Introduction

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.

Waleed Shawkycreated a community-based system to collect, sort and distribute medicine to low-income families in Egypt using medicine wastedby affluent households, pharmacies, and pharmaceutical companies. Waleed’sorganized, professional, and fluid systemcounters ineffective public health insurancepolicies, which do not cover the cost of medicine for its patients.Thus, he is addressinga 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 anadvanced 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 6 years, he has developed a new 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 volunteersand a self-sufficient, zero waste strategy with no exchange of money or dependence on charity or external support. However, he established purposeful partnerships with CSOswho have direct access and connections to needy communities in their areas, who can benefit from this service. In addition to CSOs, Waleed targets all relevant stakeholders which include the sources of waste (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, includingindividuals and families who have public health insurance, an estimated 48-55% 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 such medications.

Even worse, is the large number of Egyptians holdinginformal jobs that offer no health insurance coverage. 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 medications.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 in the country, with no system to link the supply with the demand. According to an estimate by the Chairman of Pharmaceutical Cosmetic and 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. Moreover, regulations by the government mandate pharmaceutical companies to 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 pharmaciesgo against this regulation they open the opportunity for counterfeit medicine to be added to boxes, replacing any missing strips which havebeen illegally sold individually to patients.Illegally selling individual strips makes it difficult to track the originalmedication and distinguish from counterfeit medicine. If selling smaller amounts was allowed,however, more people would be able to afford the medicine they need.

Pharmaciesthus 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 returnedmedicine in addition to what they do not manage to sell well before its expiration date.Due to the hazards of uncontrolled disposal, the wastebecomes a cost for patients who buy the whole package as well as for the companies and pharmacies that share the loss of unsold medicine. The existing regulations provide no incentives to curb corrupt practices or to help different stakeholders reduce their medicine waste.

In order 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 started implementing his idea by first creating hubs to collect excess medicine,sending it through an intensive sorting process, filtering and then distributing it to those who need it through various distribution channels. Waleed enters a community and identifiestherelevant stakeholders including pharmacy students to ensure the constant availability of specialized volunteers, CSOs that collect and distribute medicine, and those who donate excess stocks of medicine (pharmacies, pharmaceutical companies, and households). The combined efforts of each component designed by Waleed, with each stakeholder serving a specific purpose, composes a fully functioning system.

Waleed has secured the support of 10 Board members—six 6 university students and four professionals, who are helping establish organization. Registration is expected to be finalized by April 2013. To build up his work, Waleed is working on two tracks: establishing university pharmacies and working on reforming the 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 as “El Kheir Educational Pharmacies,” which means 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 whom Waleed trains during their clinical university years. Their classroom education does not provide the students with hands-on experience in dealing with medicine or patients. Since Waleed is a practicing Pharmacist and a member of the Egyptian Syndicate of Pharmacists, the Egyptian Drug Association sends the volunteers a monthly report that includes a list of counterfeit medicine. Waleed provided the two Educational Pharmacies with software programs in whichthey 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 CSOs that deliver medications to needy households who have a recent prescription. The CSOs collect these prescriptions and get the needed medicine from universities where it has to be documented in the software of the Educational Pharmacy. 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 these caravans are able to deliver medicine to people living in remote areas of the country as well as urban areas. Waleed’s plan for scaling up includes increasing the number of educational pharmacies in other universities throughout the country. He is currently negotiating agreements to establish new hubs at the German University in Cairo (GUC) and Misr International University.

In an agreement with one of Egypt’s major pharmaceutical companies, Pfizer, Waleed managed to secure all excess stocks of medicine six months before theirexpiration date so he can distribute it in time and people can use it while it is still valid. He is currently 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 these 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 helped attract people to his initiative through his campaign.

To date, the El Kheir Educational Pharmacy includes over 200 active student volunteers who perform all the necessary functions of work Waleed’s operations. The infrastructure he built also provides the pharmaceutical students with on-the-job training that makesa significant difference in their ability to find jobs after graduation. The initiative has benefited more than 1,000 patients per month.

Waleed’s work additionally saves the community, pharmacies and pharmaceutical companies an estimated360,000 EGP annually by recycling the unused medicine that would have ended up in the trash. Simultaneously, his work illustrates benefits beyond cost savings, as pharmaceuticals can benefit from giving their excess medicine to needy patients, gaining a community outreach aspect to their company instead of disposing it as waste and strengthening their corporate social responsibility position in the community. Also, he is providing young people from local communities with the opportunity to volunteer and benefit their communities. Waleed believes that capitalizing on the spirit of volunteerism and spreading a culture of pay-back among Egyptian youth is one of the assets of his model.

Waleed’sfuture plansinclude establishingten new educational pharmacies to expand his reach to othergovernorates (districts) in Egypt—he is currently working in five. These pharmacies are going to provide the screened filtered medicine to CSOs that will deliver the donated usable medicine to the poor of their communities. By this, Waleed is capitalizing on the sense of giving and volunteering among the Egyptian community by recruiting volunteer university students,while developing university-based hubs that act asa mediator between donors and recipients.

Currently, Waleed’s operational costs are extremely low. He relies on individual contributions, specifically from board members. The operational costs of his new CSO, soon to be officially registered, will be covered partially by board members, who have committed themselves to donating 200 Egyptian Pounds per month each, covering the salary of one full-time employee. An administrative secretary will be hired in the next six months in addition to a Health Insurance Program Officer and a Finance Officer. As he continues to grow his organization, he will expand his revenue sources to include donations and sponsorships from pharmaceutical companies.

Waleed’s long term plan to document accurate national data for wasted medicine will serve as a valuable tool in reforming 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. When he was a student he was involved in school journalism and enjoyed being aware of the issues that his community and nation were facing. Waleed attended Cairo University’s School of Pharmacy in which he was elected to be the Student Union President during his senior year in 2001. Wanting to be more involved in the pharmaceutical sector, Waleedjoined the International Pharmacy Student Federation (IPSF) world congress in which he served as an organizing committee member. By the year 2003, Waleed started his own private pharmacy in Cairo. It was while interacting with his customers that 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 by an experience he had while attending a lecture about volunteerism and changemaking that inspired Waleed to do more than just be aware of these problems. It inspired him to act. He knew that he had the skills and the drive to address the drug industry problems in Egypt. In 2006, Waleed 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 in 2011. This role has since allowed him to spread his work. With its activities with students, medical caravans, drug companies, and CSOs, Waleed’s work is being replicated by other pharmacies and has received attention from other Arab nations. Waleed’s hope is that all families and individuals in Egypt will have access to affordable medicine.