Interview

Key Takeaways

Below are some of the main takeaways from COVID-19 Africa Watch’s conversation with Vivian Nwakah, the Founder and CEO of Medsaf, a curated medication marketplace that was launched in 2017 and distributes high-quality medicines to African hospitals and pharmacies at competitive prices.

• The COVID-19 pandemic has revealed major cracks in the healthcare system across the world, and in Nigeria. Medsaf was uniquely prepared for these disruptions owing to its online distribution channels, and so its partnering hospitals and suppliers were able to adapt quickly.
• Even the most developed countries have seen inequality in terms of COVID-19 vaccine distribution. This inequality is likely to be further exacerbated in Africa. In the African context, there arguably needs to be a huge push from the government and NGOs to enforce efficiency and equity in vaccine distribution and to ensure that the vaccine does not solely benefit the wealthier segments of society.
• Economic hardships caused by the pandemic, including unemployment and reduced income, have driven people to cheaper medicine and to self-medication, raising considerable health concerns and favoring the growth of fake sub-medication suppliers. This situation makes it even more urgent for responsible stakeholders to connect in an efficient way, drive down costs, and improve suppliers’ operational efficiency.
• Technological solutions are available, but they need investment.

The interview was conducted by Leah Kusensela Simasiku, an IFC-Milken Institute Capital Market Scholar from the Securities and Exchange Commission of Zambia. A transcript is available below.

Transcript

Interviewer

My name is Leah Kusensela Simasiku, and I’m with the Securities and Exchange Commission, Zambia, and an alumna of the IFC-Milken Institute Capital Markets Program. Today, I’m delighted to be having a conversation with Vivian Nwakah. She is founder and CEO of Medsaf and a serial entrepreneur and strategist who has created and innovated around the delivery of healthcare pharmaceuticals. So happy to have you here, Vivian.

Vivian Nwakah

Thank you so much for inviting me to speak about what I do every day, all day, which is Medsaf and pharmaceuticals in Africa. I appreciate it.

Interviewer:

To kick off Vivian, could you share with us how Medsaf got started and why pharmaceuticals?

Vivian Nwakah:

I really just wanted to be part of a success story for Africa. And as part of the story, I’m taking a lot of the problems and issues here and creating solutions that can impact not only Nigeria or Africa, but also the world.

Once I’d just gotten here, I was quite aware of the inefficiencies and inequalities in the healthcare system. And I was taken aback by the state of healthcare in Nigeria. A friend of mine died from taking a fake malaria pill. The process of just trying to wrap my brain around that and knowing that he was quite young, but then also hearing the story, which is even just more tragic, of how he died… That identified many lapses in the healthcare system overall. It really made me extremely passionate about just trying to understand what the problem is.

“Everybody knows someone who has been impacted by fake or substandard medications. And I just got to a point where I said, this is not fair. We deserve better. Who’s doing something about it?”

So fast-forward three years, I had done quite a few things. I had started a distribution company in the U.S., thinking that I was just going to send medications to Nigeria so that there were real medications available. I ran into regulatory issues, started to understand how the laws actually impacted the problem. I talked to hospitals and pharmacies on the ground and just kept running into people. Everybody knows someone who has been impacted by fake or substandard medications. And I just got to a point where I said, this is not fair. We deserve better. Who’s doing something about it?

This was back in 2016, when no one was really talking about this issue or any solutions. And I realized that with the rise of the telecoms – the rise of Jumia and Konga and e-commerce, and all of the FinTech companies that started to build out of that – technology is getting to a place that’s creating a framework that can allow a specialized concept like pharmaceutical distribution to be built on the back of the already existing infrastructure.

And so I said, this is actually the right time in history to start trying to work on a transparent platform for pharmacies and suppliers, where we connect real and vetted medications directly to hospitals so that they can pass those medications down to their patients and increase the quality of medication. So that was the overall concept. And Medsaf has spun out of that. We are the Amazon of pharmaceuticals.

But you know, everything in Africa is way more complex than that. We’ve created this controlled ecosystem that is connecting suppliers of medications to hospitals and pharmacies, and we’re facilitating that trade. We give access, we give financing to hospitals and pharmacies. We vet the sources of the medications. We plug in logistics players and we use data analytics and technology to increase the efficiency of that movement of medications. It is really just about disrupting status quo using technology and guiding us to a more equitable future, as it pertains to healthcare.

Interviewer

That is very commendable, Vivian. Speaking about right now, we are in the midst of a pandemic. How has this affected your business and what challenges are you facing?

Vivian Nwakah

What we saw with COVID-19 is that the future arrived. The moment in history for people to be able to wrap their heads around the concept that digital solutions could work arrived because all of the traditional trade lines of medications were disrupted. Borders were closed, locked down. During lockdown, you couldn’t move unless you were an essential worker. You have now all these barriers to getting medications from the various sources that you typically get them from, and you need a place where you can go online in the safety of your house, and actually purchase everything that you need.

And so, we were already set up that way. We’ve been training hospitals and pharmacies to purchase and manage their medications with us online since 2017. So we were ready for that. We were actually able to grow and exceed expectations last year because we were ready. We supported the hospitals and pharmacies and suppliers that we work with and we adapted really quickly, because it’s already in our DNA to operate in the way that you need to operate during a global pandemic. I would say we did well. But overall, the pandemic definitely showed the real cracks, the huge craters in the healthcare system across the world.

Interviewer

There’s a lot of attention being placed on the potential of the health sector for trying to find tech solutions to the pandemic. What resources and support do you think entrepreneurs need in Nigeria, and in Africa at large, in order for them to be able to step up and to this potential?

Vivian Nwakah

We need to combine the forces of the best and the brightest and all the various kind of industries to really take a look at this, to support already existing entrepreneurs or new entrants into this space to really be able to succeed. For example, everyone started talking about tele-health, and the fact that you can go online and speak to a doctor. But think about all the infrastructure that needs to be set up to get the doctors to be available and to train the patients to be able to plug into the systems of the hospital for tracking and medical records. All of these types of things - the solutions for Africa are not going to be as easy and plug-and-play as they would be in a Western context. And so I think we need to understand how complex these problems are and appreciate the amount of money that actually needs to go into healthcare (tech specifically) to be able to make a difference.

I definitely think that, yes, everyone’s talking about healthcare, but they don’t necessarily know how to invest in healthcare companies right now. And I think that needs to really be sharpened. It really is about stakeholder engagement right now, and funds and support for entrepreneurs to really be able to make a difference, because these are very complicated problems.

Interviewer

Thank you for that, Vivian. As a pharmaceutical distributor who is very familiar with the local supply chains, what are your views and suggestions around the fair and equitable distribution of the COVID-19 vaccine?

Vivian Nwakah

It’s not going so well in the United States - if you look at the types of people who are getting access to the vaccines, the neighborhoods that they live in, versus where they’re not getting access to vaccines.

“If we’ve already seen inequality in vaccine distribution in the most developed countries, how is it going to work in the African context, or in a Nigerian context?”

If we’ve already seen inequality in vaccine distribution in the most developed countries, how is it going to work in the African context, or in a Nigerian context? This is another area that really is going to have to have a huge push from the government. Otherwise, vaccine distribution (in a Nigerian context at least) will be driven purely from profit. And this will end up dividing access between those who can actually have this vaccine and those who cannot.

Vaccine distribution is going to take some NGO and government engagement to really enforce efficiency and equity for it to be successful. Otherwise, it will just be a vaccine for the rich. We will see those that have been vaccinated be able to travel outside of Nigeria, make new opportunities for themselves, and we will see that those who haven’t been able to be vaccinated be left out. And so it’s not even just about not getting sick or not having COVID-19, there’s also going to see some division from a financial aspect as well. I think that this is a huge topic to really be discussing at the government level as far as distribution is concerned.

Interviewer

And with the continued effects of COVID-19, Vivian, what other health concerns do you think are affecting Nigerians and Africa at large?

Vivian Nwakah

Everything. During the lockdown, my heart broke so many times when we would just get these dramatic, drastic messages from people looking for medications that can only be prescribed from their doctor, but they were cut off from the doctor, they were cut off from the hospital. And so they didn’t really have access to these medications.

We need to ask, can they actually afford the medication that they need now? Can they continue that, maybe because they’ve lost their jobs or they get less money, or they are maybe taking care of more family members? Can they actually afford to take the medications that they’re supposed to take? Can they afford to see the doctors that they’re supposed to see?

This going to drive people into self-medicating, which is also a big healthcare risk. If I used to be able to afford a manufacturer’s medication, and now, because I need to save some money, I’m just looking for the cheapest medication that I find, that’s going to put people in situations where they’re less likely to care as much about quality over cost. And that is where the fake sub-medication suppliers win. Right? I have this medication. It’s already a 2,000% profit margin because it’s not real. I’m just going to price it at what you can afford. And so it’s really making this entire issue that we have been fighting for years a lot worse.

So it’s up to companies like mine to really help the various stakeholders connect in an efficient way, drive down costs, improve their operational efficiency so that they can still get their products across the country at prices that people can afford.

Interviewer

That’s true, so many problems that have come out of this pandemic. What are the things that would keep you awake as CEO of Medsaf? And how are you leveraging technology to try and make the public aware and educate them in this difficult time to address some of those challenging issues that you have brought up?

Vivian Nwakah

What keeps me up at night is definitely raising funds. We each have so much opportunity that we end up turning away opportunity, which is a good problem to have, but we could do more. We could help more. There are so many ways that we could do more, but we have to be constantly thinking about managing funds. And another thing, too, is that last year we financed 190 of our hospitals and pharmacies. We finance their medication purchases. We lent out over $780,000 of medication purchases and were able to collect the majority of that money back. But that’s a support that we’re giving to the industry that is not even just about medications, it’s also working capital. So there’s a ton of ways that we are supporting the healthcare industry in a Nigerian perspective – and of course we need support, too.

“My biggest hope for the ecosystem is that people start to really understand their responsibility, the social impact responsibility that should be aligned with every single startup and investor in an African context.”

And I also feel that the impact that any one player makes here, whether it’s an entrepreneur or whether it’s an investor or a regulator – the impact is outsized, just because of the amount of people that it affects. And so my biggest hope for the ecosystem is that people start to really understand their responsibility, the social impact responsibility that should be aligned with every single startup and investor in an African context, because it’s not just about, am I going to make the most money? But literally you’re changing the course of history in some of these countries.

Interviewer

I think this brings us to the end of our conversation today. The Milken Institute and I would like to thank you for those wonderful insights, and for making time to come and have this conversation with us. Please do take care of yourself and stay safe.

Vivian Nwakah

Thank you so much for the opportunity to keep pushing Medsaf’s mission, which is that quality medication is a fundamental human right.