Module 7: Telephones and Communication

Sub-Saharan Africa has only minimal investment in infrastructure. (1) Only 29 % of roads are paved, 25 % of the population has access to electricity, and there are fewer than 3 landlines per 100 individuals.(2),(3) Internet access lies below 4.2 % for the African population. Nevertheless, one modern technology that has made significant inroads is the cell phone. In 1999, roughly 10 % of Africans had cell phone coverage, but by 2008, that number had reached 60 %, a figure which does not consider the rather common practice of sharing cell phones..(4) During that time, there has also been an evolution of cell phones from simple communication devices into service delivery platforms. Rapid, reliable communication in developing world countries has considerable uses: not only does it connect individuals with markets and acquaintances, but it can also give text message reminders about medication, or warn users about an outbreak of violence.(5) 

Cell phones can be used in a number of ways. First, they can reduce the cost and time it takes to evaluate food markets, which can also confer increased consumer power. This type of practice also benefits producers, as they can standardize their prices, which can increase the profits for the average farmer. Second, the cell phone industry can form jobs in both the formal and informal sector. Third, cell phones can increase the speed of communication within a social network and hence increase the coping capacity of a population. Cell phone applications can be used for online banking and voting, and could also be used for patient monitoring.(6) According to Krisda Chaiyachati, the use of cell phones could one day replace directly observed therapy (DOT).(7) Along with text messaging, however, many of these applications require literacy, a problem currently being tackled through adult literacy programs. A final benefit of cell phone use is that there is a correlation between telecommunications penetration and economic growth, likely resulting from all of the aforementioned benefits of mobile communication. When complemented with advances in infrastructure, mobile communication can strongly aid development.(8)

A Case Study: Sproxil

Every year, over 200 billion dollars worth of counterfeit drugs are put into the marketplace.(9) In some areas of the developing world, fake drugs can make up more than 50 % of the total drug market.(10) These fake medicines erode patient trust and lead to worse health outcomes, either because their content is dangerous or because they lack the active ingredient. According to the International Policy Network, counterfeit drugs are responsible for 700,000 deaths annually from tuberculosis and malaria alone.(11)

The World Health Organization acknowledges that one main reason why it is difficult to track the counterfeit medicine market is because it is difficult to trace its manufacturing and distribution channels.(12) Another issue is that repackaging and relabeling of drugs is increasingly used to conceal the country of origin, making it difficult to distinguish real from fake medicines.(13) Both of these issues are addressed by a cell phone application developed by Sproxil. The Sproxil application allows users to verify the authenticity of products by text messaging an item-unique code, and users receive an immediate response about whether or not the product is genuine. These codes can be verified at each step of the supply chain, from distributor to wholesaler to retailer to consumer.  

The technology that Sproxil has chosen works to ensure that it is as counterfeit-proof as possible. Codes are concealed using scratch-off technology, which has been proven in the mobile operator market to be highly reliable.(14) Furthermore, the system of using unique item codes is more reliable than holograms and less complicated than chemical and physical tests.(15) Sproxil is also designed to be culturally-sensitive to illiteracy. Rather than using complicated sentences in their text messaging system, Sproxil sends a checkmark if the product is genuine and a cross if it is not. Sproxil labeling is now present on 800,000 items in Nigeria.(16)

Other Measures to Combat Drug Counterfeiting

Counterfeiting is a lucrative business, and many countries have not yet introduced laws banning counterfeiting, which allows the unbridled growth of the industry.(17) There have also been recent efforts at the international level to combat the counterfeiting of drugs. On June 24, 2010, national customs chiefs from the 176 countries of the World Customs Organization will sign an international agreement to ban the production and marketing of fake drugs.(18) Justice Ministers on the Council of Europe are also planning to ratify a convention to combat counterfeit drugs in the autumn of 2010.(19) Enforcing these measures with heavy penalties will help to deter counterfeiters.

Counterfeit drugs can be a problem for developed countries as well. Countries such as India produce drugs that are sold worldwide, meaning that a lack of regulation and control can lead to dangers in the developed world.(20) Consequently, developed nations have a vested interest in eliminating counterfeiters from the pharmaceutical industry.

Since the purchase of medications takes up a significant fraction of patient income, many seek to save money by purchasing the cheaper drugs at non-regulated outlets.(21) Unfortunately, these drugs are often counterfeit. Increased regulation would help reduce this problem. Additionally, stock-outs can drive desperate patients to these non-regulated markets.(22) Problems and solutions related to stock-outs are addressed in a previous module.

Overall, although technologies such as Sproxil are clearly useful, it is also important for governments to introduce and enforce legislation to eliminate the counterfeiting industry.

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(1) Aker, J.C. and Mbiti, I.M. “Mobile Phones and Economic Development in Africa.” CGD Working Paper 211. Center for Global Development. 2010. Washington, DC.

(2) International Telecommunication Union. “Information Society Statistical Profiles 2009 Africa.” International Telecommunications Union. 2009. Geneva, Switzerland.

(3) World Bank. “World Development Indicators.” World Bank Online. 2009a. Washington, D.C. Accessed on June 4, 2010.

(4) Aker, J.C., 2010.

(5) Ibid.

(6) Ibid.

(7) Chaiyachati, K. “Connecting MDR Patients and Providers: Employing a Cellphone-Based Strategy to Improve Patient Care in Rural South Africa.” Unite For Sight Global Health and Innovation Conference. 2010. New Haven, CT, Yale University. 

(8) Aker, J.C., 2010.

(9) Irish, J. “Customs Group to Fight $200 Bln Bogus Drug Industry.” 10 Jun 2010. Reuters.

(10) Harris, J., Stevens, P. and Morris, J. “Keeping it Real: Combating the Spread of Fake Drugs in Poor Countries.” International Policy Network. 2009.

(11) Ibid.

(12) World Health Organization. “Medicines: Counterfeit Medicines.” Jan 2010. World Health Organization.

(13) Ibid.

(14) Sproxil. “Mobile Product Authenication.” 2010. Sproxil. Accessed June 22, 2010.

(15) Sproxil. “Technology Solutions.” 2010. Sproxil. Accessed June 22, 2010.

(16) Sproxil. “World-Class Band Protection For Emerging Markets.” 2010. Sproxil. Accessed June 22, 2010.

(17) World Health Organization. “Medicines: Counterfeit Medicines.” Jan 2010. World Health Organization.

(18) Irish, J. “Customs Group to Fight $200 Bln Bogus Drug Industry.” 10 Jun 2010. Reuters.

(19) Ibid.

(20) Harris, J., Stevens, P. and Morris, J. “Keeping it Real: Combating the Spread of Fake Drugs in Poor Countries.” International Policy Network. 2009.

(21) World Health Organization. “Medicines: Counterfeit Medicines.” Jan 2010. World Health Organization.

(22) Ibid.