![]() Regional wholesalers may be primary or secondary wholesalers ( Fein, 2011). In some countries, including the United States, there are also large regional wholesalers ( Fein, 2012 White and Bothma, 2009). There are two kinds of drugs wholesalers: primary wholesalers who have written distribution contracts with manufacturers and buy directly from them, and secondary wholesalers who buy from other intermediaries. ![]() Around the world, drug wholesale is a common point of vulnerability to falsified and substandard medicines. The first step on this chain is the drug wholesale market. Managing the drug distribution system in developing countries means containing the costs of the last mile, moving medicines to patients quickly, and keeping records of all transactions between the manufacturer and the consumer. In developing countries, the last mile is exceptionally long, extending to sparsely populated villages far from a paved road and farther from a supply center ( USAID, 2011). Supply chain managers are always concerned with the last-mile problem: the disproportionately expensive and inefficient final leg on the distribution chain. The costs of drug distribution in India are two to three times greater than in the United States or the European Union, despite vastly lower labor costs ( Langer and Kelkar, 2008). In India, for example, nearly 70 percent of the population lives in rural areas, where the health posts may be few and lacking in staff, electricity, and supplies ( Langer and Kelkar, 2008). It is expensive to transport products over rough terrain with poor roads. Of course, donor demands alone do not drive the costs of supply chain management in developing countries. As Chapter 4 explained, this drug scarcity in turn creates a vacuum for poor-quality products to fill. Inefficient supply chain management directly drives up costs and causes drug stock-outs in low- and middle-income countries ( Yadav, 2010). Donors and developing-country governments favor this system, wherein the central store manager can neither hire people with business experience nor fire incompetent workers ( Yadav, 2010). In sub-Saharan Africa, a government-owned-and-operated central medical store manages the distribution of drugs, transporting goods around the country in a government-owned fleet. In OECD countries, private companies ship and transport almost all pharmaceuticals, but in developing countries, despite their vastly smaller tax base, the government does ( Yadav, 2010). ![]() Despite its many stops along the way, only at one of the final destinations (more.) A donated batch of Ringer's Lactate Infusions made its way to humanitarian aid workers in Darfur through a UN agency and other suppliers. Disorganized drug markets, both real and on the internet, undermine regulatory checks on medicines distribution.ĭrug Distribution in Humanitarian Emergencies. These solutions can improve drug safety as long as the supply chain does not disintegrate at the point closest to the patient. Drug tracking systems could also improve security by preventing products that leave the legitimate supply chain from returning to it. Better controls on the wholesale market could improve the security of the distribution chain. ![]() The drug wholesale system is a weak point where the licit and illicit supply chains mix. This chapter gives an overview of the drug distribution chain, explaining differences between the systems in developed and developing countries. Changes to the drug distribution system could improve drug quality around the world. Drugs change hands many times between the manufacturer and patient every transaction is an opportunity for falsified or substandard products to infiltrate the market. Packaging, repackaging, and sale can happen in many other countries. Medicines are made from ingredients sourced from different countries. The modern pharmaceutical supply chain is complex. ![]()
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