The country is facing a public health crisis characterized by too few affordable medicines and pharmacies.
In August 2024, President Dennis Nuguesso, Congo Brazzaville President, received the World Health Organization (WHO) Award for his commitment to promoting health in Africa and his country. His achievements included ten years of work to address the trade in counterfeit medicine across the Congo Brazzaville and the continent.
However, despite these efforts, illegal trade between fake and real drugs that are not permitted to be used at Congo-Brazzaville continues. In major cities such as Brazzaville and Pointe-Noire, medical supplies are primarily provided by the private sector (59%), with 28% of supply from illegal trade and the remaining 13% being provided by the public health system.
This indicates a public health crisis characterized by low availability of drugs in health facilities, few pharmacies and their unfair geographical distribution. Drugs provided by official sources are expensive – even generic drugs can be seven times more expensive than international reference prices.
In contrast, bana mangaga (refers to both sellers and practices of selling illegal drugs – “bana” means “manganga” meaning “drugs” meaning “children”) – provides extensive access to a variety of drugs, including antibiotics and painkillers. Street medicines are inexpensive, can be accessed with credit and can be used in small quantities if necessary.
Ray Mankele, pharmacist and president of access to drugs, says the continued use of illicit drug therapy is linked to limited public awareness of potential harm. They also lack knowledge about the availability of alternative generic drugs, which may be cheaper than street drugs. Pharmacists often fail to recommend generics in order to make more profit from selling branded medications.
Bana Manganga is mostly young people with no background in health sciences and acts as prescribers, dispensers and wholesalers. Their products appear on exposed makeshift stands where unsanitary conditions can damage quality. These drugs have escaped restrictions by health authorities and have seriously limited their efficacy and safety.
Other street vendors selling illegal medicines include veterans of the 1997 civil war who tried to earn cash when other options are limited. For them, selling street medicine is a form of economic reintegration, said a local journalist who requested anonymity.
Organized cross-border criminal supply chains and distribution networks drive the Banamanganga process. A local Congo police officer told Entertainment Organized Crime Project that much of the illegal trend comes from the Democratic Republic of the Congo (DRC).
Shalina Healthcare, the DRC branch of an Indian company known for its cheap drugs, produces DRC-approved drugs rather than Congo-Brazzaville. These drugs enter the country through illegal supply chains, are inappropriately stored and sold by unqualified vendors.
More expensive and unauthorized street medicines are also smuggled from India and China to Nigeria, and then trafficked to Brazzaville, Congo. The country serves as a distribution hub for illegal drugs trafficked in its neighbouring countries, particularly Cameroon, Angola and Gabon. In July 2024, approximately 80,000 counterfeit tablets were seized in Gabon along the way from Brazzaville, Congo.
Enacting interviews with journalists, pharmacists and police officers revealed the established distribution of these medicines. This trend is facilitated by LAX border control and corrupt officials who divert approved medicines to divert approved medicines from public purchasing centres or pharmacies for sale to Bana Manganga. Wholesalers smuggle the medicines into local towns, supply public hospitals and sell them directly to retailers on the streets.
This illegal trade undermines health outcomes. Global Health progress reported an estimated 170,000 children die from pneumonia each year due to poor quality and sham drugs in sub-Saharan Africa alone. Globally, illegal medicine trade generates substantial profits for criminal organizations, reportedly up to 20 times more expensive than heroin trafficking.
Fake drugs on the streets of Brazzaville Congo have also weakened the rule of law. In 2021, following police crackdowns against Banamanganga, pharmacies belonging to the head of the Pharmacists Association were looted. There were no arrests or prosecutions, and the pharmacist felt vulnerable.
In 2016, Congo-Brazzaville signed the Medicrime Convention to tackle drug crime. In 2017, Nguesso urged the global community to prioritize the fight against fake drugs and ensured that they would actively participate in the Rome initiative against human trafficking in substandard and counterfeited medical products.
In June 2023, Congo Brazzaville adopted the Central African Economic and Currency Community Regional Plan to address counterfeit medicines and illegal distribution networks. At the national level, the fight against trade is the focus of the country’s national health policy.
However, political intent has not led to implementation. Slight statistics on the size, type, and effectiveness of illicit drugs lead to skeptical of their risks and lack of urgency in addressing the issue.
The government has adopted WHO definitions for “substandard”, “unregistered” and “counterfeit products”, but it does not have the capacity to effectively control quality. This includes effective post-marketing management and conducting bioequivalence studies on all pharmaceuticals.
Proper monitoring of imported medicine manufacturing practices does not exist despite advocacy by Congolese pharmacists advocating for expanded regulations on imported drugs, particularly storage and handling conditions.
Despite signing the Lome Initiative, laws against the sale and possession of drugs other than official channels remain unenforced in Congo Brazzaville, allowing vendors to operate at minimal risk. Sporadic police raids do little to prevent Bana Manganga from returning and selling the products. Disagreements between stakeholders about how to define illegal drugs complicate legal frameworks and punitive measures aimed at blocking and punishing criminal acts related to trade.
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Congo made progress by establishing a central purchasing centre for essential drugs in 2015 and adopting pharmaceutical policy, but challenges remain.
You need more pharmacies to spread over a larger area. Access to affordable generics and harsh penalties for corruption along illegal distribution chains are essential. Without these procedures, efforts to oversee the import of quality drugs, train customs officials, inspect medical products, and impose criminal penalties for illegal transactions are unlikely to be successful.
A dedicated process is needed to reach a consensus on the operational definition of illicit health care, along with awareness campaigns highlighting the benefits of illicit drugs and the health risks associated with illicit drugs.
Raul Tomotayo, a senior researcher in Central Africa,
ENACT is funded by the European Union and is being implemented by the Security Institute in partnership with INTERPOL and in collaboration with Global Initiatives on Organized Crime across Borders.
(This article was first published by Premium Times Syndication Partner, ISS Today. I have permission to republish it).
