Project Everest

Supply-Side Semantics and a Swanky Solution

Luke Wetmore
Luke Wetmore | Feb 15, 2018 | in Health Consulting

The February Health team has dived head-first into situational analyses of clinics in the Blantyre region. While this has given valuable data on the demand-side issues such as over-congestion, lack of health literacy and short consult times, it has also reared the head of significant supply-side bottlenecks particularly in District Health Office (DHO) registered clinics.

The Problem? Supply-Side Semantics.

We are constantly seeing clinics complain of shortages in general medical supplies (ie gloves, sanitisers & facemasks) and – more significantly – medicinal supplies to treat common illnesses. Various clinics have also gone on record to state monthly supplies have lasted as little as seven days during busy periods of the year. This seems to stem from the fact the DHO (who supplies each clinic monthly) attains its supplies from ONE pharmaceutical company called Central Medical Stores Trust (CMS). Once this supply runs dry – as it seems to do regularly – the DHO is left with a difficult proposition: send out emergency tenders or tell clinics they will have to simply wait for crucial medical supplies.

Thus, whilst we are hard at work on improving and resolving the prevalent demand-side concerns, future teams can take action on these supply-side factors that Your.MD cannot solve.

The Solution? New Tech.

The explosion in cryptocurrency interest in the last 12 months has seen immense financial speculation. Yet, it has also seen a similar eruption of Distributed Ledger Technology (DLT) or: the blockchain – that can mitigate issues previously left unresolved.

Let’s take one cryptocurrency as a possible solution in this space: Chronicled.

Their aim is to use the DLT to track the temperature and location of medical supplies as they travel from depot to warehouse to end-point. Whilst temperature tracking might not be the crux of the supply-side issues in this context, the location monitoring could provide clinics and the DHO with vital information on how far off future shipments are and thus whether more should be ordered to keep up with ongoing healthcare demand. Not only this, but Chronicled-tagged supplies can be geotagged at each new location and in real-time sent to each user as an automatic update. There are of course other options as cryptocurrencies move forward into the healthcare space to deal with these supply-side problems inherent in any healthcare system. But I see Malawi as one system that could benefit significantly from more efficient and increased supply chain management.

This is a space future teams could definitely watch out for as we move forward with the project and one that I think could alleviate the insurmountable pressures clinicians deal with every day in the Blantyre system. I know what you’re thinking, why continue to rely on local Malawian wholesalers – instead of importing Western pharma… that brings us to the block.

 What is the Block? Monopolistic Competition.

 CMS is a public trust funded with Government money. A World Bank article (McCabe, 2009) contended CMS accounted for around 70-90% of pharmaceutical purchases in Malawi. For an industry that is only US$110 million, CMS seems to take a significant portion of the market in one fell swoop. Yet, it is the small pharmaceutical market in Malawi that is hindering an improvement in this monopolistic market as US companies prefer to satiate domestic demand that sits at over US$450 billion per year.

So, while we may be able to improve supply chain management and efficiency it seems the widening of this infrastructure bottleneck is limited by the lack of competitive Pharma.

Feel free to leave a comment on this ‘moonshot’ or a solution to the competition situation here!


Link to Chronicled Website:

edited on Feb 15, 2018 by Luke Wetmore

Isaac Crawford Feb 15, 2018

How would you propose a way to test the positive influence geo-tracking medicinal shipments could have? Are there specific examples of cryptocurrencies in the Healthcare world working on fixing supply chain issues?

From an altruistic perspective, would there be any attractions that a Malawian pharmaceutical market could offer large US or Developed world pharmaceutical companies?

Reply 1

Luke Wetmore Feb 15, 2018

The positive influence can be measured in the possibility that shipment times reduce due to knowledge shipments are being tracked in real time and could lead to repercussions if timings aren't adhered to. Additionally, the positive influence can be measured in the ability of DHO/Government purchases of pharmaceutical to become more regular if they notice supplies are not tracking on time for the upcoming month/quarter.

It's definitely something that could be looked into but from the same World Bank article (2009), it seems most Western entrance of Pharma is through MSF/other NGOs (with MSF importing 90% of their supplies from Europe). While Western pharma may be able to enter with lower, more competitive prices they're really competing with Indian manufacturers as well as a State owned pharmaceutical distributor in CMS. These barriers to entry might reduce the potential attraction for these companies - hence the presence of Western aid rather than competition.

Reply 0

Brittannie Northey Feb 15, 2018

This is some thoroughly intriguing moonshot thinking that has significant potential to further develop Malawi Health projects’ continuation and success in targeting the issues you mentioned. Deeper understanding in regards to the current working process and success of utilising cryptocurrencies in this sector would be something beneficial to look into for future projects. Whilst cryptocurrency is currently a prominent investing space, its viability in the Malawian context may be questionable and looking at a system that can be mutually beneficial as mentioned may perhaps see this solution seek its potential viability.

Reply 2

Isaac Crawford Feb 15, 2018

Very much agree with this point. Cryptocurrency technology itself may be too early and unpredictable for the Malawian context. However I do believe that the processes and ideas it raised may be applicable. Do you know of any other African nations in which this technology is more established?

Reply 3

Luke Wetmore Feb 15, 2018

Unfortunately most of the crypto technology has had little real-world implementation. Only big names such as Ripple / Stellar Lumens have had the opportunity. But its a space that is steadily evolving, and while African uptake/onboarding may not be present the technology itself is suited to nations with low GNIs as a low-cost solution to the usual expensive accounting/supply chain management software that developed countries are used to.

Reply 0

Luke Wetmore Feb 15, 2018

These are great points and you're right that the usability of cryptocurrencies is still to be told. For example Chronicled has not launched their product. However the value of the upcoming technology has definitely been recognised in many developed nations. Chronicled is a low cost solution to supply chain management and efficiency improvements that can be used on smart devices (tablets, Apple, Android etc) that stream lines the entire process. While the technology and its implementation may be a year away, I definitely think these supply side issues are something future teams should shift focus towards as Your.MD viability/usability is tested and pitched.

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View all replies (3)

Dolly Phiri Feb 16, 2018

Hi Luke,

LOVE the moonshot thinking! I think this has great potential although it's viability at the moment is almost unimaginable.
I think South Africa may be the only country in Africa really using crypto but there's no regulatory framework at the moment so it would be very risky and also hard to implement the 'tracking' you mentioned but it's only early days.
There is also a new African crytpo called 'nurucoin' with like 5000 investors at the moment. I think it would encourage trade between African countries (e.g you could potentially import med supplies from Nigeria or South Africa) cause I don't think many countries trade with each other as much as they do with other continents especially Asia as you may already be aware.

All the best with the rest of your month!

Reply 1

Luke Wetmore Feb 16, 2018

Love that thinking as well - a massive problem that seems to be hitting Malawi is their inability to access Foreign Exchange markets due to the weak Malawian Kwacha. Cryptocurrencies themselves could definitely open up these quasi-protectionist barriers that seem to have evolved out of having a weak currency.

The idea itself here doesn't necessarily involve the purchase of cryptocurrencies but rather a utilisation of the blockchain technology that cryptocurrencies are built upon. In this way stakeholders who manage the supply chain would not purchase crypto but rather start utilising the technology. This might reduce the need for any regulatory framework on the financial side - but hopefully the next 12 months brings even greater strides forward in this space!

Thanks for your wishes and all the best with your future projects.

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Samantha Fisher 2 months ago

The swanky solution provided is exactly what I was searching. I had a problem with my semantics at Pharma regulatory consulting, and this solution will help me to get rid of the problem I was having. I am happy now!

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