1. Bad intentions - good policies: Who wins? Case exercise and role play on drug counterfeiting in an LDC context World Bank Case Exercise – all names and characters are fictional, possible similarities with living persons or existing businesses would be unintentional

2. Republic of Buwani, Central Africa Ngorone Kuwabashi Seronego Posi MfanaAluna Kaluni River 255,000 sqm 18 million inhabitants GDP per capita USD 385

3. Key Facts A typical young African democracy History of postcolonial civil war But now stable for almost 10 years Low Income Country, 4% growth 35% urban/suburban population 18% wealthy, 42% very poor

4. Healthcare System Majority gets care in the private sector Public clinics/hospitals reach 15-20% Cash-and carry system Community insurance funds, covering 30% of Posi people Malaria health priority #1 HIV infection rate estimated at 7%

5. Pharmaceutical Supplies Public CMS – PMS system, yearly planning Typical weaknesses: Corruption, stock-outs. Leading to under-utilization of public providers. Lively private sector market for medicines, through pharmacies and street sellers. Prescription drugs can be purchased without prescription. Usually good quality of drugs in public sector No data on counterfeits, but anecdotal reports

6. Law and Regulation Food and Drug law, regulatory approval system, but illegal imports are possible Limited enforcement capacity, inspectors spend most of their time checking imported drugs at customs. No serious punishment for selling non- registered drugs or violating trademarks. No special legal provision dealing with counterfeit drugs

7. Donor Support for Malaria World Bank and Global Fund provide USD 15 million Education, prevention, treatment Switch of first line therapy from chloroquine to artemisinin combination (ACT)

8. The Counterfeiters Patrick Kafomo, rich businessman and owner of an “ informal ” trade empire History as arms dealer, now in “ branded ” textiles and luxury goods, cosmetics etc. Works through network of informal sellers Invests in good relationships with officials Owns a private security force Get an offer to build a counterfeit drug business, based on new treatment guidelines

9. The Government / MOH Knows that 80% of malaria treatment is in the private sector Has to introduce ACT treatment Gets financial support to cover increased procurement costs and implement information campaign Needs to secure the distribution chain to prevent counterfeits from entering

10. Questions to Answer – Bad Guys Are counterfeit drugs good business? What resources are needed to develop this business? What are strengths and weaknesses of the counterfeiter ’ s operation? How can the business risk be managed?

11. Questions to Answer – Good Guys Will counterfeits become reality? Who will be affected? What is your defense strategy? What are the obstacles you are facing and how do you address them? What resources do you need? How long will it take?

12. Logistics Breakout Groups 6-8 participants Breakout rooms 3d/4 th floor Use flipchart for discussion No presentations required Facilitated discussion based on your answers to the questions Please be back at 12:00 for box lunch Meeting resumes at 1:00 pm sharp