In 2020, Madagascar had a population of over 28 million people but only 317 community pharmacies. Given this extreme scarcity of pharmacies, much of the Malagasy population, especially in remote areas, have no other choice than to rely on drug shops for access to basic medicines.
The United States Agency for International Development (USAID) has been funding the Improving Market Partnerships and Access to Commodities Together (IMPACT) Program in Madagascar since 2018. IMPACT aims to improve the capacity of the Malagasy health system to ensure that quality pharmaceuticals and health commodities are available and accessible to all Malagasy people on a sustainable basis. The program is supporting the Ministry of Public Health (MOPH) and its Direction de la Pharmacie, des Laboratoires et de la Médecine Traditionnelle (DPLMT) in strengthening the capacity of drug shops, which are crucial to providing access to medicine in rural areas.
What is a Drug Shop?In Madagascar, drug shops are small stores operated by licensed owners who have at least a high school diploma and have completed a short internship at a pharmacy. These shops are authorized to sell a limited list of medicines and are considered a sort of stopgap solution to allow access to health commodities in areas not yet served by a formal pharmacy.
With support from IMPACT, DPLMT conducted a census of drug shops operating throughout the country and identified over 1,300 licensed drug shops (many more drug shops operate illicitly, without a valid license). However, even licensed drug shops do not always follow MOPH regulations regarding authorized medicines, required documentation, and good practices for inventory and financial management. In order to address these weaknesses and improve the quality of the health services provided by drug shops, in 2023 MOPH decided to establish a new training program which is mandatory for all licensed drug shops in Madagascar. The training curriculum was developed with the financial and technical support of the IMPACT project and includes five modules: foundations of public health and the regulatory framework for drug shops, services which drug shops can offer, basic pharmacology, inventory and financial management, and the use of an electronic management system.
The training courses will be delivered in the capital, Antananarivo, by the Institut National de Santé Publique et Communautaire (INSPC). To ensure that the program is financially sustainable, INSPC and MOPH estimate that there will be a training fee of MGA 600,000 (about $130) per drug shop. However, regional drug shop associations reported that their members were very concerned that they would not be able to attend the mandatory training due to this charge, in addition to travel expenses (transportation, lodging, and meals during the training). Faced with this challenge, DPLMT requested IMPACT’s support to find a way to finance the cost of drug shop training.
The IMPACT team began searching for potential sources of funding to cover all or part of the drug shop training expenses, and it found the Fonds Malagasy de Formation Professionnelle (Malagasy Professional Training Fund or FMFP). FMFP is an association created in 2019 whose purpose is to finance the professional training of private Malagasy companies. The Fund collects mandatory contributions from private companies for employee training and is also supported by international donors (such as the Agence Française de Développement and the European Union) to finance training costs for startups and associations through its equity fund. Due to its relatively recent creation, the FMFP and its benefits are not well known yet to the majority of Malagasy companies, while the funds made available to it are substantial and currently under-utilized.
IMPACT contacted FMFP and organized several presentations and working sessions, with the Fund and DPLMT and INSPC. After several working meetings, a partnership agreement was negotiated between FMFP, DPLMT, and IMPACT to establish a mechanism for FMFP to provide financing to licensed drug shops, through their regional associations, to allow them to attend the DPLMT’s mandatory training. The three parties signed the partnership agreement in a ceremony on June 30, 2023.
Through this partnership, IMPACT has demonstrated to the MOPH the possibility and importance of obtaining funding from sources other than the usual donors. This exercise will not only build the capacity of drug shops and help improve access to health supplies for the Malagasy people, but by teaching government ministries to think outside the donor “box,” the experience will help Madagascar create more sustainable development programs in the future.