A young pharmacist is driving a project to get Tanzania to make more of its own medicine.
Geofrey Yambayamba is young and ambitious. He is a recent pharmacy graduate of St John's University, located in Dodoma, Tanzania, and is the brains behind a project that could help to train more pharmacists and make medicine for his country.
Tanzania is battling with a shortage of pharmacisists: it has fewer than 0.05 pharmacists for 10 000 people, according to the World Health Organisation's (WHO) 2013 World Health Statistics report. Africa had 0.6 pharmacists for 10 000 people, and South Africa had 2.5 for 10 000.
The WHO estimates that Tanzania's health sector has less than half the required workforce. The reason, in part, is that Tanzania simply doesn't train enough pharmacists. The country currently has 500 pharmaceutical students, according to the Tanzanian Pharmaceutical Students' Association, and not all of them will graduate, or stay in Tanzania if they do.
According to the Pharmacy Council of Tanzania, in 2011 there were 915 pharmacists, 654 pharmacy technicians, and 391 pharmacy assistants in the country. For a population of nearly 48-million people, that's simply not enough.
But the country's universities are stretched thin. Yambayamba's alma mater only opened its doors in 2008 and was the third university in Tanzania to offer a bachelor's degree in pharmacy.
But the university does not yet have a laboratory on site, meaning that students have to travel to universities in Mwanza to the west or Dar es Salaam to the east to receive hands-on laboratory training.
The Mwanza and Dar es Salaam programmes are over-burdened, and without new facilities the students' association doesn't expect the number of pharmacists trained to rise.
This shortage comes as Tanzania is also looking for homegrown ways to expand access to medicine.
The country is largely donor dependent: the WHO estimates that nearly half of the ministry of health's budget comes from foreign funds.
Medicine manufacturing in Tanzania to date
Tanzania has attempted to make its own medicine, but no active pharmaceutical ingredients – the part of the medicine that actually makes it work – are made in the country, and relatively simple products such as antibiotics and cough and cold preparations are the focus of the local industry.
Tanzanian Pharmaceutical Industries, until recently one of Africa's flagship pharmaceutical projects and one of two Tanzanian companies producing antiretroviral drugs (ARVs), closed its doors last year after a fake batch of ARVs was attributed to the factory.
Before its closure, there were eight pharmaceutical manufacturing facilities in Tanzania, but the country still imported 70% of its medicine.
According to a former Tanzanian Pharmaceutical Industries pharmacist – who asked not to be named, as she's hoping to get her job back if the company reopens – there are now only three companies operating in the country.
A 2010 study by the Institute of Development Studies, the University of Dar es Salaam and the Institute for Social and Economic Research at Rhodes University shows that "the quality of medicine manufactured in Tanzania [is] often inadequate, with general manufacturing practices being lower than international standards."
The authors say that a lack of skilled staff is one hindrance to the local industry.
Yambayamba has just finished his term as president of the International Pharmaceutical Students' Federation and still acts as president of the Tanzanian Pharmaceutical Students Association. He is obsessed with all things pharmaceutical.
Other twentysomethings may post pictures of bars and beaches on Facebook, but he recently adorned his wall with shots of himself standing in front of the headquarters of big-name pharmaceutical companies such as Novartis and BASF during a summer trip to Europe.
Ambitious as he is, Yambayamba wants to use his degree not just to dispense medicine, but also to make it.
"In school, we learn how to give out medicine, but really nothing more than that," he says.
"We don't learn anything about research and development. My professor told me: 'You study, but you don't have a good foundation. You don't know how medicine is made.'
"And then I looked at where the medicine comes from, and it all comes from outside [Tanzania], and I thought: 'Why can't we do it here? I don't know what's wrong with my country. What can I do?'"
Incited, Yambayamba drafted a plan for a project with a price tag of 33.6-billion Tanzanian shillings (about R216-million) that would enable St John's University to train 100 students at any given time in good dispensing practice, pharmaceutical analytics, and research and development.
Because the university has extra land, St John's would host the new laboratory, but students could come from across Tanzania for training. Yambayamba hopes this will increase the number of pharmacists schooled countrywide.
"Since this project is a national programme, I believe other schools will be motivated to increase student enrolment," he says.
"It has been a big challenge for universities to start a pharmacy programme because they don't have enough funds to invest in scientific laboratories."
Idea in hand, Yambayamba went to Thailand in 2011 to attend an International Pharmaceutical Students Federation conference.
There, he met Krisana Kraisintu, a Thai pharmacist who became famous in the 1990s for defying multinational pharmaceutical companies by making a generic version of the patented ARV Zidovudine (AZT). At the time, she was the director of the Research and Development Institute at Thailand's Government Pharmaceutical Organisation.
The organisation's generic AZT cost only seven or eight Thai bahts (between about R2.23 and R2.56) a capsule, compared with the 40 bahts (R12.79) a capsule of the patented product.
Kraisintu is now the dean of the faculty of oriental medicine at Thailand's Rangsit University, and a devoted evangelist of local production. She spends a lot of her free time travelling around Africa and Asia, speaking about the need for countries to make their own medicine.
Excited by Yambayamba's idea, Kraisintu offered her knowledge, as well as technical assistance from Rangsit, but insisted that St John's makes medicine.
Local production a solution to stock-outs
For Kraisintu, local production is the only sustainable solution to Africa's chronic crisis, in which medicine is frequently out of stock, bills are unaffordably high and governments are dependent on donors.
"Other sources will finish one day, but if you build your own capacity, bit by bit, you'll build self-reliance. I believe local production is the long-term solution," she says.
When asked whether Tanzania's poor infrastructure could prove a hindrance, or whether the country's small market may prove unappetising, Kraisintu counters: "Even if it's only for 10 people, I will do it. Don't talk to me about economies of scale when it's people's lives. Business in the lives of people is dangerous."
Kraisintu says that St John's should start with relatively easy medicine production, making anti-malarial medicine and painkillers, before moving along to more complicated products such as ARVs.
Yambayamba says that, since Kraisintu has joined, the "project has gotten a lot of attention".
Earlier this year, Dr Hussein Ali Awinyi, Tanzania's minister of health and social welfare, publicly gave his support for the new laboratory. The vice-chancellor of St John's, Gabriel Mwakulo, has also thrown his weight behind the project.
But money remains a problem, with no one yet committing a cent to building or sustaining the lab and production site.
When the Mail & Guardian accompanied Kraisintu and Yambayamba to the potential site in July, what should have been a three-hour drive from Arusha to Dodoma took five because of poor roads.
Local production naysayers like to cite the World Bank's assertion that it costs less to ship a container from Tokyo to Mombasa in Kenya than it does to transport it from Mombasa to Kampala in Uganda, with costs increased because of poor infrastructure.
But Kraisintu insists that the government must foot the bill and take ownership of medicine production.
Yambayamba is set to meet with the prime minister later this year.
"Geofrey is small, but he is very big in intention," says Kraisintu.
"Don't talk to me about economies of scale when it comes to people's lives"