ETHIOPIA

AN EMERGING
MANUFACTURING
HUB IN AFRICA

Tilahun E. Kassahun
Senior Policy Advisor, Ethiopian Investment Commission
 Pharmaceutical manufacturing is a nascent industry in Ethiopia but has the potential
to promote import substitution, grow exports, and improve health through access to
medicines
Pharmaceutical manufacturing market

▪ Ethiopia has a sizable and growing domestic pharmaceutical market

($684M in 2018), ~85% of which is met by imports
▪ Pharma manufacturing is a nascent industry:
– 9 local pharma manufacturers in Ethiopia
▫ Only few are GMP-certified
▫ Out of 380 essential medicines, less than 90 are produced locally
– 200+ importers
▪ Nonetheless, there are significant opportunities to grow the sector to:
– Promote import substitution
– Grow or diversify exports
– Improve access to essential medicines
▪ The Ethiopian government is keen to establish a pharma manufacturing hub
Population 100+ million and plans to launch an industrial park for pharmaceuticals (Kilinto)
– In July 2015, the government put forth an ambitious 'National Strategy
Economics Total GDP : $74.bn for Pharma Mfg Development (2015-25)’
GDP/capita : $740
Gini coefficient : 0.3 Pharmaceutical market in Ethiopia (2015-18F, $M)

Health Health spend : $2.7bn 595 684

Health spend/capita : $27 450 518
Health spend/GDP : 5%
Availability of EDMs* : ~70%

Literacy 49% of total population

Note: *Essential drugs and medicines 2015E 2016F

Source: World Bank, IMF, WHO, National Strategy and Plan of Action for Pharmaceutical Manufacturing
2017F 2018F 2
 The key drivers of demand are increasing disease burden, rising healthcare coverage,
and progressive growth of the Ethiopian population and economy

Key drivers of pharmaceutical demand in Ethiopia

• Awareness, diagnosis and treatment of diseases are increasing for both communicable
Increased and non-communicable diseases in Ethiopia
determination to – Ethiopia is affected by the burden of communicable diseases; the country is
address disease among the highest burden countries for Malaria, HIV/AIDS and TB
burden – In addition, prevalence of non-communicable diseases, such as diabetes, cancer,
and hypertension has also increased.

• The Ethiopian government is increasing healthcare coverage to its large rural

population, thus promoting the need for increased access to pharma
Rising healthcare – Ethiopia has a Health Extension Programme (HEP), which is a community based
coverage strategy to deliver health promotion and awareness creation among the public
– The overall primary health care service coverage has reached 100% in 2015 and a
social health insurance scheme has been introduced to the public aiming to
increase access to health services

• With a population size of > 100M, Ethiopia has the second-largest population in Africa
Progressive growth of • Ethiopia is expected to become a middle income country by 2025 with an average
the Ethiopian economic growth of 10% per year resulting in an increase in the disposable income
population and of the population; the increase in disposable income will influence spending on
economy healthcare pharma products

Source: Interviews, market research, AGI analysis 3

 The Ethiopian government has put forth an ambitious national strategy to
develop the pharmaceutical manufacturing industry

Strategic objectives
1.Improve access to medicines through quality local production
2.Strengthen the national medicine regulatory system
3.Create incentives designed to move along the value chain
4.Develop HR through relevant education and training
5.Encourage cluster development & API production
6.Create a R&D platform
7.Attract FDI in the pharmaceutical sector
8.Exploit the LDC status to locally produce patented products

Selected targets
Indicators 2015 2020 2025
target target
Pharmaceutical manufacturers with 2 5 20
international GMP compliance (n)
WHO prequalified products produced 0 4 15
locally (n)
New manufacturing companies and 0 5 11
local capital invested (n)
Joint ventures with international GMP 3 8 15
compliant companies (n)
API manufacturers (n) 0 1 3
Export of locally produced meds by 2 30 80
GMP-complaint producers (USDmn)

The study also incorporated other reports from the MOI, e.g. proposed incentive package, implementation plan for national
strategy, policy advisory report on intellectual property and local pharma manufacturing in FDR Ethiopia

Source: National Strategy and Plan of Action for Pharmaceutical Manufacturing Development in Ethiopia (2015-2025) 4
 Clustering, infrastructure and exports: Pharmaceutical industrial parks have
unique infrastructure requirements from ones focused on other sectors

Infrastructural requirements for a pharmaceutical industrial park

• Power consumption is dependent on the pharmaceutical product line, although it is not different from other
industries
- Power reliability is as important as availability in the pharmaceutical sector, as interruptions highly affect
the production process and quality of the end products

• Water supply is vital for pharmaceutical production. Depending on the product, different grades of water purity
are required (potable, bulk purified water, bulk highly purified water, water for injections, etc.)
- Input water treatment is typically done individually by investors, but GoE can provide the standards for
potable water. It can also be provided at different purity levels (Potable water < cleaning water < water for
syrups & suspension < water for injections)

• Waste Management: Pollution prevention, reduction, and/or treatment is required for air emissions, liquid
Pharmaceutical effluents and solid wastes. The toxic concentration depends on the type of product. Pre-treatment at the
Industrial facility / cluster before joining the CETP is most often required. Zero-liquid discharge is also a possible
Park (but quite expensive) technology. HVAC for air emissions should be chosen and justified by companies

• Warehouse: Storage area should be of sufficient capacity to allow orderly storage of the various categories of
materials and products (raw materials, intermediaries, packaging, finished, quarantined, released & rejected
products). Segregation and labelling is required to prevent errors/mix-ups
- Warehouses should be designed to ensure good storage conditions (clean & dry, maintained within
acceptable temperature/humidity limits). Highly active products stored in a secure area

• Others: transportation facilities and one stop shop services should be included
- Ideal if the one-stop-shop include customs, FMHACA, environmental protection and other government
offices for ease of operation

Notes: in manufacturing Finished products, the loss is projected to be 2-3%

Source: EFMHACA, Arvind, WHO
5
 The strategy of attracting a high-profile company to serve as an ‘anchor’ for
pharmaceutical cluster development can work, but needs to be nuanced

Hawassa Eco-Industrial Park

6
7
 Kilinto industrial park - dedicated to pharmaceuticals

Source: Kilinto design report, IPDC 8

The goal is to attract investment from leading pharmaceutical manufacturers so that
Ethiopia can become an export hub and top API manufacturer in Africa

Criteria for targeting foreign

companies for investment promotion

 Companies should have strong technological capability

Technological that they will bring to Ethiopia through investment
capability

 Companies should have proven track record of

Export exporting pharmaceuticals, and should have the
experience intention of exporting pharmaceuticals from Ethiopia

 Companies should bring their own financial resources

Financial (debt and/or equity) to finance their investment in
resources Ethiopia

EIC will:
• Lead targeted recruitment of anchor investors
• Conduct due diligence on potential investors
• Cooperate with relevant GoE agencies (MoI, FBPIDI, MoH, FMHACA, PFSA, MoFA)

Goal: To become an export hub and leading API manufacturer in Africa

9
 Market access 1:
Ethiopia is highly dependent on imports; local production contributes only ~15-20%
of domestic demand

Ethiopia pharmaceutical imports (2015E-20F)*

$US million

32 4 38 35 2 364 3 74
Ethiopia 74.71902.3526
38 3

2015E 2016E 2017F 2018F 2019F 2020F Special pharmaceutical goods

Pharmaceuticals in bulk form

878.5
Pharmaceuticals in finished dose form

Blood, antisera, vaccines, toxins and cultures

Glands and organ, dried and extracts, for

therapeutic use

Note: Forecast based on external market research report

Source: BMI Research, AGI analysis 10
 While there are 200+ importers, there are only 9 local manufacturers of
human medicines in Ethiopia

Mapping of the Ethiopian Pharmaceutical sector in the value chain

Level 1 Level2 Level 3 Level 4 Level 5

Import Packaging and Product API Research and

labeling manufacturing manufacturing development

Distribution of Packaging and Formulation of Production of Active Research and

finished labelling of imported finished products Pharmaceutical development for new
Description pharmaceutical bulk finished from imported Active Ingredient (API) and formulations,
products pharmaceutical Pharmaceutical excipients by processes and new
products following Ingredient(API) and following national or chemical entities
national or excipients by international GMP following national or
international GMP following national or standards and WHO international
standards international GMP prequalification for GLP/GCP and
standards and WHO APIs ethical standards
prequalification
standard for products

>200 0 company • 9 manufacturers of 0 companies 0 companies

Domestic importers, human medicines or
companies wholesalers gelatin capsules
and − 4 GMP-certified
distributors companies
− 0 WHO prequalified
products

Source: The National Strategic Plan of Action for Pharmaceutical manufacturing development in Ethiopia (2015-2020) 11
 Government is the largest customer; 75% of all medicines consumed in
Ethiopia is procured through the public sector

Ethiopia: Public and private heath spend (2010-25F)

($US billion) 5.1 • Government contributes ~60%
4.9 of total healthcare spend in
4.6 Ethiopia
4.4
4.2
• For pharmaceuticals, the share
3.9
3.6
of the public market is even
higher

Public Private
3.4
3.1

2. 9
– ~75% of all medicines

2. 8
2.9

2.3
2.5
2.5

1. 6 1. 7 1. 8 2. 0 2. 1 2. 3 2. 4 2. 5 2. 6 consumed in Ethiopia is
procured through the public

1.3
1.6
1
2.0

. 2 1. 4 1. 5
00..76 10..06 0.8 0.9 1.0 1. 1.2 1.3 1.4 1.5 1.6 1.8 1.9 2.0 2.1 2.
sector*

• The public sector procures

products largely based on price,
favoring generics medicines

• ~90% of branded products are

sold through the private
pharmaceutical market

2010 201 2012 2013 2014 2015E 2016F 2017F 2018F 2019F 2020F 2021F 202 F 2023F 2024F 2025F
Note: *Based on National Strategy and Plan of Action for Pharmaceutical Manufacturing Development
12
Source: BMI, AGI analysis, Interviews
 The majority of drugs are procured through the public sector

Ethiopian Pharmaceutical market (2015)

Public market

Pharmaceutical market in Ethiopia (2015)

~75% of value ~25% of value*

Public market* Private market** In-kind donations

~30% ~70%
Government purchases Program purchase
(Revolving drug fund)** (donor funded)

Purchase from local International tenders

manufacturers

1 company: direct 2 or more companies:

negotiation Closed bid

Note: *Public sector includes RDF and Program Purchases (in-kind donations are not included). **private sector share was estimated at 25% of the total domestic market size
Source: PFSA, Interviews, NS-POA, AGI analysis 13
Market access and other incentives

Key incentive categories Incentive types

Market Access (Revenue 11. Procurement: Closed bids

Ethiopia enhancing) 2• Price advantages in tenders
Incentives that directly impact
3• Export incentives and facilitation
the revenue of the company
(e.g., price and/or volume) 4 Reduced import competition

Tax and Finance (Profit 51. Custom duty exemptions

enhancing) 62. Corporate income tax
Incentives that directly impact 73. VAT exemption
costs, and consequently the
company’s profit margin 84. Access to finance

91. Regulation
102. Talent development & facilitation
Operational efficiency
Incentives that facilitate setting 113. Availability of infrastructure
up and running a business in the 124. Access to R&D
sector
135. Access to foreign exchange
146. One-stop-shop services
14
 According to manufacturers, 6 out of the 14 incentives are critical

Critical Important
Category Sub-category Importance to Feedback from manufacturers
manufacturers Moderate Low
Procurement: Closed bids
1 • Manufacturers indicated that closed bid RDF procurements by
2
Price advantages in tenders PFSA and protection of the domestic market through import
Market
Access tariffs are the most important market access incentives
(Revenue 3 Export incentives and • Existing domestic manufacturers indicate that the 25% price
enhancing) facilitation
premium offered by PFSA in international tenders is less
4 Reduced import
competition
important, as they are seldom competitive even with the price
advantage
5 Custom duty exemptions • As a majority of inputs to pharmaceutical production are
Tax and 6 Corporate income tax imported, e.g. APIs, excipients, and primary packaging, custom
Finance exemption duty exemptions are one of the most important incentives to
(Profit
enhancing) 7 VAT taxes maintain
8 Access to finance

9 Regulation • Regulatory challenges and access to foreign exchange are

Talent development &
among the most significant challenges to pharmaceutical
10
facilitation manufacturing in Ethiopia, and incentives aimed at facilitating
these processes are important
Operational
11 Availability of
infrastructure
• As pharmaceuticals is a knowledge-intensive industry, talent
efficiency
development and facilitation was similarly rated as an
12 Access to R&D
important incentive to offer
13 Access to foreign exchange • Access to finance is less important for large MNCs, but a
significant challenge among existing domestic manufacturers
14 One-stop-shop services 15
 Public procurement can be more attractive to investors with proper legal
framework for closed bids and longer-term supply contracts

• Local closed-bid tenders are currently offered for products being produced in
sufficient quantity by two or more domestic manufacturers;
• Hence, the exercise of closed-bid tenders to encourage local manufacturers is
available
Closed tender • A number of improvements have been recently be introduced
for local • A significant trade-off with public health must be considered
manufacturers
Increase transparency of the tender system
• Review procurement/tender management system: Manufacturers associations/private sector should be
engaged
• Procurement results should be made public so that local manufacturers and/or other suppliers can submit
objections
• Enhance PFSA laboratory and technical evaluation capacity to ensure quality of procurement

• Long-term purchase contracts are attractive for MNCs looking to invest in Ethiopia
• The experience of Anti-retroviral (ARV) production in South Africa and Uganda
Long term • South Africa: Central Procurement Authority has a long-term contact with a local
market
manufacturer, Aspen, to supply ARVs
guarantee
(volume or • Uganda attracted Cipla to manufacture ARVs locally by signing MOU, providing 20%
price) price preference for local production and guaranteed volumes

Note: Closed/restricted bid: a bid restricted to participants selected based on a specified criteria by the procuring body. In Ethiopia, closed-bid tenders are allowed only to local manufacturers.
Source: Interviews, EIC & AGI analysis
16
Market access 2:
While the Ethiopian market ~$684 M – 1billion, the African pharmaceutical market is
valued at >$25B and is growing at a rate of ~13% per annum

The growth of pharmaceutical sales in Africa* Pharma segment growth in Africa

(2013-20E), $US billion (2013-20E), $US billion

CAGR%
17%

13%
10%
CAGR** 6%
9%
6%

As developed markets stagnate, Africa represents a promising source of growth for multinational pharmaceutical
companies

Note: * 2013 numbers are approximate; 2020 numbers are estimates; ** CAGR is for the top seven countries in Africa (Algeria, Egypt, Ghana, Kenya,
Morocco, Nigeria, and South Africa)
Source: McKinsey (2015) Africa: A continent of Opportunity for Pharma 17
 Pharmaceutical market in Africa, however, is led by seven countries, which
constituted ~70% of the total market in 2015

Pharmaceutical sales in Africa (2010-20F) 30

US$ billion Top 7 in Africa CAGR CAGR
27.8 2010-15 2015-20F
Nigeria 1.4% 0.4%
25.5
23.8 23.6 Kenya 12.3% 9.7%
22.7 22.3
21.8 Tunisia
20.8 5.4% 6.7%

18.9 Morocco 3.0% 8.6%

17.1
South Africa 0.2% 2.5%

Egypt 9.5% 5.3%

Algeria 9.5% 9.2%

Rest of Africa 3.6% 8.0%

Sub-Saharan 3.9% 4.4%

Africa
Total Africa 5.1% 6.8%

Ethiopia represented
only ~2% of the African
pharma market in 2015

Note: The order of the countries is based on their Pharmaceutical sales in 2020F
Source: BMI, AGI analysis 18
 South Africa, Egypt, and Kenya are the largest exporters of pharmaceuticals
in Africa; top 5 countries represent 90% of the continent’s exports

Top African countries that export pharmaceuticals

Exports in India and China, in
Export value of pharmaceutical products (2015), $US million
comparison, are ~$12.5B and
~$6.9B respectively
450
400
400
350 Top 5 countries in
Africa represent 90%
300 of continent’s exports
($640M)
250
200
141 Ethiopia exported only
150 ~0.14% of the continent’s
pharmaceutical exports in
100 2015*
50 39 35 25 19 12 6 5 4 4 2 2 2 2 2 1 1 1
0

Note: *While UN COMTRADE states that Ethiopian pharmaceutical exports was only $998K in 2015, the Ethiopian government in its GTP-II states that
the actual figure was $2.7M. For consistency, the data in this graph is from UN COMTRADE.
Source: Calculations based on UN COMTRADE statistics, AGI analysis 19
 Across the continent, pharmaceuticals produced locally are typically
consumed domestically or traded regionally

Concentration of exporting countries in Africa and average distance to importing partners*

Pharmaceutical products (2015)
8000
Long-distance
Average distance with destination countries (km)

exporters with many Swaziland Mauritius

importing partners

6000

South Africa

Senegal Cameroon Ghana

4000 Morocco

Ethiopia Algeria

Egypt

2000 Tunisia

Kenya Tanzania
Uganda Zimbabwe Botswana
Benin Togo

0
0 0.1 0.2 0.3 0.4 0.5 0.6
Concentration of exporting countries**
Note: *Size of bubble is proportional to the export value. **The concentration is based on the Herfindahl index. Indices between 0.10 and 0.18 is considered
to be moderately concentrated and indices above 0.18 to be concentrated. This indicator is a measure of the dispersion of trade value across an
exporter’s partners.
Source: Calculations based on UN COMTRADE statistics 20
 Manufacturers indicate that the key criteria when selecting export destinations are
market size, registration requirements, trade agreements, distance and competition

Criteria for choosing export destinations

Average ratings by companies (N=9) • Addressable market size
On a scale of 1 to 7; where 1 is not important criteria and 7 and regulatory
is most important criteria requirements for drug
approval are the two most
Market size in export country important criteria
6

Registration requirements for • Membership in Regional

marketing approval 6 Economic Communities
(RECs) is also considered an
Trade agreements important criteria, as it can
6
facilitate easier market
Distance (cost of access
transportation) 5
• Inland transport
Competition in destination considered cost effective
country 5
for export to neighbouring
Import tariff countries due to
5 inaccessibility of many
African markets by sea and
Drug pricing in destination high cost of air transport
country 5

Existing business relations

with vendors/distributors 4

Source: AGI survey of Ethiopian pharma manufacturers (2016) 21

 REC-based regulatory harmonization is important; but also bilateral
agreements can be solutions in the short run

1 Harmonize regulations through RECs as a 2 … while pursuing country-specific bilateral

medium to long-term strategy… regulatory agreements over short-term

 Target regions with high export  Prioritize countries with high export
potential and pursue RECs-based potential in Africa and pursue bilateral
regulatory harmonization, which is likely to harmonization / mutual recognition of
be achieved in the medium to long-term regulatory frameworks
 This may be a necessary pre-condition − FMHACA is pursing this approach with
for the GoE to realize its vision to become countries like Jordan
the leading regional hub for − Recommend initiating the same with
pharmaceutical production and export prioritized export destinations

Source: AGI analysis

22
Regulatory harmonization is crucial for reasons of regulatory efficiency and
market access

Harmonization overview 4 levels of harmonization identified

• Driven by AMRHI (African Medicines Registration Harmonization Level 1 – Information sharing: common
Initiative) which is led by consortium of regional organizations and data/ regulation repository - easy access
development partners to countries and companies
• RECs-based harmonization – all RECs invited to submit
proposal
• Piloting and sequenced approach – level of harmonization and Level 2 - harmonization of technical
choice of RECs and scientific materials: harmonized
guidelines for registration and GMP
Benefits of harmonization inspection (country level assessment
and decision)- streamlined procedure and
1. Differences in regulation across countries constitute trade restrictions requirements
(non tariff barriers) - Standards convergence or harmonization
facilitates market access
- assessment of dossiers and registration takes 1- 3 years in African Level 3 - Joint assessment and
countries. In the absence of joint assessment or mutual recognition inspection: simultaneous submission to
system, companies face lengthy time and complex country-specific NMRAs => REC Secretariat/lead country
coordinates joint assessment sessions =>
procedures in each importing country. joint dossier assessment => Country level
- country specific requirements (labeling, fees etc.) form NTBs registration subject to administrative
requirements - reduced time for national
2. Many African MRAs do not have the required capacity – less than 30% registration (3-6 months Vs 1-3 years)
of African MRAs are considered competent by WHO – reduces burden
on national MRAs by pooling resources, reducing duplication, and
adopting best practice

Level 4 – Joint registration: regional level

/central assessment and registration – zero
country-specific procedure

23
Source: Accelerating regulatory approval through WHO (2016), Impact of regulatory requirements on medicine registration in Africa (2012)
 Harmonization is occurring through RECs; EAC is the furthest along, while
IGAD and COMESA are lagging behind

RECs Current level of harmonization

Level 3 – Joint assessment

EAC •3 rounds, over 8 products approved, largely essential
generic drugs, registration within 3 months
Level 3 – Joint assessment IGAD
•125 generic products and one innovative medical
product assessed so far
SADC
•Focus on regional priority drugs – anti-infectives, anti-
hypertensive, anti-diabetics, registration within 11
months
Level 2 - harmonization of technical and scientific
materials ECOWAS/
ECOWAS •Developing regional “centres of excellence” on UEMOA EAC
bioequivalence centre & quality control labs
•Regionalization is championed by Nigeria ECCAS
Level 2 - harmonization of technical and scientific
ECCAS materials
•At initial stages
Level 1 – Information sharing
•Regional harmonization program launched in 2015, yet SADC/
IGAD COMESA
to establish a regional regulatory unit, preparing a
proposal for participation in AMRH
Not actively engaged so far
COMESA
•60% countries in EAC and SADC

24
Source: Accelerating regulatory approval through WHO (2016), Impact of regulatory requirements on medicine registration in Africa (2012)
 COMESA represents a large export market with an addressable market size
of $6.2B; other neighbouring regions, IGAD and EAC, are considerable in
market size as well

Addressable market size by region

($B, 2015 pharmaceutical imports)

6.2B

4.3B

2.8B
2.2B

1.4B

COMESA SDAC ECOWAS IGAD EAC

Source: Calculations based on UN COMTRADE statistics, AGI analysis
25
 Ethiopia can play a leadership role in achieving regulatory harmonization with
IGAD in the medium-term and COMESA in the longer-term

Member countries – Level of

addressable market Ethiopia harmonization Possibility for FMHACA to
Regional blocks size (2015)* membership Competition** (1-4) harmonize (Medium-term)
Medium
EAC 6 countries – $1.4B NO 20% 3 ▪ Not member, but
observer
High to Medium
COMESA 19 countries – $6.2B YES 25% 0
▪ Member, but
harmonization not high
on the agenda
High to Medium
IGAD
▪ Member, harmonization on
8 countries – $2.2B Yes 7% 1 the agenda only recently,
capacity limitations
Medium to Low
SADC
15 countries – $4.3B No 30% 3
▪ Not member, but more
than half are COMESA
members

Low
ECOWAS 15 countries – $2.8B NO 6% 2
▪ Not member

GoE should champion regulatory harmonization within IGAD, as it represents a favourable regional market
with relatively low competition; COMESA also represents a significant opportunity provided regularity
harmonization is pursued in the medium to long-term
Note: * Import of pharmaceutical products was used as a proxy for addressable market size **local supply as % of market
26
Source: Calculations based on UN COMTRADE statistics and BMI, Interviews, AGI analysis
 In the following prioritized countries, the GoE should seek to harmonize its regulatory
procedures, facilitate information exchange, and foster vendor/distributor relationships

Average rating across key export challenges

10 prioritized export faced as reported by 5 companies
markets On a scale of 1 to 7; where 1 is not challenging
and 7 is most challenging
•7 in COMESA
•3 in ECOWAS
Mali Regulatory procedures in
Senegal (see appendix for export destinations / lack
Sudan detailed list) 6.8
Burkina Faso of regulatory
harmonization

+Somaliland Limited knowledge of

Uganda 6.2
export markets
Congo Kenya
(DRC)
No vendors / distributor
5.6
relationships

Zambia Malawi
Zimbabwe Access to forex 4.8

Lack of competitiveness of
locally produced products 4.8
in export markets
Prioritized export markets
Most challenging issues

Source: Interviews and survey 27

 The following interventions are also necessary to address other export-
related bottlenecks

Export-related bottlenecks identified Recommended Interventions

Lack of competent Bioequivalence studies – key for export
competitiveness and has high cost implications
• The Bioequivalence Centre in Ethiopia (under School of Capacitate Bioequivalence
Pharmacy of AAU) lacks effective organizational structure, center through diagnostics and
adequate resources and is yet to be certified by the WHO tackling of prevailing challenges
• Undertaking the test overseas has high cost implication – the
cost of testing in Kenya or South Africa is 2X that of Ethiopia’s

Lack of timely access to foreign exchange – key for optimal

production and export CBE to enhance bank to bank
transactions
Lack of (High cost) of special refrigerated trucks necessary for
some inland transportation – the preferred means for African Enhance the forex regime (see
countries incentive)

Expensive outsourcing of pharmaceutical transports by ESLSE

due to lack of refrigerated containers Incentivize duty free import of
specialized trucks as capital
goods

Enhance ESLSE’s care logistics

capacity

Source: Interview, AGI analysis 28

Thank you!

29