Key steps forward in disease control in Sub-Saharan Africa

The author, Shyama Ghosh, recently completed a detailed study of the disease landscape in Sub-Saharan Africa. Titled “Disease control in Sub-Saharan Africa: Are we doing enough?”, the following is an excerpt.


Amid the many challenges facing Sub-Saharan Africa (SSA), there are signs of progress, as well. The RB Group, in India, noting the growth potential of SSA’s pharmaceutical markets, has set up a $12 million pharmaceuticals production plant for drugs against HIV and tuberculosis across the wider southern African region. We are seeing the governments of South Africa and Nigeria using their procurement budgets to help local manufacturers. Currently only 30% to 35% of medicines sold in Nigeria are produced locally, and agreements with the federal government are underway to boost local drug production to 70%.


Much work needs to be done on the HIV and tuberculosis fronts. Key interventions for both HIV and tuberculosis in SSA should include universal HIV testing of patients with confirmed/suspected TB.1 High-quality sputum microscopy needs to be accessible for all individuals with suspected tuberculosis, and antiretroviral treatment provided according to national guidelines for all HIV-infected individuals, including tuberculosis patients. For all HIV-infected tuberculosis patients not taking antiretroviral drugs, co-trimoxazole prophylaxis should be available.


Following successful treatment of active tuberculosis, critical considerations include secondary preventive treatment for HIV-infected individuals and early initiation of antiretroviral treatment in newly diagnosed HIV-infected tuberculosis patients. Training and retention of healthcare workers in joint HIV and tuberculosis management is necessary, and funding must be expanded for integrated tuberculosis and HIV activities, as well as tuberculosis control programs to support HIV diagnosis and initiation of HIV care. Finally, more rapid diagnosis and effective treatment of both HIV-positive and HIV-negative patients with tuberculosis are critical.


In addition to the prolific conditions discussed in this report, yellow fever, cholera, meningitis, malnutrition, diarrhea, dysentery and tetanus are some of the other conditions that require careful intervention and care in the SSA region.


Drug registration


Consumers are concerned about the quality and price of market therapeutics, while local manufacturers struggle to compete with large-scale foreign producers, particularly from China and India. For about 30% of Africa’s population, drugs are unaffordable, while another 40% buy within the informal sector. Critical therapeutics are always needed and they represent big business. However, liberalizing import laws poses the danger of encountering counterfeits and illicit products, whereas strict regulations can drive up medicine costs.


Africa’s pharmaceutical sector requires faster market access for industry and cheaper prices to the consumer, which is why policymakers are speaking about an African Medicines Agency (AMA) which would bring together individual country regulators to improve the speed of getting drugs to market.2 The African Medicines Regulatory Harmonization (AMRH) program would be overseen by the African Union (AU) and managed by the New Economic Partnership for Africa’s Development out of South Africa. The AMRH four-year project resolution was taken at the first joint AU/World Health Organization Ministerial Conference held in Luanda, Angola, in 2014. AMA establishment documents were presented during the World Health Assembly in May and will be discussed further during the third biennial AMRH conference scheduled in Accra, Ghana, November 27-29, 2017, with formal adoption anticipated in 2018.


Rather than individual countries acting independently, the AMA would carry out quality assessments on new medicines and the food and drug agencies would then decide which drugs to allow. Such regulatory steps can potentially improve the speed of getting drugs to market, something that is critically important with anti-viral therapies and treatments for emerging infections such as Ebola.


Shift in big pharma tactics


Recent years have seen a shift in tactics among the big pharma companies operating in SSA, with GlaxoSmithKline, Novartis, Sanofi and others helping to develop health systems in addition to the sale of drugs. Aiming at business growth in the long run, more companies are choosing proper regulations and an efficient health system over following a haphazard system that could aid illicit traders. They have focused on developing social businesses as well, aiding in the movement towards efficient primary health care. Nurses are empowered to provide essential services not only with efficacious drugs, but also by offering foods, solar lanterns and other vital resources to communities that need them.


If you would like to find out more about “Disease control in Sub-Saharan Africa: Are we doing enough?” and about our presence in the African and global pharmaceutical landscape, please visit us at SAPHEX 2017, stand 71, Nov. 28-29 at the Sandton Convention Centre in Johannesburg, South Africa.

The full report, “Disease control in Sub-Saharan Africa,” also may be downloaded for free here.

For epidemiological data on diseases mentioned in the paper, learn more about the Incidence and Prevalence Database.


  1. “Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment,” Corbett, EL, Marston, B, Churchyard, GJ, et al. Lancet, Vol. 367, March 18, 2006, 926-937.
  2. “Africa’s Pharmaceutical Futures,” The Africa Report.