Collusion between certain pharmacists and doctors in Iraq makes medicine prohibitively expensive for many low-income people in Iraq. The Pharx app was designed to change that.
The civil war in Iraq wrought huge devastation not only upon people's lives, but upon the physical infrastructure of the country – including healthcare facilities and hospitals. Many were completely destroyed, changing the way medical treatment is provided in post-war Iraq. Hospitals have been replaced by smaller private medical centres, comprising normally 10-15 clinics in one building with a pharmacy on the ground floor.
Usually the pharmacy owns or rents the building and sub-lets the clinic spaces for free or at a very low price to doctors in exchange for patient traffic. These pharmacies, which are usually tied to commercial drugs reps, often work out informal arrangements with the doctors where they direct patients exclusively to their pharmacy by, among other methods, prescribing certain drug brands or even inventing codes so that no other pharmacies can understand their prescriptions. The doctors are usually given commissions or other benefits in return. This allows the pharmacies to charge much higher prices. Even when they do not engage in such practices there are no price controls on medicines, so prices can vary wildly from one pharmacy to another. This is a big problem for Iraq's poor, many of whom live on around only 15 dollars a day.
In response to this problem, social entrepreneurs Ameen Hadeed and Ammar Alwazzan created the Pharx app and launched it in March 2020. The app is designed to break the stranglehold of these pharmacy/medical-centre arrangements by providing information to its users about what the price of drugs should be and where to access them most cheaply. The app is Mosul-based, although it has potential to grow into other areas of Iraq as the same problems exist throughout the country. They developed the prototype with the help of Oxfam-led Iraq Response Innovation Lab funding, and during the pilot test found that there was great enthusiasm from local independent pharmacies – 173 of which signed up.
Setting up an app in the midst of an internet shutdown
However there has been no shortage of obstacles along the way. Starting an app in a country where many people are not digitally literate is not easy. Most people's understanding of the internet is limited to “Facebook and Instagram - if even this much. There is no such thing as PayPal or electronic payment in Iraq. Even the government still uses pen and paper for everything it does,” explains Ameen. Beyond this, economically-marginalised people – the app's target audience – usually cannot afford internet access. The internet infrastructure is so bad that even those that can afford it are often not able to access it (almost on cue Ameen's internet cut out in the middle of our Skype interview).
Then they ran up against Iraq's terrible legislative environment and stifling bureaucracy. To Ameen's surprise, he discovered that facilitating the distribution of medicine in Iraq is illegal, and their team would be legally classed as drug dealers. Moreover start-ups are a new concept in Iraq, and registering a new company can take months or even years.
All this came on top of the usual technical and financial problems which every startup faces, as well as the December protests in Iraq which shut down the internet. And then Covid-19 struck!
Their response to these numerous challenges was to pivot away from the individual-user strategy, and they began working with local charities providing medicines to economically-marginalised people. Even charities suffered from the same lack of information about drug prices, and so Ameen found that Pharx could be a useful aid to these organisations. Moreover the charities have databases of the kind of people who are most in need of the service, as well as certain allowances and permissions that mean they can get around legislative hurdles and, more recently, through Covid checkpoints.
Everything in Iraq takes a long time, said Ameen, “so you have to be persistent.” It looks like their persistence is beginning to pay off, and with any luck the Pharx app will help shift the control away from the colluding pharmaceutical interests and permanently improve access to medicine for those who really need it.