Tikur Anbesa Hospital has a cancer treatment centre on the ground floor. Medical professionals busy themselves by checking on their patients, room after the other. The gateway to the ward is huddled, with attendants desperately waiting to buy unavailable drugs from the store next to it.

A young man in his mid-20s occupies the first bed inside one of the rooms with a secured IV line on his left hand. His weak stature and distressed expression speak volumes about his pain and suffering. Gebre Kiros hailed from Adigrat, a town in the Tigray Regional State, 1,000Km north of the capital, with his younger sister two years ago. He is a truck driver and the breadwinner in his family.

A year ago, he began to experience discomfort around his groin area and went to Yekatit 12 Hospital only to receive life-changing news; inflammation of the testicles. He was on medication for over six months without much improvement. He returned to the Hospital for a check-up but was instead diagnosed with testicular cancer, which forced him to transfer his follow-ups to Tikur Anbessa.

It was all downhill from then.

Although medications are supposed to be available from the Hospital, patients are often told to buy from private pharmacies due to stock depletion.

Gebre started chemotherapy for nearly 14,000 Br for one visit. He takes the treatment every three weeks while staying in the hospital for at least five consecutive days. To top it all off, the young man has little to no help from family members since they are far away with no access to payment services.

He also has to buy IV fluid through which the medicine is given, which is not easily available in most places. He has had to wade through to find it in pharmacies throughout the city.

''I don't know how I can survive if things go on like this,'' he told Fortune.

The shortage of drugs has always lurked around the underfunded healthcare system, but the dire economy and global supply chain disruptions have exacerbated the problem lately. Both local and private manufacturers are unable to meet the high demands. The scarcity of foreign currency has also posed a serious challenge for private importers of pharmaceutical products. They are struggling to meet the growing demand. Although the challenge has been recurring, it has become severe in the past couple of months.

Owned by the Midroc Investment Group, Pharmacure Plc manufactures pharmaceutical products, mainly supplying IV fluids for the Ethiopian Pharmaceutical Supply Agency (EPSA) and local pharmacies since 1998. According to Deputy General Manager Solomon Gebreamanuel, the company can produce 10 million litres of fluids annually. It is now forced to operate at 20pc capacity due to foreign currency shortage.

"The demand for IV fluids surged after the start of the war two years ago," he said.

The Agency has been buying IV fluids from domestic manufacturers. It is forced to be in search of international markets as the demands for fluids, commonly known as Normal Saline, Dextrose Water, and Ringer Lactate, could not meet the supply lacking inputs to bag the fluids.

The Agency had ordered 6.2 million bags from India, which can cover for up to eight months of use.

Long queue at the laboratory of Tikur Anbessa hospital on a cold December afternoon.

"We hope it will address the shortage somehow,” Solomon said.

Amba Pharmaceutical Import Plc is one of the drug importers in the capital that was left hanging for six months to get foreign currency to import drugs. The last time the company imported a container of drugs was in June after getting 100,000 dollars from Berhan Bank. According to Operation Manager Fasika Mekuriya, getting foreign currency has become very challenging as they are expected to deposit 400pc equivalent of their ask in Birr.

For the company that supplies drugs in consignment, collecting payments takes more than three months, putting pressure on the cash position. She said that they are being forced to shift into the coffee processing business.

Amba Pharmaceutical Imports was established in 2002 with an initial capital of four million Birr, in which Ambanesh Kebede is a significant investor among the five shareholders. With 61 employees on its payroll, the company imports drugs from Europe and the Middle East, distributing them to nearly 500 retail pharmacies and 150 wholesalers.

The lack of foreign currency drives importers with reserved finance to look elsewhere.

Biotech Pharmaceuticals Importer was established in 1991 by three shareholders with an initial capital of 12 million Br. It has imported drugs for over two decades. According to General Manager Fistum Mulugeta (MD), it has been a year since the company got access to the foreign currency from banks. He desperately needs foreign currency but cannot meet the requirement.

"Importers with intermediate status are going out of business,” he said.

Even though there were incentives for the pharmaceutical sector, it has done little to address the forex shortage.

The medical researcher and lecturer at Addis Abeba University, Semayawit Bahiru, argues that although the shortage of foreign currency is apparent, the skyrocketing prices of drugs should also be attributed to distributors holding on to products to sell at a higher price.

Tikur Anbessa Specialised Hospital is one of the long-existing hospitals facing a crippling shortage of medications and medical supplies. A daily average of 20,000 patients from all corners of the country have been flocking to the institution since it opened its doors in 1972.

The Hospital acquires medicines from the Agency.

Demisew Gezahegn, pharmacy director, feels that the drug supply system is much better than the previous year despite essential narcotics such as IV Fluids and drugs for cancer treatment being unavailable in the market.

"The drug demand is beyond the budget allocated for drug procurement,” he said.

According to Solomon Nigusse, deputy head of the Agency, the distribution to pharmacies and hospitals was delayed due to debt settlement issues. The Agency supplies pharmaceuticals and medical equipment to state-owned and private health institutions through its 19 branches. Two in the Tigray Regional State have been non-operational for the past two years.

Two countries -China and India- supply 70pc of the drugs the Agency imports. They acquired a quarter of their supplies from 11 local manufacturers before 2019; however, the rate dropped to less than 10pc. EPSA offers health centres access to buy drugs on credit and settle payments within two months of receiving the supplies. However, many hardly adhered to the rules and failed to pay on time, with close to 1.4 billion Br worth of goods left unsettled.

In the last budget year, Tikur Anbessa paid 16 million Br debt to the Agency after securing funds from the Ministry of Health. Parliament appropriated a 70-million Br budget to the Hospital to cover 170 million Br worth of pharmaceuticals for this year, with a 100 million Br difference, according to Demisew. This year the Hospital owes the Agency 74 million Br, and it has paid off 40 million Br so far.

Tikur Anbessa Hospital administrators had proposed a 444 million Br budget for drug procurements this year. The actual budget fell short by 82.5pc, landing them at 77 million Br. The Hospital has already spent the budget received for this year and needs an additional 200 million Br for drug procurement.

Although 87pc of drugs are in stock at the Agency, there are unavailable drugs such as HIV and Cancer medications, Amocaciline, and immunosuppressants. Countries partner with one another to procure certain drugs in large volumes in a pool procurement scheme.

For Solomon, the shortage of such prescriptions manifests as a result of small orders and hopes to deal with the problem by searching for partners to pool-purchase.

“We've agreed to partner with Kenya,” Solomon disclosed.

Dawit Tafesse, a lecturer at the pharmacy department of Addis Abeba University, argues hospitals have the tendency to overestimate the forecast when applying to get drugs from the Agency. With a 53pc success rate, the rest of the demand is hung out to dry at the Agency, waiting for its fate of expiration. He recommends that priorities be given to drugs in a wide range of demand.

The effects on the grassroots can be observed in local pharmacies near hospitals.

Saway Pharmacy is located on Swaziland St, in the Paulos Hospital area. The pharmacist at the store, Nejat Abdu, saw how patients suffer due to the severe shortage of drugs. She estimated 40pc of the patients that visit their pharmacy do not get the prescribed drug. About 15 people visit the pharmacy daily, asking to buy IV fluids.

“I'm so worn out of saying there is no fluid,” she said.

There is a considerable gap between supply and demand, which leads to price increases. Drug prices increase by the day pharmacies visit wholesalers. The pharmacy where Nejat works at did not stock any fluid for the past four months as they could not find it in the hands of importers, wholesalers, and local manufacturers.

She observed people forced to buy local drugs even though the demand was low when there was the luxury of choosing brands with fair price differences.

Yezak Pharmacy is located on the same street. Jumana Tofiq, one of the four pharmacists in the drugstore, said that drugs prescribed to treat chronic diseases and IV fluids have been scarce for the past two months.

According to Jumana, close to 50 patients visit the drugstore, and 35pc of them would not get the drug they have asked for.

“The shortage of drugs has highly affected our business," she told Fortune.

"How are we going to survive if things keep going this way? We couldn't even buy the drugs at a price we have already made a margin!”

While retailers turn their heads at distributors, the latter point the finger at the inconsistency in the availability of drugs.

Kezak Pharmaceutical Supply & Distributing Plc was established two years ago by Zekariyas Kelil. The company has been buying drugs from importers and distributing them to pharmacies.

"We don't even find the medicine we bought today the next day,” said Himan Reyad, the pharmacist.

Contrary to the industry players, the private-owned Teklehaimanot Hospital has not faced a severe shortage. However, it uses IV fluids for emergency cases. The Hospital used to source drugs from the Agency and importers.

Teklehaimanot was established a half-century ago. Biruktawit Hagos, a pharmacist at the Hospital, saw the price of drugs rising. The price of Phenoburbition, a drug used to control seizures that was 200 Br, is now five times higher, reaching 1,000 Br.

According to Biruktawit, the only option left is to source drugs at a very high price from importers as a couple of months have passed following their approach to the Ethiopian Pharmaceutical Agency to get the required amount of drugs.

The researcher Semayawit believes that the lack of diversity in the type of drugs imported also played a role in the shortage. She is working on an App that identifies the problems in the supply chain, dubbed SemayLink, in partnership with Zala Technology which will pilot in the coming months. She recommends creating a method to let importers know what type of drug is needed in the market.

PUBLISHED ON Jan 01,2023 [ VOL 23 , NO 1183]

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