Selling drugs in developing countries entails more than simply striving for profits
by Felix Abt
Now and again, Western multi-nationals earn themselves a bad reputation in developing countries. They are regarded as being arrogant and too strongly geared towards single-mindedly maximising profits. In many cases, however, this reputation appears to stem from too narrow a business philosophy, which places the interests of the customer second to those of the seller. The author of this article is however of the opinion that Western companies can still be profitable if they focus on customer needs. Regarded in this way, it appears that even in the Third and Fourth Worlds, customer closeness is far from an empty catchword. (Ed.)
Of course, I could have made things a lot easier for myself if, like many of my colleagues in the industry, I had simply made short shrift of the countless letters from black African doctors, pharmacists, authorities and universities or just filed them away, or if I had given all the people queuing up to see me the cold shoulder. But unlike with other Whites, who were often regarded as arrogant, my unconventional "open door" attitude increasingly earned me a reputation among the locals as an "approachable White", the likeable Swiss "underdog", who worked for a - logically - equally likeable Swiss pharmaceuticals company.
A productive private initiative ....
Immediately after my arrival at my new place of work in French-speaking West-Africa, a group of young pharmacists and pharmaceutics students wanted to present to me a project, a monthly information bulletin for pharmacy customers and patients. Until now a publication of this kind had not existed here. It was to be published by the group of pharmacists and purchased by the pharmacies, who would then distribute copies to customers and patients free of charge. The group had already presented their project to other pharmaceuticals companies before my arrival, but without success - too high was the level of mistrust on the part of the white company representatives.
The private initiative of these young pharmacists fascinated me. While they started work on developing the concept for the new "Santé-Conseil" bulletin, I took on the roles of external consultant, marketing expert, teacher and challenger. They quickly learned that the bulletin had to be on the pharmacy counters by the first day of the month. Alliances were forged with the main drug wholesalers, who agreed to deliver the bulletin free of charge to subscribing pharmacies. A scientific editorial advisory board comprising pharmacists and doctors was set up, and the moral support of the Ministry of Health and the Association of Pharmacists was secured.
... bridges more than a gap in the market
Each month, the unassuming-looking information bulletin, "Santé-Conseil", explained, using simple language and illustrations, various problems relating to nutrition, hygiene and disease prevention, as well as the different diseases and their treatment. This last factor was also important because the vast majority of the African population are simply not able to afford a doctor or nurse, and if they fall ill take great risks by indiscriminately taking drugs or other products. We encouraged the general public to take an interest in "Santé-Conseil" by organising competitions, in which vouchers exchangeable at pharmacies could be won by correctly answering questions relating to the bulletin's contents. These competitions brought great crowds flocking to the pharmacies, with the result that all the bulletins were snapped up in no time at all.
The pharmacists were proud of the work of their young colleagues at "Santé-Conseil", for they were frequently criticised for failing to do anything for the public health, preferring instead to simply rake in lots of money. As supporters of the project from its humble beginnings, they rewarded our efforts by giving preference to our products when advising customers. And whenever particular drugs were recommended in the editorial section of "Santé-Conseil", the editors were only too willing to refer to products manufactured by our company. Thus everyone benefited from this project: patients, pharmacists, "Santé-Conseil" - and ourselves.
Preconceived concepts versus tailor-made marketing
Of course, as a company we could have fostered relations with our business partners and the outside world in the conventional manner - by saddling local business activities with concepts cooked up by head offices light years away and regurgitating material in the form of brochures and product information printed on European-style glossy paper. Or by flying in white medicine-men from abroad and arranging for them to lecture in 5-star hotels to black medical staff on the results of some clinical studies carried out on white patients far removed from the reality of African life, before moving over to the climax of the event, a slap-up dinner laid on by the pharmaceuticals firm. However, a number of my local colleagues and I had in mind "Africanising" our marketing activities; that is, we planned to develop a marketing concept that was specially tailored to local problems and needs.
Widespread impact
In African nations, where eight out of ten of the population are illiterate and where governments only have very limited funds available to teach people the absolute basics of how to prevent the more common infectious diseases, journalists - in particular those from the electronic media - play a key role. For this reason, at our instigation an association of journalists specialising in health care was founded, which we then also actively supported. The association was inaugurated by means of a training seminar held over a period of several days, which we prepared in collaboration with the journalists, doctors and the Ministry of Health. Physicians and recognised experts explained the main, most fatal infectious diseases and their causes, symptoms and methods of prevention in a manner which could also be easily understood by the layman.
Together with another pharmaceuticals firm and the World Bank, we bore the costs of this training seminar. The outcome was most impressive: the journalists reported extensively on what they had learned and repeatedly took up the various topics at a later date.
The cost of this venture was for us relatively modest, and certainly lower than the expense of producing a new brochure. However, the benefits were all too plain to see: an increased level of competence and awareness on the part of the journalists in their specialised field, and audiences, listeners and readers who were better informed about the various diseases and, in particular, their prevention. Moreover, it brought us goodwill, which manifested itself through our company's activities figuring more prominently and positively in the media and our products being mentioned more frequently than those of other event organisers. The motive here was simple: I'll rub your back and you rub mine.
Anti-Aids campaigns in need of revision
Although malaria continues to be a more common cause of death in West Africa than Aids, the latter constitutes a considerably higher risk for the public health, not to mention for the economic development of the fragile young West African countries. Depending on the country and region, the proportion of the population who are HIV-positive ranges between 10 and 20 percent, and the tendency is rising. Among members of the army and police force, it is even around 30 percent. The costly anti-Aids campaigns, financed by means of Western taxpayers' money and according to Western concepts, frequently founder as a result of the Africans' deeply-rooted promiscuity and aversion to using condoms. Ours was the first pharmaceuticals company to sponsor training seminars for military and police doctors, which aimed to enable them to correctly diagnose venereal diseases and to treat them rapidly and effectively.
The reason for our involvement in this area was very simple: according to the experts, a person suffering from venereal disease has an up to 50 times greater chance of becoming infected with the HIV virus than a normal, healthy person. Moreover, research carried out among practising doctors and nurses revealed that up to 80% of all diagnoses were incorrect and that in most cases ineffective drugs were being prescribed. The concept of our jointly drawn up contribution towards the battle against Aids was therefore quite straightforward: everyone treating venereal diseases should be properly trained to make an accurate diagnose based on the symptoms (laboratory tests were for the most part impossible due to the lack of facilities and the high costs on the part of the patient) and be familiar with the most effective methods of treatment.
Training as a marketing tool
As a result, the national Anti-Aids Committee developed training programmes geared towards army and civilian physicians, nurses, midwives and even pharmacist's assistants; since many patients avoided doctors for fear of being associated with the Aids virus, they frequently turned to pharmacy staff, who usually sold them the wrong or an ineffective medicament.
As marketing and communications specialists, we were able to contribute our expertise during the conception stage. We advised the organisers to develop training courses tailored to the needs of the various target groups and to draw up practical diagnosis and treatment documentation for seminar participants to refer to at their place of work. We also recommended they drum up widescale support in order to secure a massive mobilisation of seminar participants on the part of the doctors', nurses' and pharmacists' associations, as well as arrange for a significant media presence. Naturally the organisers were also able to count on our support during the implementation of these activities (printing costs, transport of seminar participants living in more remote areas, etc.). The doctors were pleased at and proud of the success of their campaign. The results of the "after" tests held at the end of the seminar were a huge improvement on the "before" tests taken at the beginning. The benefits for both the practitioners and their patients were clearly in evidence. And we profited too!
After all, the employment of funds by a private enterprise to promote behaviour of this kind, even if it is so beneficial to society, should bring with it an adequate amount of success. Quite apart from goodwill and friendly relations, the doctors also positioned those of our drugs which were regarded as being highly effective as reference products in the therapeutical standards. If specialists at the very top of their profession describe a product as being effective and expressly recommend it at seminars and in therapy documents, this also does much to promote its acceptance - not to mention its sales, as is exemplified by one of our antibiotics for treating gonorrhoea and chancroidial ulcers, which as a result recorded exceptionally high growth rates. All this showed that we were on the right track with our new marketing approach.
Customer need for professionalism
The areas of health and education in the impoverished French-speaking West African countries are in a deplorable state. Teaching materials at medical and pharmaceutical faculties are out-of-date, or totally lacking altogether. University hospitals, too, are not any better equipped to offer up-and-coming doctors and pharmacists a sensible education. Around 80 percent of general practitioners are nurses, of whom only a minority have followed a several-year course leading to a diploma. However, they receive no follow-up training once they have completed their course. We discovered a tremendous need on the part of doctors and nurses for further training. In this respect we saw possibilities for offering support in a targeted manner, such as by placing at their disposal scientific data bases, sponsoring interesting lecturers or secretarial services and advising on and supporting the effective organisation and implementation of relevant events. At the same time we assisted doctors' associations in drawing up modern, uniform standards of therapy.
No "second-class" medicine
In the meantime, word had got around that events organised with our help were guaranteed to be a success, which attracted other doctors' associations and paramedical organisations in their droves. For economic reasons we naturally had to be selective and could only become involved in areas where we had good products which had the potential of establishing themselves as first choice products. We helped found the African Society for Haematology and assisted with their first congress. We provided leading haematologists (specialists in diseases of the blood) with a constant supply of scientific publications and placed at their disposal sufficient quantities of medicaments for them to gain first-hand experience in their use. Later, the haematologists joined together with oncologists (cancer specialists) and hepatologists (liver specialists) to form a national working group for cytokines. This working group studied the latest generation of drugs and therapies, revised the valid therapeutical standards and concerned themselves with the official approval of the various drugs and their funding. At the same time, the group, equipped with statutes, organisation charts and action plans, was of course also familiarised with all our new products, which in turn meant that these products stood a good chance of being included in the revised therapeutical standards. Ours was the first company to offer these doctors an impeccable service of this kind, and as a result helped them up-date and extend their knowledge, something which was highly appreciated. And by so doing, we had also gained a clear edge over subsequent competitors.
In conjunction with specialists, such as gastroenterologists, hepatologists and biologists, we organised working groups for such topics as vaccinations, diagnoses and treatment in connection with the different forms of hepatitis, one of the most common diseases in this part of the world. Here our role comprised helping to obtain complete, up-to-date information, which always had to be objective - even if this was to the detriment of our products.
Confirmation of economic factors relating to health
The fact that we also supported pacesetters in other ways and in more unusual fields is illustrated by a study carried out by a pharmaceutical faculty lecturer in collaboration with the Association of Hospital Internists. We provided the lecturer with ideas relating to his chosen theme and supplied him with extensive literature. He was also able to study our drugs at length and examine their cost-benefit ratio, some results of which he wanted to include in his evaluation. The study supported the theory that, generally speaking, in comparison with expensive modern drugs, low-priced drugs require a longer period of treatment, call for additional drug treatments and complicate the condition. They require a higher number of medical staff, place a greater strain on the body and magnify the patient's shortfall in earnings. In short, it declared that the notion of "cheap drugs", which, according to the popular opinion held by Whites, should be used in preference to expensive ones when treating poor patients - which Africans just happen to be - should not be so rashly bandied about. For the first time, an African had made some important observations on economic factors relating to health, of which he was justifiably proud and which were enthusiastically supported by young hospital internists. The fact that the study was disputed by the white heads of a number of pharmaceuticals companies only served to add to the admiration and weight that it already enjoyed.
Because of - not in spite of - socially useful behaviour and genuine partnerships, we succeeded in optimising our operating results to an even greater extent than our competitors, who used up far more munition with their traditional, interchangeable marketing activities. The wealthy foreign company based in a poor developing country which is able to recognise those needs and shortcomings of its customers and business partners which are of key importance for their livelihood, and which, with a great deal of sensitivity, helps them to rectify such problems, while at the same time using its edge in expert knowledge and experience constructively and assisting with organisational and logistical matters, will be generously rewarded by customers and partners alike, and will succeed in asserting itself strongly against its competitors.