriate technology, the monitoring systems and the capacity to respond to the information. On-going costs would include the tracking technology and the staff required for monitoring, security and investigation.

Impact Assessment

Drugs account for 10-30% of typical total medical costs. It is estimated that 15% of drugs in public health system do not reach their final intended users. Therefore, the impact of these ‘missing’ drugs can be estimated at 1.5%-4.5% of total health care costs. We have not calculated the impact in any particular country for the project as this proposal has yet to be developed. Therefore, the analysis is included as an example of cross sub-Saharan African impact in the following section.

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5.1

Introduction

For our impact assessment, we have undertaken an analysis for each of the case studies set out in the previous section to assess the potential impact on health outcomes and systems through the scaling-up of the satellite-based telemedicine and eHealth programmes described and assessed in the previous section. We have adopted an approach which scales up the impacts on two key demand drivers for such projects for each country in sub-Saharan Africa: the population that is able to be reached only through satellite communications (estimated to be those living outside the reach of the current mobile telephone network) and the level of disease burden.

For five of the projects, we initially calculate the expected impact in the country in which the programme is currently being delivered and then extend it across Sub-Saharan Africa. For the RAFT and pharmaceuticals tracking projects, we have begun with the Sub-Saharan African impact as these projects are already international in their scope. We have calculated for the Care at the Clinic, Care in the Village, eLearning (Nursing), eSurveillance and eAdministration (TRACnet) economic and health impact models which are driven by the potential net change in health outcomes from the relevant interventions. These have been calculated for all Sub-Saharan African countries62for which we were able to find all the relevant data using the parameters set out in the individual case study project assessment.

We have provided in this section the details of the methodology and the aggregated impacts for sub-Saharan Africa. The calculations have not been discounted nor have they been adjusted to reflect expected future growth in economic output and incomes in Sub-Saharan Africa. The benefits in each case are those that would be attributed across the entire society from the intervention undertaken and not simply those that would accrue to the individual. Therefore, any linkages between potential benefits and costs would need to take this into consideration in determining how likely it would be that beneficiaries could be able to pay for the costs of the interventions. Additionally, the calculations have made the assumption that these programmes would be able to be rolled out at the scale and current levels of effectiveness modelled. There has been no review of the technical, medical, financial or other constraints which might make this more difficult to achieve in practice. The detailed calculation steps are included in Annex C.

5.2

Assessment of the Case Study Impacts

5.2.1 eCare in the Clinic: Mali IKON Project

The Mali IKON project illustrates the ability of clinics in rural areas to communicate with specialists in the capital for the transmission of radiological results for specialist feedback.

Our estimate for the impact on Mali reflects the impact of one year’s operation at the current rate of implementation that is then rolled out across all of Mali’s rural population at the same density of operations is set out in Table 17.

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Excluding South Africa