Waleed Shawky is altering the culture of medicine waste by creating the first system in Egypt for collecting, sorting, and distributing medicine that would otherwise be thrown away by individuals and pharmaceutical companies.
The New Idea
Waleed has created a community-based system to collect, sort, and distribute medicine to low-income families in Egypt using medicine wasted by affluent households, pharmacies, and pharmaceutical companies. Waleed’s organized, professional, and fluid system counters ineffective public health insurance policies, which do not cover the cost of medicine for its patients. Thus, he is addressing a pressing need by implementing the first organized, non-profit model addressing this issue, while planning for long-term public health policy reform. In a data-poor country, Waleed’s documentation at all steps of the process—with advanced pharmaceutical software—provides an essential wealth of missing knowledge that can be used as a solid resource for policy reform and regulatory changes in pharmaceutical companies and public health insurance.
Waleed has designed a system that reduces waste, while also improving quality, efficiency, and equity in its ingenious distribution of medicine among needy patients in Egypt. Over the last seven years, he has developed a model to effectively implement his idea of redistributing resources. Its interlinked series of processes add value at every stage. Waleed relies on a steady flow of specialized volunteers and a self-sufficient, zero-waste strategy with no exchange of money or dependence on charity or external support. However, he established purposeful partnerships with citizen organizations (COs) who have direct access and connections to needy communities in their areas, who can benefit from this service. In addition to COs, Waleed targets all relevant stakeholders which includes the sources of waste (i.e. households, pharmaceutical companies, and pharmacies) as well as pharmacy students, and needy households. He is currently working in Egypt with plans to spread to other Arab countries.
More than half of Egyptians do not have access to all the medications they need, including individuals and families with public health insurance, an estimated 48 to 55 percent of the population. These individuals have access to some drugs through public insurance pharmacies, however it is still difficult to access medications for serious illnesses such as cancer or other chronic diseases as there is no reduced price for medication.
Even worse, is the large number of Egyptian’s holding informal jobs with no health insurance. These working citizens do not qualify for public health insurance, making it almost impossible to be able to afford the medications they and their families need. Such individuals are able to go to public hospitals for consultations, but are unable to receive medications at a lower cost or be covered by any public health policy for medication. Further aggravating the situation is that the impoverished population is more susceptible to infectious diseases as a result of unhygienic living conditions and chronic diseases like diabetes and high blood pressure.
Despite this dire need by half of Egyptians to access medicine, there is a huge amount of wasted medicine, with no system to link supply with demand. According to an estimate by the Chairman of Pharmaceutical Cosmetics & Appliances Chamber, based on his observations of 458 industrial companies which are part of the Federation of Egyptian Industries, corporate waste reaches about 1 billion Egyptian Pounds worth of medicine per year. Further, there is additional waste from households and pharmacies that is undocumented. Government regulations mandate that pharmaceutical companies sell full packages to pharmacies in quantities usually far exceeding the actual need of the patient, and pharmacies are not allowed to sell individual strips of medicine. In cases where pharmacies go against this regulation they open the opportunity for counterfeit medicine to be added to boxes, replacing any missing strips which have been illegally sold individually to patients. Illegally selling individual strips makes it difficult to track the original medication and distinguish from counterfeit medicine. If selling smaller amounts was allowed, however, more people would be able to afford the medicine they need.
Pharmacies thus either waste medicine that is not sold before its expiration date or return it to the pharmaceutical company at a loss. The pharmaceutical companies destroy the returned medicine in addition to what they do not sell well before its expiration date. Due to the hazards of uncontrolled disposal, the waste becomes a cost for patients who buy the whole package as well as for the companies and pharmacies that share the loss of unsold medicine.
To create a system that fills the gap between the great need to access medicine and the huge amount of waste produced by various actors, Waleed implemented his idea by creating hubs to collect excess medicine, sending it through an intensive sorting process, filtering and then distributing it to those who need it through distribution channels. Waleed enters a community and identifies the relevant stakeholders, including pharmacy students to ensure the constant availability of specialized volunteers, COs that collect and distribute medicine, and those who donate excess stocks of medicine (i.e. pharmacies, pharmaceutical companies, and households). The combined efforts of each component with each stakeholder serving a specific purpose, creates a fully functioning system.
Waleed has secured the support of ten board members, six university students and four professionals, who are helping to establish the organization. To build his work, Waleed is working on two tracks: establishing university pharmacies and reforming health insurance policies. He is doing the latter by building coalitions with hospitals, companies, and the Ministry of Health. He has established quality-control hubs in Egypt’s two main universities, Cairo University and Ain Shams University, which receive the largest number of pharmaceutical students from throughout the country. These hubs are independently run by students and are deemed, El Kheir Educational Pharmacies, meaning the “educational pharmacies for doing good.” In these educational pharmacies, Waleed has created a process to ensure sustainable screening and filtering systems for all the medicine that comes through diverse branches in the collection phase. By so doing, he has succeeded in creating a mechanism to divide volunteers into efficient committees, monitor their performance and ensure the sustainability of human resources to carry out all the technical aspects, a system that is easily replicated to classes and students.
To achieve professional-level quality control, the harvested excess drugs are screened, and filtered by student volunteers from the Faculty of Pharmacy. Waleed trains them during their clinical university years, since their classroom education does not provide them with hands-on experience with medicine or patients. Since Waleed is a practicing pharmacist and a member of the Egyptian Pharmacist Syndicate, the Egyptian Drug Authority sends the volunteers a monthly report that includes a list of counterfeit medicine. Waleed provided the two Educational Pharmacies with software programs in which they track all the received medicine and document which medicines are donated to patients.
These two main hubs are at the core of the sorting and filtering process and act in tandem with other collection and distribution channels. In the distribution phase, the screened and sorted medicine is channeled to COs that deliver medications to needy households with a recent prescription. The COs collect the prescriptions and get the needed medicine from universities where it is documented. Waleed also contributes a large supply of medications to medical caravans operated by other health organizations. This is an important piece of Waleed’s work because the caravans are able to deliver medicine to people living in remote areas as well as urban areas. Waleed’s plan for scaling includes increasing the number of educational pharmacies in universities throughout the country. He is currently negotiating agreements to establish new hubs at the German University in Cairo and Misr International University.
In an agreement with one of Egypt’s major pharmaceutical companies, Pfizer, Waleed secured all excess stocks of medicine six months before their expiration date, so he can distribute it and people can use it while it is still valid. He is in negotiations with other companies to do the same, as it offers the company a good chance to serve the community they are trying to access. By serving their corporate social responsibility needs, the companies will have better access to diverse markets. To gain access to companies, Waleed partnered with the Cairo Chamber of Commerce. Likewise, to gain access to pharmacies and form relationships with pharmacists, Waleed formed connections with the Syndicate of Pharmacists, where he ran for office and attracted people to his initiative through his campaign.
To date, the El Kheir Educational Pharmacy includes 200+ student volunteers who perform all the necessary functions for Waleed’s operations. The infrastructure he built also provides the pharmaceutical students with on-the-job training that makes a significant difference in their ability to find jobs after graduation. The initiative has benefited 1,000+ patients per month.
Waleed’s work additionally saves the community, pharmacies, and pharmaceutical companies an estimated 360,000 EGP (US$50,340) annually by recycling the unused medicine. His work also illustrates benefits beyond cost savings, as pharmaceuticals benefit from giving their excess medicine to needy patients, they also strengthen their corporate social responsibility position in the community. Waleed is also providing young people from local communities with opportunities to volunteer. Waleed believes that capitalizing on the spirit of volunteerism and spreading a culture of giving back among Egyptian youth is one of his model’s assets.
Waleed plans to establish ten new educational pharmacies to expand his reach to other governorates (districts) in Egypt--he is currently in five. These pharmacies will provide the screened filtered medicine to COs that will deliver the donated usable medicine to the poor in their communities. Waleed is recruiting volunteer university students, while developing university-based hubs that acts as mediators between donors and recipients.
Waleed’s long-term plan to document accurate national data of wasted medicine will serve as a valuable tool to reform the overall ecosystem of medicine waste. This data will help Waleed present concrete figures to the Ministry of Health and pharmaceutical companies as he lobbies for policy change.
Waleed grew up as an active member of his community. As a student he was involved in journalism and enjoyed being aware of his country’s issues. Waleed attended the Faculty of Pharmacy, Cairo University, in which he was elected Student Union President during his senior year. Wanting to be more involved in the pharmaceutical sector, he joined the International Pharmaceutical Students’ Federation World Congress in which he served as an organizing committee member. By 2003, Waleed started a private pharmacy in Cairo. While interacting with his customers he realized how difficult it is for low-income families to afford medicine.
Not long after he had started his pharmacy, Waleed was conducting his Ramadan night prayers in a mosque, when he found a room packed with donated medicines. He learned that the mosque board stored significant amounts of medicine only because they did not know how to distribute it. This experience, coupled with a lecture about volunteerism and changemaking, inspired Waleed to do more. It inspired him to act. Waleed knew that he had the skills and the drive to address the drug industry problems in Egypt. In 2006 he launched his initiative.
Wanting to position himself in a way that would give his work exposure and provide him with access to a large network of pharmacists, Waleed ran for board candidacy for the independent Egyptian Pharmacists Syndicate (2011). This role has enabled him to spread his work. With its activities with students, medical caravans, drug companies, and COs, Waleed’s work is being replicated by other pharmacies and has received attention from other Arab nations. Waleed’s hope is that all Egyptian families and individuals will have access to affordable medicine.