Micro and small business sector is being left behind

Sufficient time has elapsed, we believe, for the new government to provide a clear policy picture in relation to the level of support that the local small business community can anticipate from it in terms of initiatives that can help to strengthen the sector if only on account of the substantial job-creation and poverty alleviation weight that it carries.

One makes this point mindful that the advent of the Covid-19 pandemic has impacted on the small business sector in such a manner as to force the closure of many of the various micro and small enterprises in areas like agriculture, agro processing and vending. These closures have arisen both out of reduced demand for some of the goods and services that they provide as well as pandemic-related strictures that either restrict or prohibit them altogether from plying their trade.

The fact of the matter is (and we have said so before) that outside the very limited initiative that saw a relatively small number of small businesses affiliated to the Small Business Bureau (SBB) receive a modest level of financial support from the Bureau (whether what they received would have been able to ensure the survival of some of their enterprises over the past several months is probably questionable) no really meaningful provision has been put in place to help see small businesses in the agriculture, agro-processing and vending trades through this period. So, the sad reality is that some of these businesses have either folded completely or have diminished appreciably. We may not have the numbers but we are aware of the fact that these circumstances have resulted in job losses (which, in the longer term may well be permanent losses in many instances) and consequential loss of important personal and family incomes. One need hardly spell out the knock-on consequences of such situations.

The reality of the situation, of course, is that there was nothing that anyone could have done to forestall the Covid-19 pandemic and the consequences that derived therefrom even though, bearing in mind what we knew at the outset would have been some of the likely consequences for small businesses, there appeared to be, from the outset, no inclination to go beyond what was being offered to a limited number of small businesses through the vehicle of the Small Business Bureau.

One must of course point out that much greater numbers of small businesses than those registered under the Bureau exist in the various sectors, including significant numbers in our rural and hinterland regions and, moreover, that these provide important services to their respective communities. Accordingly, in circumstances such as those that face us at this time, remedial measures must also take account of them.

In the instances of significant numbers of small businesses in areas such as small farming, agro, craft production and vending, the nature of the Covid-19 crisis has meant that serious restrictions have severely retarded their ability to ply their respective trades. These restrictions have derived from both a mindfulness on the part of the business owners to the dangers of exposure as well as the requirement of compliance with official strictures that have to do with the spreading of the virus. Contextually, it should be noted that public gatherings that manifest themselves at Street Fairs and Farmers’ Markets (which help to boost patronage for most categories of small businesses) have been virtually set aside in the face of the pandemic.

We raise again not just the absence of any significant state-driven initiative to respond to these particular types of challenges that have impacted small businesses, but also what we believe has been the pointed and, we believe, unacceptable indifference of our Business Support Organizations (BSO’s) to the challenges facing the ‘lesser’ business enterprises in the country. Sometimes one gets the impression that entities like the Private Sector Commission (PSC) exist solely for the convenience of a cloistered circle of entrepreneurial enterprises and that those who are not part of that elite group must simply fight their own corner. Specifically, we have commented on what sometimes appears to be the single-minded preoccupation of the PSC with matters pertaining to the Local Content considerations that inhere in the oil and gas industry to the exclusion of all else; and while we are in no way indifferent to the benefits that can accrue to the economy as a whole from maximizing the opportunities that can derive from Local Content, we do not believe that this preoccupation should be allowed to engender a self-centred posture that leaves a legitimate part of the business community behind.

There are options to those that appear to obtain at this time and it is government and our BSO’s that must lead the way. Pursuit of those options must begin with an overall recognition of the fact that such provisions as exist for small business support locally are, for the most part, insufficient to do much more than ensure the persistence of their subsistence status and that if they are to grow, to become generators of growth, raise employment levels and do their bit for poverty alleviation, those contributions will have a knock-on effect on our state of being as a country. That, in our view, is not what obtains at this time.

Here we believe that government and the BSO’S must share the responsibility for affording small businesses a genuine seat at the decision-making table. We cannot expect to be excused empty trumpeting about the role that micro and small businesses have to play in the development of the country if we do not do more to properly position them to succeed. This is the juncture at which government and the mainstream private sector Business Support Organizations have to act.

Recent incidents suggest that Guyana has had to deal with incidents of both ‘importation’ of expired drugs and their use of such drugs in the public health system. Reportedly, the importation of expired drugs is linked to corrupt practices involving handlers of drugs-importation at the level of the state and businessmen seeking to maximise their earnings. The ‘importation’ of expired drugs and their infusion into the national public health system is also a function of monitoring-related weaknesses in the system, not least at the level of the Government Analyst Food & Drugs Department (GA&FDD). One of the GA&FDD’s weaknesses is linked to its human resource limitations while another is believed to be the overriding of the agency’s authority by state functionaries.

While this World Health Organization (WHO) article was written in 2016, its contents address some of the challenges associated with the Guyana situation not only in terms of the impact on the national health delivery system but also in terms of the dangers posed by the misapplication of procedures in the disposal of the considerable quantities of these expired drugs which are frequently never used by the receiving countries.

It has been edited for length without compromising its content.

Introduction

In many low-income countries governments’ health budgets are insufficient to finance adequate access to pharmaceuticals. Accordingly, many health systems rely, in large measure, on external drug donations from high-income countries and development agencies.

Donated pharmaceuticals often mismatch those needed. International guidelines require that drug donations be responsive to recipient countries’ needs and that the drugs involved have a shelflife of at least one year on arrival. However, drugs that are already past their expiry dates have often been dumped in poor countries while some donations are large and unwanted. Stockpiles of expired pharmaceuticals may also build up as a result of poor forecasts of future demand.

In most low- and middle-income countries, the supply of pharmaceuticals is centralised and one state agency is entrusted with the procurement, storage, and distribution of pharmaceuticals. The network of public health facilities in any given country is often expansive and complex so that it is impossible for a single agency to respond effectively to the unique demands of each client. Dysfunction in the management of a pharmaceutical supply chain can promote the accumulation of large quantities of expired pharmaceuticals in central stores and health facilities. In the absence of the timely and safe disposal of expired pharmaceuticals, these may either be dumped indiscriminately, creating the risk of environmental pollution, or else, repackaged for the counterfeit market.

Pharmaceutical pollution

The control of pharmaceutical pollution of the environment in low- and middle-income countries needs to be based not only on the safe disposal of expired drugs but also on the optimisation of pharmaceutical use before expiry. New pharmaceutical expiries might be curtailed by: (i) strengthening the management of pharmaceutical supply chains in the public sector; (ii) reducing the workload at central medical stores, through liberalisation and reimbursement schemes; (iii) improving the regulation of drug donation; and (iv)investigating the salvage of drugs that are officially expired but still usefully active, through re-analysis and possible shelf-life extension. There should be better supervision of stockpiles of expired pharmaceuticals and the disposal of such stockpiles needs to be improved and better regulated. The enforcement of any existing national and international regulations on the safe disposal of pharmaceuticals e.g. by incineration at so-called ultra-high temperatures - needs to be strengthened. Every country needs to have such regulations.

Management systems

Robust management systems for the supply of pharmaceuticals, in which reorder quantities are informed by reliable consumption data and demand forecasts, are essential in minimising the amounts of pharmaceuticals that remain unused when they reach their expiry dates. In many low-income countries, it may be wise to invest in both robust information systems for logistics management, to track consumption, and the development of skilled human resources capable of optimising forecasts of future demand. The use of computerised inventory management can greatly enhance data retrieval and analysis.

Central stores

To enhance the performance of publicly funded pharmaceutical supply, poor countries need to transfer some of the duties to the staff at community pharmacies. At peripheral health facilities where the capacity to track consumption and forecast demand is often inadequate, the delegation of prescription services to community pharmacies – wherever available – could again help to reduce the amounts of pharmaceuticals that remain unused when they reach their expiry dates.

Drug donations

To suppress the unregulated export – from high-income countries to lowerincome countries – of pharmaceuticals coming towards the end of their shelflives and other nonconforming medications, countries need to strengthen the enforcement of national policies and WHO guidelines on drug donations. According to WHO, any low- or middleincome country considering the receipt of a proposed drug donation should ensure that: (i) only solicited donations are allowed entry; (ii) any donated drug is approved for use in the recipient country and congruent with the relevant national policies and regulations; (iii) donations are in accordance with a plan mutually agreed upon by both the recipient and the donor; (iv) the donation is on the essential medicines list of the recipient country; and (v) the donation meets the quality standards of the donor and the recipient country. Ideally, the presentation of any donated medicine should match that already used in the recipient country, the labelling should be in a language that is widely understood in the recipient country and any donations of recycled medicines should be denied entry. Many low- and middle-income countries have designed their own policies, on the receipt of drug donations, which conform to WHO guidelines.

Pharmaceutical salvage

Manufacturers generally assign pharmaceuticals shelf-lives of one to five years. Some pharmaceuticals are held in reserve for use in an emergency situation. This can result in large stockpiles of expired pharmaceuticals. In poor countries, it should be possible to extend the useful lives of medications that pass tests for efficacy and safety. However, such shelf-life extension or drug salvage is only feasible where there is sufficient capacity for pharmaceutical analysis.

Disposal

If unsafe disposal and leaching of pharmaceuticals into soil and water bodies are to be avoided, many poor countries will have to strengthen the enforcement of national policies and WHO guidelines on pharmaceutical disposal. Within the WHO guidelines, it is recommended that: (i) the user unit should obtain approval for drug disposal from the appropriate authority, such as the national medicines regulatory agency; (ii) personnel at the disposal site should wear protective gear; (iii) expired pharmaceuticals are sorted into their different categories to ensure the appropriate disposal method is used for each category; and (iv) appropriate security is ensured during the disposal of controlled pharmaceuticals.

Accountability

A potentially effective tool to prevent the misuse and improper disposal of expired pharmaceuticals is the enforcement of routine accountability for pharmaceuticals. For optimal effectiveness, lowand middle-income countries should make user accountability for expired pharmaceuticals part of the routine accountability regimes for their health sectors.

As expired pharmaceuticals pose threats to both health systems and environments, low- and middle-income countries need to suppress the accumulation of such pharmaceuticals and their slippage into the environment or counterfeit drug markets. Critically, such countries need to strengthen the management of their pharmaceutical supply chains and the associated accountability and regulatory mechanisms.