CASE STUDY Bringing Safe, Quality Medicine to All Goodlife Pharmacy: A Health Hub for East Africa December 2018 ABOUT IFC ACKNOWLEDGEMENTS IFC, a member of the World Bank Group, is the largest global A special note of appreciation is extended to the entire development institution focused on the private sector in team at Goodlife, especially Amaan Khalfan (CEO), and at emerging markets. Working with more than 2,000 businesses LeapFrog, especially Michael Jelinkse (Investment Officer), worldwide, we use our capital, expertise, and influence to Felix Olale (Partner and Global Co-Leader for Health create markets and opportunities in the toughest areas of Investments), and Ken Muriungi (Investment Associate) for the world. In FY18, IFC invested $23.3 billion, including nearly taking the time to provide insights on the company’s journey $11.7 billion mobilized from other investors. Our comprehensive thus far. Without their input, this case would not have been approach helped businesses innovate, build internationally possible. competitive industrial sectors, and create better jobs. For more information, visit www.ifc.org. Thanks to David Lawrence for copy editing support and Groff Creative for the design. ABOUT THE CASE STUDY Expanding access to quality and affordable healthcare DISCLAIMER is a central element to eliminating extreme poverty and The findings, interpretations, views and conclusions promoting shared prosperity. The World Bank Group has expressed herein are those of the author and do not a goal to end preventable deaths and disability through necessarily reflect the views of the Executive Directors of Universal Health Coverage (UHC). In many developing the International Finance Corporation (IFC) or of the World countries, governments do not have the capacity to serve Bank or the governments they represent. While IFC believes the entire population and private health care providers often that the information provided is accurate, the information play a critical role in meeting societal needs. is provided on a strictly “as-is” basis, without assurance or representation of any kind. IFC may not require all or any of IFC’s focus on inclusive business looks specifically at the described practices in its own investments, and in its sole companies that expand access to goods, services, and discretion may not agree to finance or assist companies or income-generating opportunities for people living at the projects that adhere to those practices. Any such practices or base of the pyramid. By combining purpose with profit, proposed practices would be evaluated by IFC on a case-by- inclusive businesses redefine business-as-usual. case basis with due regard for the particular circumstances of the project. IFC’s health and inclusive business practices are jointly developing case studies that demonstrate the contribution RIGHTS AND PERMISSIONS of the private sector to achieving global and national health © International Finance Corporation 2018. All rights reserved. care goals and to serving lower income people. The material in this work is copyrighted. Copying and/or WRITTEN BY transmitting portions or all of this work without permission The case study was written by Piya Baptista and Kathleen may be a violation of applicable law. Mignano with valuable inputs from IFC colleagues Alexis Geaneotes, Ann Casanova, Biju Mohandas, Brenda PHOTOS Kathambi Kithinji, Brendan Michael Dack, Charles William © Goodlife Pharmacy Dalton, Chris McCahan, Elena Sterlin, Eriko Ishikawa, Njeri Mwaura, Srividya Jagannathan, and Toshi Masuoka. Table of Contents 1 Introduction 2 The Early Days 2 Establishing the Infrastructure 6 Driving Operational Improvements 7 Expansion and Diversification 12 Conclusion Region: East Africa Sector: Health IFC Commitment: $7.5 million Goodlife Pharmacy Millions of low-income Kenyans rely on informal pharmacies for medicine. Informal pharmacies—constituting around 66 percent of the estimated 12,000 private pharmacies in Kenya—dwarf the number of formal ones and pose critical health risks to Kenyan consumers.1 Many informal pharmacies offer a narrow selection of products, carry low-quality substitutes, or sell expired and even fake medicine. While Kenya’s Pharmacy & Poisons Board (PPB) is actively involved in regulating and enhancing the sector from a quality perspective, in 2011, for example, an estimated 20 to 25 percent of drugs sold in the country were counterfeit.2 Because they contain few or no key active ingredients, counterfeit medicine can cause treatment failure, adverse reactions, and even death. Lower-income consumers, who do not have the disposable than 25 stores that target “emerging consumers,” that is, income to purchase high-quality medicine from reputable low- to lower-middle-income population segments—can pharmacies, are particularly vulnerable to these risks. be found in diverse locations such as malls, gas stations, and High-quality medicine is often expensive in Kenya because near bus stops. As of September 2018, Goodlife had reached of the highly fragmented pharmaceutical distribution around 1.1 million people during the previous twelve months system in the country. Given the lack of coordinated with approximately 50 percent classified as emerging distribution, numerous distributors and sub-distributors consumers. mark up prices, adding to the final price paid by consumers. Even the lowest-priced generic medicines in Kenya are estimated to be two to five times higher than their international reference prices.3 Against this backdrop, Goodlife Pharmacy was founded in 2014 to meet the need for a trustworthy, customer-centric, branded pharmacy retail chain that offers safe, high-quality medicine to all Kenyans. Ultimately, Goodlife aims to become a health hub—a one-stop-shop to meet basic primary health care needs through pharmaceuticals and services throughout East Africa. In only four years, Goodlife has become East Africa’s largest pharmacy chain, doubling its revenues since launch. In 2017 alone, Goodlife’s annual sales increased by 30 percent. Its 50-plus pharmacies in Kenya and Uganda—including more 1 THE EARLY DAYS Transforming a Vision into Reality A Big Vision Goodlife Pharmacy was formally launched in 2014. The In 2012, public health specialist Joshua Ruxin, teamed up three co-founders used their own funds, tapped into a few with investor Jeffrey McCormick to explore opportunities other private investors, and obtained an equity investment to invest in Africa’s health sector—particularly in a regional from Catalyst Principal Partners, a regional private equity retail pharmacy chain of world-class standards. For years, firm. The co-founders then brought in senior executives Ruxin had been working at the intersection of public who had experience with pharmacies, such as the Alliance health, business, and international development. He had Boots Retail Pharmacy chain in the United Kingdom, to been a part of several health initiatives, including co- help build the foundation for the business. founding Health Builders with Professor Jeffrey Sachs and others to help countries acquire and manage financing Over the next four years, Goodlife took a methodical from the Global Fund to Fight AIDS, Tuberculosis, and approach to eventually reaching lower-income customers Malaria. He also had experience running a network of 4 and expanding its offerings. The company would undergo pharmacies and health centers in Rwanda. Ruxin and three major phases of development: McCormick soon brought in David Zapol, who had been leading the health practice at a global consulting firm. The 1. Establish Infrastructure: It first established its three founded Goodlife on the belief that basic primary pharmacy infrastructure and developed its business health care services can be delivered at pharmacies model through stores that served middle- and high- through partnerships with qualified medical experts. income customers. The timing was right to enter the Kenyan retail pharmacy 2. Optimize Operations: It then worked on optimizing market. The country’s pharmaceutical market was the operations by increasing efficiencies and reducing costs. fastest-growing in Sub-Saharan Africa, driven by factors such as a growing population combined with an increase in 3. Expand and Diversify: It finally turned its focus to chronic diseases—an estimated 27 percent of deaths in expansion and diversification, including building its Kenya are attributable to chronic noncommunicable presence in East Africa, expanding its target customer diseases. Also, over-the-counter medicine was (and 5 market to include emerging consumers, and remains) popular in Kenya with nearly 60 percent of the transforming into a “health-hub” by delivering basic population self-medicating. 6 primary health care services. At the same time, there was a clear opportunity to disrupt PHASE 1: ESTABLISHING THE and consolidate the Kenyan retail pharmacy market. Less INFRASTRUCTURE than six percent of private, licensed pharmacies were part of a multi-outlet chain.7 Most private pharmacies were Getting to Market mom-and-pop enterprises; few had the ambition and Goodlife wanted to get into the Kenyan market quickly. capacity to grow beyond a handful of locations. Hardly any Since building new stores and the necessary corporate had more than 10 stores at the time. The co-founders knew infrastructure would be time consuming and capital that a multi-outlet chain could offer a larger selection of intensive, the company focused instead on acquisitions. It products and services of better quality, at higher standards, acquired the four-store Mimosa Pharmacy chain and built and often at lower prices. on the goodwill and relationships that Mimosa had created in the industry. Goodlife leveraged these shopping mall locations to gain an instant presence in the market. It also retained Chris Gitonga, Mimosa’s founder, who played an 2 Goodlife’s Value Chain An Overview of Challenges and Solutions Procurement Distribution Marketing & Customer Sales Service Value Chain • Highly • High capital • Lack of granular • Low staff to fragmented expenditures customer data customer ratio market for (CAPEX) and in small stores • Customers are pharmaceutical operating price sensitive Challenges distribution expenditures and often lack in Serving drives up costs (OPEX) of new the ability to pay Low-Income of medicine stores relative to customers’ Customers purchasing power • Lack of access and convenience • Purchase • Lower CAPEX • Invest in market • Cross-train staff medicine in and OPEX of research to perform bulk from new stores multiple • Ensure manufacturers through a functions consistent and wholesalers no-frills, supply of good to lower pre-fabricated quality products procurement store model costs • Offer discounts, Goodlife’s • Offers nation- purchases on wide network of Solutions credit, and locations single-unit sales; accepts insurance and mobile-money payments • Integrate affordable primary health care services 3 Figure 1. Key Milestones in Goodlife’s History Begins focus Over 50 Goodlife on serving pharmacies emerging operating in Co-founders 1st loan Investment consumers Kenya and develop the vision from IFC by Uganda for Goodlife LeapFrog 2012– 2013 2014 2015 2016 2017 2018 Goodlife launched; 19 locations Starts delivering Acquires Mimosa operating in Kenya; health services; Pharmacies to gain Expansion into 2nd loan from instant market presence Uganda IFC Box 1. Managing Quality of Pharmaceuticals Substandard and counterfeit medicine is a significant issue in Kenya, causing adverse health effects—including death. Despite these risks, counterfeits persist due to the low purchasing power of much of the population, limited public health insurance, and limited monitoring by government due to resource constraints.7 Goodlife sees quality assurance as a key brand differentiator and delivers this by: STREAMLINING PROCUREMENT CONDUCTING DUE DILIGENCE ENSURING PROPER STORAGE Goodlife procures pharmaceuticals Goodlife’s pharmacy team Goodlife has instituted simple from authorized manufacturers and researches and reviews every measures such as refrigerators with wholesalers; the latter distribute the medicine—whether prescription or power back-up to avoid medicine products to Goodlife stores. By over-the-counter—before it is sold degradation. Practices such as cutting out smaller sub-distributors in its stores. This check ensures temperature and humidity from its supply chain, Goodlife that the company is only selling monitoring ensure that medicine is reduces the risk of counterfeit high-quality medicine that has maintained at the recommended products entering its system. The been approved by Kenya’s ambient conditions. company’s chief pharmacist also Pharmacy and Poisons Board. conducts periodic inspections on their suppliers. 4 instrumental role in the early rollout of Goodlife’s Box 2. A Loan from IFC operations and continued as a Goodlife shareholder. In 2015, IFC provided a $4.5 million Mimosa also offered other critical infrastructure: a head loan to Goodlife. IFC wanted to office of around 10 staff and back-end technology, such as build the market of high-quality retail a point-of-sale system to track stock levels and product pharmacies in East Africa. Goodlife had already expiry dates. The point-of-sale system allowed Goodlife to grown to four stores and IFC believed that the easily create a database of customers so that the company pharmacy chain had a scalable model that could could track its regular customers and offer services such as introduce international standards to the region. automatic prescription refills. Goodlife also had the potential to bring in lower prices for consumers and significantly improve the Enhancing Procurement quality of products. Goodlife’s plans to extend to Procurement quality was a critical component of Goodlife’s emerging consumers was also important to IFC. go-to-market strategy. It reduced the number of pharmaceutical suppliers servicing the newly-acquired For Goodlife, a capital infusion from IFC—on terms stores to better manage the supply base and thereby not readily available in the local market—was minimize the risk of counterfeit drugs entering into its essential for growth. It came at a critical time as system. All suppliers were asked to rebid the contracts they its largest store had incurred significant losses due had with Mimosa based on new parameters for volume, to the 2013 terrorist attack at the Westgate Mall, pricing, and quality. This first important step in where it was located. IFC’s loan enabled Goodlife streamlining procurement would lay the foundation for to grow to approximately 20 locations, thereby Goodlife’s quality assurance system (see Box 1). attracting interest for a further capital infusion from private investment firm LeapFrog. Training Staff Talent management was key to delivering on Goodlife’s quality promise. Goodlife developed a staff training program that covers technical and non-technical topics. Employees undergo a two week-long, face-to-face induction program. Launching the Brand They learn about international best practices in store The elements in Goodlife’s go-to-market strategy were management, sales skills, and customer service, as well new in East Africa and important differentiators from the as receive training customized to their individual roles. competition. By mid-2015 Goodlife had attracted financing 9 Pharmacists and pharmaceutical technicians participate from IFC that would catalyze growth. This financing in additional training on monitoring the effects of drugs enabled the company to acquire six stores from two other (pharmacovigilance) and providing services such as supporting multi-outlet chains and launch flagship stores in large, blood pressure, blood sugar, malaria and HIV self-testing. high-volume locations (see Box 2). The Goodlife brand was formally launched through the flagship stores while the In addition to its induction training for new hires, company continued to work on refurbishing the acquired Goodlife conducts monthly online training so that its stores and rebranding them as Goodlife. As the in-store pharmaceutical professionals can stay abreast of new experience was one of high quality—from store layout to information on medicine, diseases, and customer service product offerings to customers service—Goodlife was able practices. These mandatory trainings include tests and to get customers and patients to trust its brand immediately. results are tied to key performance indicators to ensure that employees are incentivized to participate and learn. 5 PHASE 2: DRIVING OPERATIONAL network. Subsequently, several other key hires were made IMPROVEMENTS to build the team that would be required for the next phase of growth. These hires included a chief retail director, LeapFrog’s Investment an IT manager, purchasing lead, head of marketing, and an By the end of 2016, Goodlife’s early success in Kenya was internal auditor. clear. It had 19 stores up-and-running in and around Nairobi and was serving thousands of customers. LeapFrog, Increasing Efficiency, Reducing Costs also an IFC investee, had taken note. LeapFrog is a private Before it could broaden its customer base to the emerging investment firm that focuses on purpose-driven consumer, Goodlife and LeapFrog conducted a businesses. In 2017 it was ranked by Fortune as one of the comprehensive review of operations to ensure Goodlife top five companies changing the world. In Goodlife, 10 was running as effectively as possible. This included: LeapFrog decided to make its largest-ever investment in the East African retail pharmacy market—a $22 million 1. IMPROVING INVENTORY MANAGEMENT: equity investment. Goodlife needed capital to perfect its Managing inventory is critical since neighborhood model, systems, and store look, and to be pharmaceuticals are costly and have a large enough to obtain discounts from the drug limited shelf life. Pharmacies must ensure that manufacturers. 11 they neither have too little nor too much of the same stock. Goodlife introduced a new point-of-sale system to LeapFrog supported Goodlife’s vision and thought that better capture and report on store level data (for example, Goodlife had the components that would be critical for stock levels and ordering patterns). Data from the point- success in the broader market: of-sale system was integrated with data from the company’s warehouse and backend SAP financial system. 1. The potential to become a primary health care These linkages enabled Goodlife to optimize inventory and services hub stocking, as well as forecast what products to buy or not buy to ensure steady and consistent supply. 2. A commitment to quality and customer service 2. RATIONALIZING PRODUCTS: A review 3. A pricing model affordable to low and lower-middle was undertaken of Goodlife’s category income “emerging” consumers management, a process that looks at groups of products as discrete business units and Kenya’s growing pharmaceutical market12 and the favorable customizes them according to customer needs.13 The regulatory environment for investors reinforced LeapFrog’s company focused on purchasing and maintaining a decision to invest. consistent supply of key, fast-moving items. As these products drove approximately 80 percent of sales, the Expanding the Team company was able to use its cash more efficiently and LeapFrog was a hands-on investor, bringing with it both increase sales conversions. Goodlife reduced the number of operational knowledge and relationships in the health care products—or stock keeping units (SKUs)—by nearly 50 market. Among the first things LeapFrog did was to further percent as a result. strengthen Goodlife’s management team. It first brought in a veteran health care executive, Amaan Khalfan, as CEO. 3. RENEGOTIATING SUPPLIER Prior to Goodlife, Mr. Khalfan worked with the Aga Khan CONTRACTS: Based on the new SKU list, University Hospital, one of the leading health care Goodlife renegotiated contracts with networks in Africa, where he led their outpatient clinic suppliers to optimize stock consistency, 6 selection, and margins. These contracts included new terms 6. IMPROVING LOCATION SELECTION AND and conditions regarding pricing, payment periods, expiry LOWERING ROLL-OUT COSTS: An policies, and delivery lead times. Today, all new orders go assessment tool was built to better evaluate through preferred suppliers that typically offer the best new store sites and accelerate roll-out. At the pricing. same time, Goodlife worked with key contractors to review costs for fitting out new stores and refitting acquired 4. STREAMLINING STAFFING: Store hours stores. This lowered fit-out costs by over 20 percent. and staffing were reviewed to improve efficiency. Goodlife implemented a staffing PHASE 3: EXPANSION AND format based on a formula that reflects DIVERSIFICATION volume of customers and when they frequent the stores. Goodlife also introduced a scorecard at the store level to With fundamental infrastructure and product offerings in improve performance, accountability, and customer service. place, Goodlife began to focus on expansion from various angles. In its next phase, Goodlife would make a big push 5. DECREASING RENTAL COSTS: Goodlife into Uganda, extend its reach to emerging consumers, and undertook a robust store lease analysis take steps towards its goal of becoming a health hub. exercise. As a result, Goodlife adopted a disciplined approach for new store expansion Expansion into Uganda and lease renegotiations across its store network. As Goodlife looked to develop its regional presence, Uganda emerged as a natural fit. The country’s economy and middle class were growing and the demand for pharmaceuticals was increasing. At the same time, 7 informal drug stores were common, and the Goodlife knew that customer insights on the emerging pharmaceutical market was flooded with low-quality consumer market would be critical, as 80 percent of its pharmaceutical imports, including those being distributed new stores would target this segment. Emerging consumers by “suitcase pharmacy distributors.” Goodlife launched its are typically considered to be in the lower-middle or first store in Kampala, Uganda’s capital, in 2016 and has low-income segments, most earning $2–$10 per day and since expanded to five stores—two in shopping malls and residing in densely populated, low-cost residential areas. three in middle-to-lower income neighborhoods. These consumers are price sensitive and typically choose to purchase lower quality medicines from informal retailers. Understanding Emerging Consumers Expanding to the emerging consumer segment had been But to make meaningful investment decisions, such as part of Goodlife’s goal from the onset. Given that emerging where to locate stores and what products and services to consumers represent an estimated 63 percent of Kenya’s 14 offer, Goodlife needed more granular market data—such as population, Goodlife recognized the business case for patient demographics, spending trends, disease patterns, expanding to this consumer segment and knew that this and chronic health history. By combining that with market would be important to its growth. data—such as rent prices and profile of supermarkets— Goodlife would be able to develop deep insights. Figure 2. Goodlife’s Store Formats STORE TYPE FLAGSHIP STORES CLASSIC STORES NEIGHBORHOOD STORES Customer Middle- to high-income Lower-middle-income to Low-income to lower- Segment middle-income middle-income Locations Higher-end shopping malls Shopping malls, plazas, and Co-located in petrol stations strips and shopping center parking lots, near bus stops and health clinics Store Size 100-120 square meters 70–100 square meters 30-50 square meters Employees • Pharmacist, pharm tech, other • Pharmacist, pharm tech, • Pharmacist, other staff staff other staff • Average staff: 1-2 • Average staff: 4-5 • Average staff: 2-4 Product Mix • Nearly 70 percent pharma • Nearly 75 percent pharma • Nearly 80 percent pharma products products products • Average SKUs: 81,000 • Average SKUs: 60,000 • Average SKUs: 48,000 Other • Flu vaccination • Flu vaccination • Flu vaccination services • Laboratory testing • Laboratory testing • Laboratory testing • Nutrition and clinical • Nutrition and clinical • Nutrition and clinical consultations (pilot stage) consultations (pilot stage) consultations (pilot stage) • Skin care consultations • Skin care consultations • Teleconsultations • Teleconsultations • Teleconsultations 8 Box 3. A Second Loan from IFC To get the data Goodlife needed, LeapFrog’s internal Consumer Centricity team developed and commissioned IFC’s second loan to Goodlife came primary surveys of over 5,000 emerging consumers. It in early 2018, totaling $3 million. found that emerging consumers want convenience, high The financing was aimed at helping quality products, good customer service, and better the company expand to 100 stores managed care in one location. Based on this research and in Kenya and Uganda, including both with support from LeapFrog, Goodlife would eventually the no-frills, prefabricated model in neighborhood implement quick monthly surveys at its stores on a regular locations, as well as larger stores in shopping basis. The surveys are conducted by pharmacy staff and malls. This aligned with IFC’s strategy to build the cover topics such pricing and customer experience. private sector’s role in increasing access to quality, Goodlife uses the data to continuously refine its product affordable health care for all through partnerships. and service offerings at different store locations. Goodlife Access to affordable, quality medication in would also partner with a company that conducts mobile emerging markets is a key aspect of this strategy. phone-based surveys with customers that pay via mobile IFC was able to offer Goodlife financing terms that phone. The surveys are conducted immediately after a included a flexible repayment schedule. customer makes a payment at a Goodlife store and therefore provide real-time customer insights. From Goodlife’s perspective, this additional financing from IFC came at an important time as Developing a New Format it allowed the company to leverage LeapFrog’s Choosing the right store format and location were also equity investment with debt from an existing critical to ensuring brand visibility and sufficient foot traffic lender. In addition to scaling the existing business, among emerging consumers. Up to this point, Goodlife had it is allowing the company to experiment with developed two store formats to serve its middle-and new services, such as telemedicine, while investing high-income customers, flagship stores, and classic stores in training and development, enhancing IT (see Figure 2). Stores targeting emerging consumers on the systems, and building a strong management team. other hand, would be small, no-frills locations—40 to 50 percent of the size of a classic store and a third of a flagship—but they would still have a modern feel and meet Goodlife’s high standards of quality. Each store would have a pharmacist or pharmacist technician on site. locations typically carry 60 percent of the SKUs of a Aptly calling them “neighborhood locations,” Goodlife flagship location, nearly 80 percent of their products were aimed to take pharmaceutical products to locations that pharmaceuticals. By late 2018, the number of neighborhood emerging consumers frequently visited. In addition to the stores would reach over 10 locations and cover low-income expertise of its retail and business development staff, areas in and around Nairobi, as well as peri-urban areas. Goodlife also considered objective criteria such as demographics, competitive landscape, accessibility by Staying Affordable public transportation, and revenue potential. It focused on Goodlife’s appeal was that it offered convenient modern locations near bus stations and health clinics, and—through stores, a good product selection, and that it kept products partnerships with Shell and Total—inside gas stations. in stock. To draw emerging consumers away from informal pharmacies, Goodlife began to offer upfront discounts and By the end of 2017, Goodlife had launched two neighborhood single unit medicine packs that cost significantly less than locations in low-income areas in Nairobi. While these full packs. Maintaining a sharp focus on controlling costs 9 was key to keeping products affordable for price sensitive unbranded medicine and physicians still have the emerging consumers. Measures included: tendency to prescribe brand names. As a result, a general preference for branded medicine persists. Goodlife • LOWERING CAPITAL EXPENDITURES (CAPEX) FOR pharmacists continue to educate consumers about the NEIGHBORHOOD STORES: Goodlife’s research on store similarities between branded and generic medicine. formats that serve low-income consumers indicated that it needed a flexible store model to respond to changes in Nearly two years after the launch of its first neighborhood the market. It introduced a prefabricated store concept store for emerging consumers, Goodlife had gained several which has enabled the company to lower CAPEX costs for important insights to serve this segment: new neighborhood stores. This model offers a four-week build and installation period for new neighborhood stores ▶▶ Understand customer demographics as emerging based on a simple design, compared to an eight to 12-week consumers differ from location to location period in a standard greenfield model. A major benefit of this approach is that Goodlife can close or shift a store ▶▶ Adapt the product mix and prices according to local quickly and at a relatively low cost if it is performing poorly. market characteristics • LOWERING OPERATING EXPENDITURES (OPEX) FOR ▶▶ Ensure staff are well trained, including across different NEIGHBORHOOD STORES: The prefabricated model store functions to provide adequate support also allows Goodlife to rent a small, fixed amount of space from a gas station or other convenient location. ▶▶ Focus on quality of service irrespective of the price of the This significantly reduces the monthly rent compared to product to build customer loyalty what Goodlife would pay if it rented an existing built out space for its neighborhood stores. ▶▶ Continuously educate the public on health and the importance of quality and authentic medicine through • LOWERING PRICES THROUGH BULK PROCUREMENT: sidewalk sessions, community camps, and outreach Economies of scale enable Goodlife to procure both activities to local churches and community groups prescription and over-the-counter medicine at competitive prices compared to small-scale chains or small mom-and-pop pharmacies. Also, by procuring directly from manufacturers and wholesalers, Goodlife cuts out numerous pharmaceutical sub distributors who drive up prices through additional mark ups. • OFFERING GENERICS: While all Goodlife stores carry both branded and generic medicine, many of its neighborhood store formats typically carry more generics. Providing generics for noncommunicable diseases such as diabetes and cardiovascular conditions is particularly important. The company has found that price-sensitive emerging consumers are typically more open to generics as these can be three to four times cheaper than their branded counterparts.15 However, the prevalence of counterfeits makes consumers wary of 10 Figure 3. Examples of Goodlife’s Primary Care Services LABORATORY TELECONSULTATION TYPE OF SERVICE SERVICES SERVICES What is Available • Have blood drawn (full blood count, • Collect medicine prescribed by doctors pregnancy, malaria, HIV testing) • Conduct video consults with doctor for acute • Take blood pressure health problems (flu, sinus infections, urinary • Test blood sugar tract infections, vomiting/diarrhea) • Assess body mass index • Drop off specimens (urine and stool) How it Works Phlebotomists use private spaces in Goodlife Option 1: Patient connects via mobile phone pharmacies to collect, store, and process lab app with a doctor who provides advice, samples for testing per guidelines prescribes medicines, suggests a video-based consultation at a Goodlife pharmacy, or provides a referral to a specialist Option 2: Patient visits a Goodlife pharmacy for a video-based consultation Becoming a Health Hub problem of unlicensed labs within pharmacies, which can Part of Goodlife’s original vision had been to become a lead to misdiagnosis and put patients at risk. “health hub.” It recognized that pharmacies are the first point of contact for many Kenyans seeking care, and that To offer teleconsultations, Goodlife partnered with a offering select health care services would be a key teleconsultation company to begin testing basic primary differentiator in the market. For customers who would care services. Cracking the teleconsultation market would otherwise travel great distances or spend a long time not be easy as people are accustomed to seeing doctors in waiting at a hospital or clinic for basic health care, this person, unsure about e-health technology, and concerned would mean improved access, convenience, efficiency— about the quality of care they may receive and the privacy and at lower cost. This is especially critical for emerging of their information. To combat these concerns, Goodlife consumers who can be vulnerable to falling back into ensures privacy by offering private spaces for poverty due to an illness. teleconsultations in its pharmacies, trains store staff to assist customers with the technical aspects of In 2018, Goodlife began to build health care services into its teleconsultations, and ensures that teleconsultation is business model by developing partnerships with health provided by licensed doctors. Goodlife is also piloting care providers that already had relevant services and face-to-face nutrition and clinical consultations with expertise. Goodlife would provide the physical doctors and nurses at select sites. infrastructure, that is, a private space within its pharmacies for the providers to deliver services (see Figure 3). For lab services, Goodlife partnered with Lancet Laboratories, a well-recognized leading provider of pathology services across Africa. Integrating reputable lab services into pharmacies was important for addressing the emerging 11 CONCLUSION has six million members, when it rolls out coverage which Goodlife is now the leading pharmacy brand in East Africa includes private outpatient pharmacies. and it continues to build its presence in Kenya and Uganda. It expects to reach 100 stores by 2021 and reach over 5.5 Goodlife is demonstrating that there is a business million people. opportunity to bring a modern, high-quality pharmacy experience to the emerging consumer segment. At the Increasing store profitability continues to be an important same time, the company is progressing in becoming a hub focus for Goodlife. By mid-2018, most Goodlife stores were for basic primacy health services akin to the path taken by profitable, with younger stores expected to break even as large pharmacy chains in other countries. Flexibility, they mature. The company is pushing top-line growth by continuous learning, and adaptation will be critical to driving foot traffic to stores, increasing sales conversions Goodlife’s growth and success as it navigates unchartered and basket size, and improving the average fill rate on each territory in serving the emerging consumers segment. prescription dispensed and the average number of prescriptions filled per day.16 It recently launched a national advertising campaign and began to reach out to general physicians to encourage them to talk to their patients about the importance of quality medicine. It has also launched insurance partnerships with more than five major private sector insurance companies to cover prescription medicine. Over time, the company also hopes to partner with Kenya’s National Health Insurance Fund (NHIF), which ENDNOTES 1 “Sustainable community pharmacy network launched in Kenya.” The 9 Students pursuing careers as pharmacists participate in a five-year de- Guardian. Accessed November 7, 2018. https://www.theguardian.com/ gree program, while those studying to become pharmacist technicians sustainable-business/2015/aug/26/sustainable-community-pharmacy- participate in a three-year diploma program. network-launched-in-kenya. 10 Fortune 2017. “Change the World.” Accessed November 7, 2018. http:// 2 Tai, Elaine. 2011. “Counterfeit medicines in Kenya.” Pfizer Global Health fortune.com/change-the-world/2017/. Fellows Program essay. https://www.pfizer.com/files/responsibility/ 11 Calber, Phoebe. 2017 “Goodlife Pharmacy, A True Health Partner.” Africa global_health/elaine_tai.pdf. Outlook, August 27, 2017. https://www.africaoutlookmag.com/outlook- 3 IFC internal documents. The last documented drug pricing study was features/goodlife-pharmacy. conducted by the Kenyan Ministry of Health (MoH) and the World 12 Pharmaceutical sales are forecasted to reach $1.41 billion in 2022, a Health Organization (WHO) in September 2004. compound annual growth rate (CAGR) of eight percent. Source: Fitch 4 “Josh Ruxin: Development expert and author of A Thousand Hills to Solutions. 2018. Kenya Pharmaceuticals and Health Care Report, Q4. Heaven.” Biography. Accessed November 13, 2018. Huffington Post. 13 Nielson Marketing Research. 1992. Positioning Your Organization to Win, 9. https://www.huffingtonpost.com/author/josh-ruxin. Chicago: NTC/Contemporary Publishing Group. 5 World Health Organization. 2018. Noncommunicable Diseases (NCDs) Country Profile. http://www.who.int/nmh/countries/ken_en.pdf?ua=1. 14 IFC internal reports. 6 Fitch Solutions. 2018. Kenya Pharmaceuticals and Health Care Report, Q4. 15 Information on estimated cost of generics provided by Goodlife. 7 IFC internal documents. 16 Basket size refers to the average number of items sold in a single purchase. 8 A recent World Bank study found low-quality medicines in clinics and pharmacies in Nairobi county. In the study, 17 percent of samples failed quality tests at the Kenya National Quality Control Laboratory. Gathura, Gatonye. 2018. “Fake drugs killing Kenyans as traders smile to the bank.” The Standard, July 1, 2018. https://www.standardmedia.co.ke/health/ article/2001286166/how-bad-medicine-is-killing-kenyans. 12 Stay Connected WEB: www.ifc.org/health LINKEDIN: www.linkedin.com/company/ifc-health TWITTER: #ifchealth For more information about IFC’s For more information about IFC’s focus on investments in health please contact: inclusive business please contact: Elena Sterlin Toshi Masuoka Global Manager, Health and Education Senior Advisor, Inclusive Business Email: ESterlin@ifc.org Email: TMasuoka@ifc.org Washington, D.C., USA Washington, D.C., USA www.ifc.org/heatlh www.ifc.org/inclusivebusiness www.ifc.org/education Chris McCahan Global Lead, Health Care Email: CMcCahan@ifc.org Washington, D.C., USA www.ifc.org/health 2121 Pennsylvania Ave. NW Washington, DC 20433 Tel. 1-202-473-1000