With Secret Shoppers and an App, Med Student Battles Deadly Counterfeit Drugs

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A Kenyan pharmacist using a new app that helps weed out fake drugs.  (Miti Health)

One of the mythic narratives that underlies the Bay Area’s startup culture goes like this: An entrepreneurial wunderkind identifies a problem, develops an app to solve that problem, and ends up changing people’s lives for the better.

Sometimes it actually happens that way.

The Problem

Rael Imali owns and operates two pharmacies in Majengo, a crowded, very poor neighborhood on the outskirts of Nairobi, Kenya. Many of her customers live on less than $2 day and rely on her shop as a primary source of health care.

“The hardest part is being able to provide all the drugs [my customers] need, at a price that’s affordable,” Imali says.

She knows most of the cheapest drugs on the market are counterfeit. But she can’t know from looking at the drugs she orders which ones are fake or diluted -- she only finds out whether something wrong if a patient has a bad experience. Recent studies estimate 26 to 44 percent of the medicine sold in parts of Africa is either counterfeit or of poor quality, causing an estimated 70,000 deaths every year.


The App

Before starting medical school at Stanford University, Jessica Vernon lived in Kenya for two years -- just one of those random life choices  made by a postgrad -- working for an NGO and a University of California, San Francisco cancer program.

Vernon soon discovered that access to safe drugs was a serious issue around the world. Counterfeit drugs are hard to avoid because regulations are weak and the profit for successful counterfeiters is high -- estimated globally at more than $75 billion.

So when Vernon returned to Stanford, where she'd gotten her economics degree, she went to work on the problem with some friends from her undergraduate days.

They hired a Google software engineer and started developing a sales and inventory app that could meet a Kenyan chemist’s specific needs: a low-cost tool that could work with poor Internet service and irregular electricity.

A Miti Health employee testing medications for quality.
A Miti Health employee testing medications for quality. (Miti Health)

How It Works

Two years later, there are 20 pharmacies in western Kenya using the Miti Health app, which runs on an Android tablet and transmits data—very slowly, but without the need for Wi-Fi—over the Kenyan cellphone network. Pharmacists rent the app for $10 a month and must purchase their own tablet.

Now Imali can manage orders for her two pharmacies from one location, track the quality of the drugs she orders, and get updates on drug quality from the Kenyan-based Miti Health lab.

The lab runs low-cost, quality-control tests to detect counterfeits of pharmaceutical products like deworming medication, antimalarial drugs and antibiotics. Miti hires mystery shoppers to purchase the targeted drugs from randomly selected pharmacies in various regions of Kenya.

"It's always important to use local staff from the specific region and who make purchases in the local language in order to best mirror a customer's real experience and likelihood of getting fake medicines," says Jennifer Stutsman, Miti director in Kenya. "Even dress matters to avoid perceived bias from the chemist or pharmacy on what a customer is able or willing to pay for, so all the shoppers are instructed to dress casually."

Any drug that fails the initial Miti threshold test, meaning it contains less than 80 percent of the medication's active pharmaceutical ingredient, gets sent to partners AMPATH and the University of Notre Dame for a more extensive screening that more precisely identifies what's in the medication.

Stutsman says the fake medications they find are usually sold under generic labels, but occasionally Miti finds ersatz major brand- name products.

Miti provides data on the quality of each drug they test to the pharmacists using the app. So far, 26 percent of the 412 medicines they've evaluated have failed.

The Miti team is continuing to raise funds to expand its pharmaceutical testing and aims to serve 100 pharmacists by the end of 2016.