No, not the illegal narcotics for which Afghanistan is sadly infamous. The subject of this blog is private sector healthcare, and in particular the determination of one man, with the support of the Afghanistan Business Innovation Fund (ABIF) to provide his compatriots with access to reliable, high quality medicines that they can trust.
ABIF is a 'challenge fund' financed by DFID. ABIF incentivises Afghan small and medium-sized enterprises (SMEs) to invest by providing grants alongside SMEs' own investments. Applicants compete for a grant by submitting business plans demonstrating how they will introduce innovation into markets for goods or services, in a way which will benefit poor people. Out of the 500 applications received, ABIF has provided grants to 24 Afghan businesses. One of those is Al-Hadi ‘786’ Pharmacies, run by Zabih.
Small businesses in Afghanistan face a battery of constraints. These include inadequate infrastructure (power, water and transport), a poor security environment and a legal and regulatory environment which although improving, still requires determination to navigate. And 30 plus years of conflict has left a critical element of the business environment – trust – at a low ebb. But at the cross-roads of Asia, Afghans, Zabih included, are natural entrepreneurs and traders. In a country where medicines are often counterfeit and of low quality, Zabih was determined to set up a pharmacy selling high quality products that consumers could trust – and not just 1 pharmacy, but a chain.
Regulatory constraints abounded. How to establish a branded chain when there is a regulation preventing 2 separate pharmacies having the same name? Zabih gives all his branches the ‘786’ name, with ‘Unit 1’, ‘Unit 2’ etc. added on. How to open new pharmacies when there was a regulation preventing a pharmacy from opening up within 200m of another? Zabih is lobbying the Ministry of Public Health to repeal the regulation, and in the meantime accompanies ministry officials when they make their assessments – in 1 case, his insistence on measuring with a tape rather than footsteps made all the difference! How to have a chain of shops when there is a regulation saying that each person can only register 1? Zabih registers shops in the names of his family members. (Although as his ambitions for the size of his pharmacy chain are bigger than his ambitions for the size of his family, he’s working on getting this regulation changed, too.)
Applying the same level of commitment to service and quality as to wrestling with the regulatory environment, Zabih now has 5 pharmacies, with more planned. 786 has a growing number of satisfied customers. This is good for Zabih, and good for his customers. But this is not the most exciting thing. ABIF seeks to stimulate innovation in markets – and that's exactly what's happening. 786 branches stay open longer; some other pharmacies are now also doing so. Zabih sees competitors coming into his shops and taking photographs, to copy what he is doing. Competition in the private sector is improving outcomes for customers – benefiting everyone involved.
Afghanistan has some of the poorest health outcomes in the world. The WHO has estimated that in 2010 over 60,000 children died of diarrhoeal diseases in Afghanistan, and that around 6,400 Afghan women died in childbirth – both among the highest rates in the world. (By comparison, the UN estimated that in 2012 approximately 2,700 civilians were killed as a result of conflict.) This creates a huge unmet demand for medical services in Afghanistan, and Afghans who can afford to do so typically go abroad for treatment. In an environment where the public sector can often struggle to meet its citizens' needs for basic public services, the private sector needs to play its part.
And so ABIF supports 786, and a number of other private sector healthcare projects. The Nawshakh Healthcare Centre will set up a micro health insurance scheme to provide a mechanism for poor people to access high quality medical services at a reasonable cost. Salamat Health Training and Research Institute will deliver state of the art, evidence-based training to health personnel that are working in different parts of the health system in Afghanistan including doctors, midwives, and nurses. Mili Medical Services has established a histopathology laboratory that can analyse samples of tissue that may be cancerous – 1 of the first of its kind in Afghanistan. It is also aiming to implement a system to connect rural patients with a local clinic that in turn has a connection to a global network of telemedicine, research and medical consultation.
Afghanistan suffers from conflict, corruption and some appalling development indicators, but in certain key areas things are improving. The number of girls in school has increased from virtually 0 under the Taliban to more than 2 million. Life expectancy has increased significantly in recent years. And the figure of 6,400 women a year dying in childbirth is woeful – but the rate is half what it was 10 years previously.
Development takes decades, and there is much further to go. But along the way let's not forget to mark the gains that have been made.