In the fourth and final part of my series on Issues of Black Market Supply, compromised supply chains is probably my biggest concern in Cambodia, simply because there is no regulation on what is acceptable and what is not acceptable when it comes to storing medicine by establishments who are legally permitted to do so, let alone illegal establishments.
Illegal supply chains rarely meet the requirements for safe product storage. This is a major issue for consumable products such as food, cosmetics and pharmaceuticals.
Consider the black market supply of pharmaceutical products. Pharmaceutical products need to be kept in a very specific range for temperature and humidity. They must be kept free from contaminants, in a registered business that is subject to regular pest control, cleaning and anti-bacterial treatment. Stock and inventory control is essential. These locations must be regularly audited and inspected by knowledgable authorities.
Unfortunately, the conditions that pharmaceutical products are stored in illegal supply chains in Cambodia almost never meet these requirements. In our eight years of experience monitoring and controlling the presence of illegal medicine in Cambodia and further afield, we’ve regularly seen:
- Medicine sellers storing medicines in dusty, hot and humid conditions.
- Storage of medicines in private residences and not in registered medical facilities.
- Storage alongside livestock pens or in filthy, mouldy cupboards especially in provincial areas.
- Temperature ranges exceeding 40 degrees and/or 60% humidity and never temperature controlled.
- Abundant pests, including rats and cockroaches moving in and around medicine stocks.
Locations raided for holding and distributing illegal medicine have rarely been audited or inspected. These locations exist outside the standard necessary controls that exist to protect patients. Collectively, these storage conditions pose huge risks to pharmaceutical products and their consumers. Medicine is being contaminated, or is deteriorating far more rapidly than intended.
Unfortunately there are no minimum standards in Cambodia for the regulation of establishments used as medicine storage facilities, pharmacies, clinics or hospitals and any attempt to improve these standards will be difficult as current monitoring and enforcement of medical facilities and pharmacies is extremely weak and hampered by corruptive elements. Not only are the illegal supply chains storing medicine in sub-standard conditions, but legal facilities are also following suit.
In my mid there are 3 key pillars to improving the standards of medicine storage in Cambodia.
1). The pharmaceutical industry needs to start taking more ownership in monitoring the companies they request to sell their branded medicines in Cambodia. It is not acceptable to simply get a distribution company to distrubute medicine in Cambodia on the pharmaceutical companies behalf, and turn a blind eye to sub-standard storage of their medicine.
2) The Government needs to take immediate action to clamp down on illegal supply chains for pharmaceutical products and prosecute anyone who stores and sells medicine illegally. Furthermore, the Government needs to establish a Minimum Standards for the storage of medicine and immediately enforce regulations with any pharmacy, clinic or hospital that doesn’t comply. The days of people using the ground fl;oor of their house as a pharmacy must end. Unless urgent action is taken, medicine being sold to patients will run the risk of being tainted and patients safety will be compromised.
3) The public needs to be educated about the medicine industry and what the dangers are of purchasing medicine from sub standard and illegal establishments. A stop in patients buying from illegal and shonky entities who don’t comply with new strict Government regulations will cause a drop in sales and hopefully out them out of business.
There are no exceptions or excuses to improving the standards of storing medicine. There is no debate as to whether or not it is the right thing to do and certainly no room to juggle patient safety.