Healthcare - Lifesciences and Review Algeria

EXCLUSIVE INTERVIEW WITH ONCOLOGY: THE SCRAMBLE TO A MILESTONE
MESSAOUD ZITOUNI, HEAD OF A SPECIAL REPORT LOCALISE HEALTH REFORM

THE NATIONAL CANCER PLAN PAGE 48 PAGE 35 PAGE 26
PAGE 48
PRESSING AHEAD PAGE 23
ALGERIA FEBRUARY 2019

Acknowledgements
PharmaBoardroom is profoundly grateful to…
Djaouad Braham Bourkaib, former director general of social security
Senator Louisa Chachoua, president of the Health Commission at the Senate
Essam Farouk, president, El Kendi
Haissam Chraiteh, managing director, Sanofi
Loic Galmard, country manager, Janssen
Amine Sekhri, country manager, Roche
Mohamed L’Hadj, DG of health services and hospital reform
A. Gharbi, DG of LNCPP
Farid Benhamdine, president, Algerian Society of Pharmacy
Ismael Chikhoune, president of US-Algeria Business Council
Bachir Batel, Boehringer Ingelheim
The staff of the Ministry of Health, Population and Hospital Reform
for their continuous support, enthusiasm and encouragement in the

compilation of this report.
2 Healthcare & Life Sciences Review: Algeria www.pharmaboardroom.com

HEALTHCARE & LIFE SCIENCES REVIEW
ALGERIA
Messaoud Zitouni,
National Cancer Plan
Interview
48
CONTENTS
— February 2019
2 ACKNOWLEDGEMENTS
4 FOREWORD
5 PREFACE
8 SNAPSHOT IN FIGURES
12 REGULATORY REFORM INTERVIEW
Pressing Ahead Djaouad Braham Bourkaib, former director general
Cover story of Social Security
23 14 HEALTH PROFILE INTERVIEW
Louisa Chachoua, Senate Health Commission
16 DRUG REIMBURSEMENT REFORM
FEATURE Bourkaib’s Baby
17 PUBLIC HEALTH INVESTMENT CUTS
FEATURE Center Hospitalier-Universitaires
18 MEDTECH & INTEGRATION FEATURE
Sectoral Focus
20 MEDTECH & INTEGRATION FEATURE
Sectoral Focus
23 PRESSING AHEAD COVER STORY
26 A Milestone Health Reform
29 Tweaking the Regulatory Rulebook
Oncology
Feature 32 Industrial Policy: Strong-Arm Strategies
48 35 The Scramble to Localize
38 Fit for Export?
41 Going All Out in the War on Cancer
45 Magnet for Regional Headquarters
47 Who Dares, Wins
48 ONCOLOGY INTERVIEW Messaoud Zitouni,
National Cancer Plan
The Healthcare & Life Sciences Review was produced
by PharmaBoardroom. 50 ONCOLOGY FEATURE Novartis
Report Director: Roxane Höck 52 RADIOTHERAPY INTERVIEW

Senior Editor: Louis Haynes Mourad Belkheyar, Varian
Report Publisher: Diana Viola, Laurent Pichotzki-Libano
53 CEO PROFILE FEATURE Essam Farouk, El Kendi
Report Assistants: Lawrence Toye, Guillaume Le Maut
Editor: Patrick Burton 54 MANUFACTURING UPGRADES INTERVIEW
Graphic Design: Miriam León, Irene de Aza Sofiane Achi, El Kendi
For exclusive interviews and more info, please log onto 56 THE MIDDLE EAST CONNECTION INTERVIEW
www.pharmaboardroom.com or write to contact@focusreports.net. Malika Benmouffok, Tabuk Pharmaceuticals
Copyright: All rights reserved. No part of this publication maybe reproduced in any
form or by any means, whether electronic, mechanical or otherwise including photo-
57 COMPANY PROFILE FEATURE Saidal
copying, recording or any information storage or retrieval system without prior written
consent of Focus Reports. While every attempt is made to ensure the accuracy of the
58 INVESTMENT FEATURE The Middle East
information contained in this report, neither Focus Reports nor the authors accept any 59 LOCALIZATION STRATEGIES INTERVIEW
liabilities forerrors and omissions. Opinions expressed in this report are not necessarily
those of the authors. Haissam Chraiteh, Sanofi
61 SNAPSHOT IN FIGURES
www.pharmaboardroom.com Healthcare & Life Sciences Review: Algeria 3

Dear readers,
As Director General of Pharmacy and Health Equipment to the Ministry of Health,
Population, and Hospital Reform and former Director General of Social Security to the
Algerian Ministry of Labor, Employment and Social Security and current, I am proud to
introduce this exclusive report, Algeria Healthcare – Life Sciences. This report represents
an incomparable opportunity to precisely and fully showcase the capacity of the healthcare
industry and its stakeholders in Algeria.
Algeria, home of Africa’s fourth largest economy and second largest pharmaceutical mar-
ket, has built a system of socialized healthcare across its entire territory that guarantees
free access to any and all public health facilities to our citizens, all of whom benefit equally
from a social healthcare system that is unique to this region. Algeria is going to maintain
its commitment to bettering this system, with a focus on ameliorating the environment for
stakeholders in both the private and public sector.
The years to come will see to it that certain inherent defects in our healthcare system
are tackled, notably through the implementation of the new health law that will entail the
modernization of the management and financing of our system and the amelioration of
its performance and efficiency, whereas the social security system will see an extension of
its field of coverage, an improvement in the quality of its services, and a modernized, stable
financial strategy. We are confident in building a future that fully integrates the healthcare
sector and social security program within the national economy by virtue of our strategic
priorities, such as creating a stronger capacity to respond to the needs of the nation, the
development of the local healthcare export industry, and the integration of international
research and development sites.
To conclude this introduction, I would like to emphasize the fact that I see in this report
an opportunity to highlight the achievements and perspectives of the healthcare and social
security sectors in Algeria, and to cast a strong signal to the international community regard-
ing the potential of this country for investments and economic and scientific cooperation.
Happy reading,
Very cordially,
Djaouad Braham Bourkaib

Former Director General of Social Security - Ministry of Labor, Employment and Social
Security

Preface
Algeria, Africa’s largest country by area, was hit hard by the
global oil price slump of 2014. In terms of healthcare and the
life sciences, the state of the country’s weakened hydrocar-
bon-dependent economy meant that it was forced to shutter
plans to construct five brand new, state-of-the-art University
Hospitals (CHUs) and step away from a massive USD 262 bil-
lion 2015-19 public healthcare infrastructure renewal program.
A turbulent few years in the domestic industry has also seen
the enactment of a new, sweeping healthcare law and the impo-
sition of import restrictions on pharmaceuticals and medical
devices. Nevertheless, Algeria remains a promising investment
destination for the global life sciences industry, with a sizeable
local market and a growing number of multinationals choosing
to base their regional operations out of Algiers.
Topics covered in this report – which featured the exclusive
insights of government ministers, the heads of local pharma
champions as well as multinational affiliate leaders – include
the potential impact of the new healthcare law, the establish-
ment of a National Cancer Plan, global companies’ scramble to
localise manufacturing operations, an investment wave from
the Middle East, and Algeria’s ramped-up export capabilities.

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AMPLIFIED CONTENT IN BRIEF
@pharmaboardroom
MONCEF MEKLATI Algeria scraps plans for new hospitals, denting investor
General Manager North West confidence. #Algeria #healthcare #globalhealth #Africa
Africa, Merck, Algeria #investment #hospital #BigPharma
Read the article
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Algeria: Flouting IP to deliver cheap Hep C drugs -- we spoke
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to Rachid Kerrar from the Algerian firm @labobeker about their
General Director, Pierre Fabre development of a cheaper, generic version of @GileadSciences
Algeria #Hepatitis C treatment. #WTO #Algeria #hcsm #drugpricing
#regulation
Read the article
@pharmaboardroom
FARID BENHAMDINE
#Top20 Pharma Companies in #Algeria based on sales in 2017.
President, Algerian Society of @sanofi way out in front with $458.6 million in sales, followed by
Pharmacy (SAP) local champion @ElkendiPharma with $254.1 million and Danish
diabetes specialist @novonordisk with $239.1 million #BigPharma
See in detail
YAHIA AKTOUF @rym_fettouche

General Manager, Philips Sanofi inaugurated, October 11, the largest industrial complex
Healthcare Algeria; CEO, of pharma production & distribution in Africa ! Proud of this
acheivement for patients as a health journey partner. Thanks to
Aktouf Medical 400 guests, Media family who shared with us this historical day
for Sanofi in Algeria.

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We are ready to share their insights and experiences

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SNAPSHOT IN FIGURES
Economy
MACRO HEALTH INDICATORS

INDICATORS STATISTICS
Population (millions) 40.3
Population aged 0-14 (%) 29
Population aged 65 and over (%) 5.5
Median age (years) 28
Population living in urban areas (%) 71
Total fertility rate (per woman) 2.74
Birth rate (births per 1,000 population) 23
Maternal mortality rate (deaths per 100,000 births): 140
Infant mortality rate (deaths per 100,000 births): 20.3
Gross national income per capita (PPP USD): 15,000
Source: CIA World Factbook Data for year 2015/16
ALGERIA: INFLATION RATE FROM 2012 TO 2022* (COMPARED TO THE PREVIOUS YEAR)
Source: Statista; IMF
10.9%
9.1%
8.92%
7.6%
7.4% 7%
6.4% 5.59%
3.26% 4.78%
2.92%
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
ALGERIA: BUDGET BALANCE BETWEEN 2012 TO 2022* IN RELATION TO GDP

0%
0%
-0.4%
-2.5%
-2.06%
-3.71%
-5%
-4.44% -4.65%
-7.5% -6.44%
-7.3%
-7.87%
-10%
-12.5%
-13.13%
-15%
-15.28%
-17.5%
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Source: Statista; IMF

SNAPSHOT IN FIGURES
Pharma
TOP 20 PHARMA COMPANIES TOP 20 LOCAL PHARMA MANUFACTURERS

IN ALGERIA IN ALGERIA
Source: IQVIA Sales for 2017 (USD millions) Source: IQVIA Sales for 2017 (USD millions)
1 SANOFI 458.6 1 EL KENDI 254.1
2 EL KENDI 254.1 2 MERINAL 104.4
3 NOVO NORDISK 239.1 3 SAIDAL 85.0
4 HIKMA PHARMA 167.3 4 PHARMALLIANCE 84.9
5 GLAXOSMITHKLINE 150.6 5 BEKER 79.3
6 PFIZER 112.3 6 BIOPHARM 67.9
7 MERINAL 104.4 7 BIOGALENIC 45.4
8 SAIDAL 85.0 8 BIOCARE 40.2
9 PHARMALLIANCE 84.9 9 INPHA-MEDIS 36.6
10 BEKER 79.3 10 VITAL CARE 29.4
11 ASTRAZENECA 73.1 11 HUP PHARMA 28.4
12 BIOPHARM 67.9 12 ABD.IBRAH.REMED.PH 25.1
13 MERCK SERONO 58.8 13 LAD PHARMA 24.8
14 ROCHE DIANOSTICS 57.7 14 PHYSIOPHARM 21.8
15 MSD 54.7 15 LDM 20.7
16 NOVARTIS 53.8 16 SOPHAL 18.5
17 ASCENSIA DIAB.CARE 48.9 17 NEOMEDIC 15.0
18 LIFESCAN 46.8 18 GENERIC LAB 13.8
19 BIOGALENIC 45.4 19 MM 13.0
20 IPSEN 44.2 20 NADPHARMADIC 12.9
ALGERIA TOTAL PHARMA MARKET GENERIC PENETRATION IN ALGERIA (2017)

GROWTH 2013-2017
(USD billions) Source: IQVIA
(USD billions) Source: IQVIA
4.11
3.66 0.51
3.32 3.48
3.22
Sales 1.66
1.31
Generic products Non categorized

Non generic products products
2013 2014 2015 2016 2017

SNAPSHOT IN FIGURES
Health Infrastructure
HEALTH BUDGET 2013-2017 DOCTORS PER 1,000 INHABITANTS IN NORTH

AFRICA (2018)
Source: Algerian
Ministry of
(USD billions)
Finance 2.11 Source: World Health Organization
3.5 2.15
3.19 3.15 3.28
3.02 1.95
1.39 1.39
3
1.75
2.56
2.5 1.55
1.35
2
1.15
0.71
1.5 0.95
0.75
1
MOROCCO
ALGERIA
TUNISIA
0.55
EGYPT
0.5 0.35
0.15
0
2013 2014 2015 2016 2017 0.00
PROPORTIONAL MORTALITY IN ALGERIA
10%
Injuries
36%
15% Cardiovascular
Communicable, diseases
maternal,
perinatal and NCDs are
nutritional estimated to
conditions account for 76%
of all deaths
19%
Other NCDs
13%
4% Cancers
Diabetes
3%
Chronic respiratory diseases Source: WHO

SNAPSHOT IN FIGURES
Timeline
EVOLUTION OF ALGERIAN PHARMACEUTICALS AND HEALTHCARE SYSTEM
2018 Passing of the new Sanitary Law
Implementation of the ANPP 2017
2016 Adoption at the ministry council of the healthcare

law and submission to the parliament
MOU signed by PhRMA’s members and Government’s five year plan (2014-19) announced
government for implementation of Vision2020
2014 with healthcare again a priority
Contracts awarded for construction of five
new University Hospital Centres (CHUs)
Creation of National Agency for Health Equipment

2013 and Management of Health Infrastructure (AREES)
charged with supervision of new healthcare
infrastructure
‘Algeria Vision 2020’: Algerian-US strategic President Bouteflika decrees the launch of a
partnership to render Algeria a biotech hub
2011 ‘National Cancer Plan’
Government’s 5-year plan (2009-14) declares

2009 €5.69 bn to be invested in healthcare
Extension of the 49-51% Joint Venture rule to Creation of ANPP: National agency for
pharmaceutical sector
2008 pharmaceutical products
Ban on imports of domestically produced Creation of the National Laboratory for Control of
1994/5
pharmaceuticals Pharmaceutical Products (LNCPP): birth of a fully
Pharmacists empowered to switch doctor’s functional regulatory apparatus
prescriptions for generics
Central Pharmacy for Hospitals (PCH) set up to
1994 coordinate and streamline the procurement of state
hospitals
Liberalization of the pharmaceutical sector:

1991 private exports allowed for first time
Private healthcare provision permitted for first time 1988

Creation of Saidal, state-owned national
1982 pharma company, taking over the PCA’s
production assets
Creation of the Algerian Central Pharmacy (PCA):

with a monopoly on importation, Manufacturing
1962
and distribution of the human pharmaceutical
products Source: Ministry of Health

REGULATORY REFORM
Djaouad Braham Bourkaib,
Former Director General of Social Security
BECOMING AN
EXAMPLE FOR
THE REGION
Djaouad Braham Bourkaib former director general
of Social Security, outlines the Algerian national pol-
icy of health expense reimbursement, weighs in on
the country’s increasing embrace of pharmacoeco-
nomics and foreground the importance of transpar-
ency.
HCLS: What can you tell us about the Algerian

national policy of health expense reimbursement? DJAOUAD BRAHAM
DJAOUAD BRAHAM BOURKAIB (DBB): We BOURKAIB
are acutely aware of the importance of explaining the FORMER DIRECTOR GENERAL OF
process in detail to our partners across the healthcare SOCIAL SECURITY
and life sciences spectrum. We understand that this
kind of transparency and clarity is at first very much
in the interest of patients and in that of the national drugs for 3 months of treatment worth thousands
social security and the national economy. of dinars, and go back home without having to pay
Algeria has been expanding the scope of its pub- anything whatsoever. This is absolutely unique in the
lic health offering across all services related to drugs North African region.
and medication. Over 14 million people now hold
a CHIFA card, which is an electronic card for every HCLS: How does the Social Security practically
socially insured person. Often, each household has one juggle tasks like price setting and health technolo-
CHIFA card covering all family members. As a result, gy assessment in a manner that is perceived as fair,
more than 38 million people can actually benefit from objective and scientific?
national social insurance. Drugs are very much our DBB: Regarding the “regular” procedure, our eval-
strong suit, as we implemented a generalized third-par- uation is based on the following elements: each newly
ty payment system under which patients do not pay a registered product is auditioned by an interdepart-
single penny when they go to their pharmacy especial- mental committee led by the Ministry of Labour with
ly those that are suffering from chronic illnesses, with the members coming from the Ministry of Health, the
very few exceptions. Department of Commerce, the Social Security, the
Meanwhile, there are over 11,300 pharmacists across Laboratory of Control and the Laboratory of phar-
the entire Algerian territory. Every single pharmacy maco-vigilance. There is an evaluation grid, the drug
is registered with the CNAS (for employees) and the is registered and authorized on the Algerian market,
CASNOS (for independent workers). All of these phar- but the funder needs to evaluate the medical service
macies are equipped with specific software programs rendered or the improve the service if other refundable
for drug reimbursement, meaning that they possess drugs of the same therapeutic class or the same indi-
card readers and can invoice electronically. Concretely, cations are available before they decide to reimburse it.
patients with illnesses such as diabetes can go to their If that medical service is sufficient, then we take the
pharmacy with their prescription, get the necessary next step, which is asking whether the corresponding

REGULATORY REFORM
Djaouad Braham Bourkaib,
Former Director General of Social Security
illness is already covered by other drugs. Presuming when a reimbursed use of the drug is based on special-
that is the case, we verify if the service rendered is more ist prescriptions.
interesting. Obviously, our evaluation is also based on
the level of evidence and the sources of evidence-based HCLS: Last time we met, you wanted to strength-
information (institutions), the healthcare profession- en your pharmacoeconomics expertise. Where are
als’ and experts’ judgment and the documents provid- you on that?
ed by the pharmaceutical companies. We also quan- DBB: We contacted renowned universities in Algeria
tify the improvement of medical services rendered to set up new academic programs in that field. There
and label it on our scale: major, important, moderate, is also a Higher School of Social Security, and we are
minor, none. We generally decide to reimburse the considering setting up a master’s degree in pharma-
drugs that are labeled moderate and above. coeconomics, with the help of Algerian experts work-
It can happen that we negotiate the price with the ing abroad, among others. That is the first step.
manufacturer, even though that step was already cov- Regarding our expertise in the evaluation of med-
ered previously. It is always well founded for the Social ical service rendered, we work with the case file of
Security to negotiate if it can ensure public interest, the applicant, but we also invested a lot into our
while at the same time ensuring win-win deals to our documentary database that compiles and collates
partners. The industry understands our intentions, so every serious and significant scientific study from all
most of the time they do their best to find common around the globe. This database is updated month-
ground. Now, in the case of a drug with no proven sig- ly, so that we have visibility when it comes to drug
nificant improvement of medical service rendered, if assessment and critical analysis. Our role is also to
it is imported and more expensive than other similar track the real effects, on the ground, of the drugs that
drugs that are produced on the territory, we have to are subject to a performance contract.
refuse to reimburse them. The other solution, that hap-
pens in general, is for the manufacturer to align his
prices with the reference class price. THE WAY WE DO TRANSPARENCY
AND RISK SHARING IN ALGERIA
HCLS: How do you define reference class prices? COULD BECOME AN EXAMPLE
DBB: Those reference class prices are median prices
between original drugs and generics. This is a way to en-
TO FOLLOW
sure coverage of the market by several brands, to prevent I say that, providing the system proves itself without
shortages. We launched that system in 2008. Sometimes, the seller feeling wronged, the way we do transparency
the laboratories set their price a bit higher, the remainder and risk sharing in Algeria could become an example to
is then at the expense of the patient. Generally speaking, follow. Our Healthcare system is important, Algeria has
we encourage the laboratories that are really interested many physicists and doctors across its territory, it will
by the Algerian market to make an effort to reduce that become even more of an inspirational system to other
amount to a minimum. One must never forget that a countries in the future. We are new in the field of phar-
great many Algerian citizens, typically the ones with a maceutical contracts between pharmaceutical compa-
chronic disease, cannot afford the expense. nies and social security, but we are working hard on
We had to deal with certain products that would this. It is very important for our patients, for our econ-
bring interesting improvement of medical service, but omy, for the country as a whole. Presently, and may-
only on 1 out of 3 indications for instance. We used be unfortunately, the priority regarding the Algerian
to add them to our lists with certain conditions. Then Social Security remains its budgetary balance, and the
we started to discern in a more sharpened way, and to impact of reimbursement on the financial capacity of
reimburse solely when prescribed for the 1 indication the Institution. This accounting vision will soon give
with a proven improvement of medical service. Now, way to a more analytical vision. Contractualization,
the manufacturers are handed a document that states meanwhile, will allow for a wider, holistic approach of
specific conditions for reimbursement, in particular the evaluation.

HEALTH PROFILE
PREVENTION
BETTER THAN
CURE
President of the Health Commission at the Algerian
Senate, Louisa Chachoua explores recent changes
in Algeria’s healthcare sector, the potential of the
new drug agency, and Algeria’s capacity to become
a flagship health system for the region.
Louisa Chachoua
SENATE HEALTH
COMMISION
HCLS: What are the main challenges currently Application decrees are very much necessary, because
facing healthcare in Algeria? we want that bill to be efficient. What to start with?
LOUISA CHACHOUA (LC): When it comes to There are emergencies indeed. I personally think that we
our healthcare system, Algeria has achieved a lot of must first, and it is a huge project, digitalize our infra-
things, but still has to face a few obstacles. This is the structure. Big Data is key to everything. Medical prior-
context around the new Health Bill. There are new itization comes second, as it is the cornerstone of an
things in this new bill. The state has reaffirmed free efficient healthcare system. I think that our regional dis-
care and health protection in the public and private tricts can drive the system, coordinate at first every med-
sectors. Amongst the new features, we introduced pri- ical specialty through regional hubs, where our public
oritization of care, a referring doctor system and home health specialists could play a key part. Then, given the
care. We also introduced the “public institution with inequality between the South and the North of Algeria,
specific management” status for public hospitals and we probably will have to resume the program to build
implemented a new audit system for our structures. University Hospitals in the South, as there are none yet.
We created a National Agency for the Promotion of To staff the new hospitals, we will need to train the peo-
Best Practices. We introduced digitalization, through ple from that region so that they stay.
the new electronic card and the dematerialization of
patient files. We added a new integrated health infor- HCLS: What about contractualization?
mation system. We updated the ethical rules in the LC: It will be a way to clarify the issue of how to fi-
field of organ and tissue transplantation, even if there nance everything. In the bill, the State, the CNAS, the
remains some work to do in that regard. Pharmacy social Security and a few others finance everything.
related regulations have also been updated. We re-de- Everyone participates. With the new bill, the CNAS
veloped our communicable disease prevention pro- money will go to the social security beneficiaries. So
grams. We also added the promotion of exchange and what about the people who are not covered? How can
twinning between health facilities. Finally, we created we conceal that with the obligation to cure everyone? To
a National Council and a National Observatory of me, it appears that we will continue to offer care to the
Health. All these new measures are welcome, and car- have-nots, and the people who can afford it will be able
riers of change. to cover for the expense and take a private insurance if

HEALTH PROFILE
instance. That system is actually build some new modern infrastruc-

pretty efficient, although we need ture, buy equipment and develop
to improve working conditions and research and training.
incentives. We do have good results, let
us keep it that way. Patients are
HCLS: You have been in favor demanding, healthcare science is
of new drug and health national improving, there are new technolo-
agencies for a long time. Are you gies for which we need the economic
satisfied with the outcome of the means.
bill in that regard?
LC: The new drug regulation HCLS: Where should the focus
agency is yet to be created. I will be on in terms of rationalizing
be happy when it is born, and in- expense?
dependent from the ministry’s LC: I believe that we need to
authority. Currently, marketing focus on prevention and emergen-
authorization is granted by the cies, prevention is better than cure,
Ministry of Health, and refund- and modern diseases require talent-
ing is provided by another, and ed and efficient emergency services.
that is the source of all our prob- Algeria has implemented very
lems of bureaucracy. The national good prevention programs, that we
they want. Contractualization will drug agency must be implemented, keep updating and adapting to the
allow for this to happen, provided staffed correctly, and its processes modern environment.
it is codified. must be set up properly.
Another issue will be that of pric- We are happy with everything in HCLS: What is the role of pri-
ing. Today, Algerian patients are that Bill, but we are still awaiting vate companies in that regard?
refunded following a pricing chart the secondary regulation. LC: The same than in the other
that was established 32 years ago. So countries: they can participate in
we need to update that. HCLS: How is Algeria dealing research and training programs.
with the country’s epidemiolog- After all, they are the ones with the
HCLS: What is your opin- ical transition? money. We need the conditions to
ion about the new Ministry of LC: Algeria made very concrete attract international interest, so
Health’s approach? progress, today we harvest the re- they can spend their money here.
LC: The new Health Bill was sults of all our past efforts: we
born of the continuity between eradicated malaria and poliomyeli- HCLS: What do you aim to ac-
Ministers. We would like it to be tis and all such diseases. The means complish in the field of Health
fully enforced because it will en- are more important, that is why we by the end of your term?
hance the situation. We had a lot have a National Cancer Plan, we LC: I am happy that a lot has al-
of discussion about voluntary and work also on non-communicable ready been accomplished, and now
therapeutic termination of preg- diseases. All of that is costly and we have several priorities to address:
nancy. We are waiting now for the require infrastructure, moderniza- financing and rationalizing the ex-
application decree, so everything tion, and so on. The more money, pense are key to our program, so
is explained. Also the civil service the better result. that we can develop prevention
was discussed: every young doc- Nowadays, Algeria spends 900$ programs and emergency services.
tor has to spend some time in the per capita in healthcare, and I Then we will address training and
civil service to participate in the believe it not to be enough. We will research. Provided we do that, we
national interest, and help in the need to spend more and above all will have accomplished a great step
fight against medical deserts for spend the money more rationally, ahead.

DRUG REIMBURSEMENT REFORM
Bourkaib’s Baby
TOWARDS AN ALGERIAN
HTA SYSTEM
A
lgeria is in the midst of a transformation in adopt a transparent pharmaceuticals selection pro-
its techniques for deliberating drug reimburse- cess. We plan to harness the expertise of health econ-
ments. The country is endeavoring to embrace omists as a complement to that of clinicians to gain a
Health Technology Assessment (HTA), where- more holistic perspective for the drug reimbursement
by both the directly intended as well as the indirect effects committee.”
of a treatment are considered in evaluating its merits. The concept of pharmacoeconomics in an Algerian
Rather than taking the drug’s price and the patient num- setting, while seldom observed, is not completely alien.
bers in isolation, a more holistic approach to the overall In as early as 2008, a new system was introduced utiliz-
effects is taken. According to Professor Tom Achoki, clin- ing data to create classes of molecules with equivalent
ical assistant professor at the University of Washington, health performances. For Dr Bourkaib, “this process
“health technology assessments that factor in both the has been a resounding success. Consider statins, where
socio-economic and clinical outcomes will be of consid- certain molecules were up to four times more expen-
erable assistance to the Algerian public and will ultimate- sive than others. Using sophisticated meta-analyzing,
ly empower the state to sustain the sort of progress that factoring in the performance regarding care, such as
has already been attained over the past 25 years.” reductions in cholesterol, social security succeeded in
The man championing this initiative is Dr Djaouad applying identical reimbursement base rates to mole-
Brahim Bourkaib, former director general of Social cules of similar effectiveness.”
Security at the Ministry of Labor, Employment & Social Nonetheless, expanding the presence of HTAs across
Security. In his own words, “Our existing drug evalu- the Algerian system will be challenging. In the words of
ation system has allowed us to function adequately in Dr Bourkaib, “Pharmacoeconomics is a new discipline
the past but is no longer fit-for-purpose”. He continues, for the Algerian state. As late as 2014, our economic
“Medical science has witnessed great advancement with evaluations of pharmaceuticals are in most cases limit-
the development of new categories costly but effective ed to simple reviews of the cost structure between orig-
biologics, meanwhile Algeria has undergone significant inal products and generics”. Thus, Dr Bourkaib con-
epidemiological changes.” cedes that “it has been a steep learning curve”.
While the focus on HTA is critical for the sustainabil-
ity of the Algerian social security system, Dr Bourkaib
OUR EXISTING DRUG EVALUATION is quick to point out that this must not be the only
SYSTEM HAS ALLOWED US TO FUNCTION string to the bow, as one must factor in national spe-
ADEQUATELY IN THE PAST BUT IS NO cificities into financing social security. “Experts who
LONGER FIT-FOR-PURPOSE work in Algeria agree about the significance of patient
Djaouad Bourkaib FORMER DIRECTOR GENERAL, education: the perceived failure of a conventional
SOCIAL SECURITY
therapy does not necessarily mean that the drug itself
For Dr Bourkaib, Algeria has a fantastic opportu- has failed. Perhaps instead drug adherence behavior
nity to embrace the concept of pharmacoeconomics: is low, or patients are failing to properly administer
evaluating the overall value of one drug with another their medicines as prescribed”. Consequently, Algeria’s
based on the weighting of a number of factors includ- future drug selection techniques must also account for
ing price and patient outcomes. “We can refine the such behavioral failures should it truly embrace HTA
criteria for integrating new medical innovations and and pharmacoeconomics.

PUBLIC HEALTH
INVESTMENT CUTS
Center Hospitalier-
Universitaires
REALITY BITES: THERE CAN

PLIGHT OF THE BE NO DOUBT
TURNKEY CHUs THAT BUSINESS
CONFIDENCE
TOOK A BIT OF
A KNOCK WHEN
The global drop in oil prices in 2015-2016 hit the Algerian economy –
which is heavily reliant on petroleum revenues – hard. The country’s
THESE HIGH-LEVEL
government implemented swingeing economic cuts across a number COMMITMENTS
of sectors – including healthcare – to redress the balance, shuttering WERE SUDDENLY
plans to create five new hospitals. With the multinational companies
commissioned to deliver these projects now in limbo, doubts remain DITCHED.
T
about the investability of Algeria’s healthcare sector.
he spill over of austerity measures into the Algerian life science

domain was finally confirmed with the dramatic announcement
of the indefinite postponement of the construction of five flag-
ship new-build Center Hospitalier-Universitaire (CHUs) with
reception capacities of between 500 and 700 beds that were to be established
in Algiers, Tizi Ouzou, Tlemcen, Ouargla and Constantine respectively.
“The intention had been to commission top multinationals to deliver
these turnkey university hospitals and contracts had actually been signed
to that effect. However, due to the dramatic fall in the price of oil, which
comprises 98 percent of state revenue, the government felt it had little
choice but to freeze these big-ticket infrastructure items,” explains Ismael
Chikhoune, president of the US-Algeria Business Council (US-ABC).
Some stakeholders have been concerned as to the message such actions
send out to the international investor community. “There can be no doubt
that business confidence took a bit of a knock when these high-level commit-
ments were suddenly ditched. The incident is frankly emblematic of the kind
of risks you can encounter when doing business in this country. Thankfully,
however, the impact was limited mostly to the hospital construction and med-
ical equipment segment and there was no real contagion effect to other busi-
ness sectors such as pharma,” recalls Marko Ackermann, director general of
the German-Algerian Chamber of Commerce and Industry (AHK).
Others, such as former health minister Messoud Zitouni, see the develop-
ment as a blessing in disguise. “I personally feel that grandiose plans to create
as many as seven new CHUs were hyped up in a way that was misguided. It
was presented almost as a silver bullet. One or two additional university hos-
pitals would doubtless be helpful for augmenting the capacities of our health-
care system, but seven would likely have been very difficult to assimilate and
manage efficiently. Merely appealing for additional hardware is too simplistic
and risks misdiagnosing the underlying root problems that we need to fix,
which are a shortage of hospital management professionals and the irrational
and wasteful deployment of the existing resource base,” he shrewdly posits.
Healthcare & Life Sciences Review:
www.pharmaboardroom.com Algeria 17
MEDTECH & INTEGRATION
Sectoral Focus
GE HEALTHCARE
READY TO USHER
IN A BRAVE NEW
ERA OF MOLECULAR
IMAGING IN ALGERIA
GE Healthcare’s relationship with Algeria has

long been a special one. The American med-
tech giant stands out as having been the
first medical device company to have had the courage to
for a country in the grip of an epidemiological transition
from infectious diseases to non-communicable, chronic
conditions with the prevalence of cancers, cardiovascu-
lar pathologies and degenerative disease skyrocketing
establish direct operations in Algeria back in 2008 and year-on- year.
now boasts an in-country, on-the-ground footprint of Ferdjioui, himself, remains passionate about mobilis-
no less than 160 personnel, 50% of whom are dedicated ing GE Healthcare’s capabilities from around the world
to services and spread across the headquarters in Algiers, to help shift the paradigm of treatment pathways in
and regional hubs in Oran and Constantine. Moreover,
the company has designated Algeria as the centrepiece of
its Maghreb-wide operations and presides over a share of
as much as 59% of local healthcare equipment market.
The company’s next venture, however, counts as the
most ambitious yet. “We recently delivered the very first
cyclotron in Algeria to a private hospital in Tizi Ouzou’s
Chahids Mahmoudi Hospital and are going to follow
that up by inaugurating the first cyclotron in a public
hospital in the coming months,” proudly reveals Mehdi
Ferdjioui, general manager for North West Africa.
“These events are no small matter as they effectively
change the rules of the game by ushering in a brand new
‘molecular era’ in the diagnosis and treatment of can-
cers,” he exclaims.
“Thanks to these investments, Algerian doctors will
now be able to follow the evolution of tumours and
deploy targeted radiation against the cancerous cells
with greatly positive repercussions for patients’ progno-
ses. Indeed, in each and every country that has imple-
mented these changes to date, we have witnessed a sig-
nificant reduction in mortality rates so there is a massive MEHDI FERDJIOUI
dividend to be accrued from the patient perspective,” GM, GE HEALTHCARE
affirms Ferdjioui. This is doubtless very welcome news

Sectoral Focus
Algeria more towards personalised precision medicine we not only possess a strong vision for the future, but
and early disease identification. “Precision health is we also tangible offerings fit for today. Our goal is thus
about using personal genetic, biological and bacteriolog- to harness breakthrough, paradigm-shifting technolo-
ical data and linking them to medical images, another gies such as Artificial Intelligence (AI), with data from
form of data, to provide individualized healthcare,” he across our portfolio, to create information to improve
explains. patient care in a more targeted and individualized man-
He believes that data is fast becoming the “new curren- ner,” reveals Ferdjioui, pointing to an array of new appli-
cy” of enlightened healthcare provision. “My background cations and smart devices built on Edison, a platform
in biology allows me to see the bigger picture and the that helps accelerate the development and adoption of
nexus between the pharma and medtech sectors. At the AI technology and empowers providers to deliver faster,
global level, GE Healthcare has signed a worldwide part- more precise care.
nership this year with Roche Diagnostics, the leader in “Edison is part of GE Healthcare’s $1 billion and grow-
in-vivo and in-vitro diagnostics. The reason for this part- ing digital portfolio and will serve as a ‘digital thread’ for
nership is a no-brainer: medical imagery combined with our existing AI partnerships and products. Clinical part-
biological diagnostics will deliver up a much more com- ners will henceforth use Edison to develop algorithms,
plete picture of organs by layering together the physio- and technology partners will work with GE Healthcare
logical structure and molecular mechanisms. This is very to bring the latest advancements in data processing to
much the future of healthcare that business leaders like Edison applications and smart devices,” he reveals.
myself have a duty to prepare Algeria for,” he affirms. How can such cutting-edge methodologies possibly
Already there have been some concrete steps in that be applied to a young, albeit maturing marketplace like
direction. In an increasing volume of Algerian hospi- Algeria? “It’s worth remembering that in emerging mar-
tals, digitalization has been improving imaging perfor- kets like this, there are often excellent opportunities
mance, workflow optimization and clinical collabora- to leapfrog forward and start adopting state-of-the art
tion enhancement, as well as services. For example, GE techniques and technologies, because more often than
has implanted a team specifically dedicated to remote not you can start from a blank page and are not ham-
maintenance, which now handles some 30% of ‘fix-it pered by the fact you need to rewire existing unsuitable
assignments,’ while 90% of the company’s in-country infrastructures… that is precisely why you should not be
installed based is digitally connected. at all surprised to encounter elements of the entire GE
“As a major healthtech multinational, GE’s digital portfolio out here right from simple ECGs to complex
journey is well underway and we now feel confident that cyclotron particle accelerators,” muses Ferdjioui.
Stronger together
for better health
in Algeria.
gehealthcare.com

Sectoral Focus
BOOM TIME FOR

YAHIA
AKTOUF

MEDICAL DEVICES
general
manager,
Philips
(AND INTEGRATION SERVICES)!

Healthcare
KAMEL
With its weighty population size, vast expanse of territory, a maturing public BOUZID
healthcare apparatus and an increasingly prominent epidemiological shift towards
chronic disease, Algeria naturally presents rich pickings for ambitious medical president,
Algerian
technology groups able to provide the sort of diagnostic and integration capabili- Society of
ties as well as the underlying infrastructure for the country’s emerging healthcare
T
Medical
continuum to hang together. Oncology
“ he Algerian medtech market

is today composed of some
3,500 different private enti-
four years of close partnership, the mar-
ket share has blossomed from 3% to 14%,
which is quite an achievement and illus-
ties, which constitutes a dra- trative of the sorts of successes that can be
matic increase in size and variety within leveraged by a serious medtech player in a
a surprisingly short timeframe,” confides market like Algeria where there is so much
Yahia Aktouf, general manager of Philips to do and therefore still so much potential
Healthcare Algeria and the founder–CEO for growth,” elaborates Aktouf.
of home grown medtech player, Aktouf Where, then, are the primary opportu-
Medical. “If you compare the 1990s with nities for business? “Today, the main seg-
today, the transformation has been pro- ments to address are cancer and cardiol-
found when it comes to the evolution of ogy, and we have made it our priority to
medical infrastructure and the sheer scope remain a trusted partner in responding
of activity for medical device companies. to these needs: especially in intervention-
Much of this has, of course come about on al cardiology, where Philips stands proud
the back of the considerable and sustained as a world leader and industry shaper… In
commitments made by both the state and short, we have been instrumental in play-
private investor community, in spaces like ing our part in the roll out of the nation-
radiology, cardiology, and imagery where al cancer plan and, as such, have been
the level of need has been exceptionally responsible for equipping three of the new
high,” he explains. anti-cancer centres: namely the Tlemcen
The arrival of Philips Healthcare is per- centre, Sidi Bel Abbès Hospital which is
haps emblematic of how Algeria’s medtech still a work in progress and the Hospital in
segment has managed to rapidly profes- Bechar. Alongside all of that, we are simul-
sionalize, within the period of only a few taneously maintaining a strong presence
small years. “I founded Aktouf Medical across military hospitals and private clin-
back in 1992 and have grown the company ics,” he explains.
to a workforce of 45 specialist personnel, Even latest generation, pioneering med-
80 percent of whom constitute top-level tech innovations are now finding their
engineers and all of whom are certified by way into the Algerian marketplace. Indeed
Philips Healthcare… When we first teamed Philips’ game changing and disruptive
up, Philips held a very small, almost insig- MRI technology – Ingenia Ambition – that
nificant share of the market, but, after only requires only 7 litres of helium instead of

Sectoral Focus
the usual 1,000 litres will be intro- “This is where professional train-
duced to the country during the ing becomes absolutely critical,”
course of 2019, while PET-scans are agrees Aktouf, “because the final
now available to many Algerians, well users of our equipment always need
before being unveiled in neighbouring to be skilled accordingly if we are
markets like Tunisia or Morocco. to actually attain the clinical, medi-
“What is particularly noteworthy cal and financial outcomes that we
about our 7-liter MRI is that it delivers envisage and promise.” For this rea-
a triple win: for the patient, the health- son, the Aktouf Medical – Philips
care system’s financial viability and for Healthcare partnership places par-
the developer,” points out Arktouf. ticular emphasis on the “after-sales”
“The services attached to it and their component. “Together with Philips
costs become necessarily lighter than Communications and our insid-
on a 1,000-litre machine, at least with er knowledge of Algerian customs,
regards to helium and maintenance we bring an important added value
expenditure. Meanwhile, the flow to the country’s health profession-
and rapidity of image acquisition are als by investing heavily in our engi-
noticeably better, which allows for an neers, training them and deploying
increase in the number of patients them on field missions so as to con-
treated every day, thus delivering an tribute to the cross-pollination of
enhanced solution at a cheaper cost. talent. In conjunction we have also
This is the very essence of the Aktouf taken the explicit step of decentraliz-
Medical-Philips value offering and we ing our operations so as to have hubs
are overjoyed that the Algerian market of technical expertise in all 4 direc-
is proving so receptive to such enlight- tions: north, south, east and west. By
ened solutions.” attaching our engineers to each of
Practitioners like Kamel Bouzid, them, we can simultaneously provide
president of the Algerian Society of our clients with rapid responses in
Medical Oncology, are quick to high- O&M whenever they should need us.”
light, however, that hardware alone Moreover, the company has been
will not solve his country’s significant partnering with the authorities in
needs in diagnostics and preventative initiatives to connect up hospitals
healthcare. “The situation is much and alleviate skill set gaps like a defi-
improved in terms of base infrastruc- cit of qualified radiologists. “Many
ture and equipment because we now University Hospitals in the north have
possess radiotherapy accelerators not only signed conventions with
and fully-fitted, dedicated anti-cancer hospitals in the south, but also with
centers. The urgency is very much in hospitals in France (Lille, Strasbourg,
sourcing the doctors, occupational Marseille and so on) under a process
therapists, physical therapists, radio called twinning. This is of major great
physicists and other specialists trained added value to the patients, as their
to staff and operate such facilities doctors can pool ideas in their inter-
otherwise we risk creating white ele- pretation of medical tests and can
phants. From a material perspective share their experience. We are fully
we are getting there but there are still involved in that effort, and are seek-
many gaps when we consider human ing to develop this process as quickly
capital,” he muses. as possible,” he confirms.

COVER STORY
Pressing Ahead

ALGERIA
PRESSING AHEAD
Given Algeria’s strong dependency on hydrocarbon ex- mission, pointing to the overnight shelving of plans
port receipts, it was perhaps inevitable that the 2014 to construct five brand new, state-of-the-art University
global oil price collapse – which halved the nation’s Hospitals (CHUs) and the shuttering of an eye-watering
foreign currency reserves, provoked a yawning budget USD 262 billion 2015-19 public healthcare infrastruc-
deficit of more than 15 percent of GDP and crimped the ture renewal program.
government’s ability to sustain costly subsidies – would Indeed, over the past five years, Algeria’s life science
ultimately impact the country’s budding life sciences space has been buffeted by a whirlwind of changes in-
sector as well. cluding: the nomination of a new technocratic-minded
“The brute fact is that, as a nation, we had not been Health Minister in the form of ENT practitioner, Mokhtar
earning what we used to and that meant there were Hasbellaoui, the enactment of a historic and transfor-
a lot of things that we suddenly found that we simply mative “sanitary law,” the sudden and unexpected im-
could no longer afford,” reflects Senator Louise Cha- position of sweeping pharma and medical device import
choua, chairwoman of the congressional health com- restrictions and much more besides.

COVER STORY
Pressing Ahead
“I think it’s fair to say that we’ve has a great deal to offer. Not only
witnessed some profound changes is this the second largest market
and a reshuffling of the rules of the on the African continent, but it
game in the pharma and medtech sec- is also a heavyweight when com-
tors that have produced a new set of pared to the Middle Eastern mar-
winners and losers,” analyses IQVIA kets. One of the characteristics
country manager, Hocine Mahdi. that immediately stands out in
LOUISA “While this USD 3.8 billion phar- Algeria is the sheer importance MOURAD ISHAK
CHACHOUA
ma market is still enjoying a growth that the authorities place on country manager,
president, health Sandoz
commission at the
spurt, it is revealing that much of that securing access to healthcare for
Senate new growth is nowadays accounted patients. This is rather exception-
for by generics,” he muses. al within the region. Algeria is one of the only coun-
Nevertheless, for all the recent upheaval, the Algerian tries where care is provided universally and covered by
marketplace remains a high priority for MNCs investing the state. Also distinctive is the maturity of the local
in the Middle East and North Africa (MENA). “Algeria healthcare infrastructure. Because of a robust contex-
stands out as the jewel in the crown so to speak, not tual environment, enterprises like Sanofi are able to
only because it is one of the most manifestly stable generate more of an impact than would otherwise be
countries in an increasingly volatile region, but also due the case,” he confides.
to the favorable population dynamics, sheer market size “Nor should one forget that the scope of medical
and the underlying reality that consumer demand con- coverage is exceptionally high, reaching some 85 per-
tinues to blossom,” explains Essam Farouk, president cent of the entire 38 million population,” ventures Loic
of El Kendi. Galmard, the recently appointed general manager of
Haissam Chraiteh, Sanofi’s managing director, very Janssen. “This is not at all common in African coun-
much concurs. “From a business point of view, Algeria tries, which are almost always characterized by high
Lowdown on the 2018 “Loi Sanitaire”

After decades of procrastination and vacillation, a landmark reform of the Algerian health system has finally recei-
ved parliamentary approval. Some of the most eye-catching tenets include:
• A reaffirmation of the principle of free, universal healthcare for all citizens.
• Contractual-ization of health services and availability of private health insurance as a means to introduce additional
revenue streams for financing the health system.
• Decentralization of powers to the Wilayas [Provinces] and the rollout of professional management processes to en-
sure better homogenization of healthcare provision.
• Reintegrating the discipline of “family medicine” with a view to enhancing healthcare proximity and rendering care
pathways more patient-centric.
• Laying the foundation for new healthcare modalities such as the concept of “home care”.
• The creation of a National Agency for the Promotion of Best Practices and a National Observatory of Health.
• Incremental digitalization of the health system, dematerialization of patient files and the strengthening of the elec-
tronic card.
• The launch of exchange and twinning programs between health facilities so as to encourage the cross-pollination
of expertise.

COVER STORY
Pressing Ahead
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VOUS VOIR SOURIRE
ET VIVRE MIEUX
Voilà pourquoi depuis près de 90 ans, nous vous apportons les médicaments dont
vous avez besoin : des traitements de pointe dédiés aux maladies invalidantes
et aux pathologies rares, et des traitements contre les maux du quotidien.
Sur les 5 continents, partout, nous voulons vous encourager à vivre mieux.
À VIVRE… ET À RÊVER.
IPSEN PHARMA Algérie SPA:Lots n°10-11 Boulevard du 11 Décembre 1960 16003 El Biar, Alger, Algérie.Tél: 021 60 64 15/17 Pharmacovigilance: pharmacovigilance.algeria@ipsen.com
Réclamations qualité : algeria-product.complaints@ipsen.com Information médicale: Tél: 023 32 44 98 e-mail: medicalcoveripsen@santedom.com
COVER STORY
Pressing Ahead
co-payment health systems whereby the patient must wide-reaching healthcare law (“Loi
pay for treatment out of their own pocket,” he adds. Sanitaire”), the first such bill since
Sandoz’s Egyptian born country manager, Mourad the 1980s, which strives to render
Ishak, agrees. “I have worked right across this part of the nation’s public healthcare
the world but have yet to encounter a country quite apparatus fit-for-purpose in an era
like here where the state is so staunchly pledged to when the patient population has
delivering up universal healthcare to its citizens,” he been ballooning and incidence of
recalls. “One only needs to consider the increase in life non-transmissible chronic, life- MOHAMED
expectancy in Algeria over the past decade, which far style disease such as diabetes and L’HADJ
exceeds regional averages: I firmly believe this derives pulmonary arterial hypertension director general,
health services and
from the strong commitment to reimbursement are undergoing a sharp rise. hospital reform
wherein patients can receive their prescriptions in full,” “This really is a watershed
he enthuses. moment, not just because of the
myriad of well thought out articles in this legislation
that will help to modernize and bring up to date our
healthcare system, but also because it is an organic
A MILESTONE HEALTH REFORM and flexible document that empowers the Ministry
of Health to make subsequent amendments through
One very exciting development has been the secur- implementing decrees,” details Farid Benhamdine,
ing of parliamentary approval in August for a president of the Algerian Society of Pharmacy.
THIS REALLY IS A WATERSHED

MOMENT Farid Benhamdine
ALGERIAN SOCIETY OF PHARMACY
One key thematic being pursued is the reorganiza-

tion of care pathways. “We seek to enhance permeabil-
ity between the public health institutions of proximity
and the hospitals, by mutualizing equipment, human
and financial resources and entrusting the manage-
ment to a single entity, as is the trend globally. In
Algeria, this should translate to a better distribution
between a Health Unit of Proximity (USP), the gener-
al hospitals (HG), and the specialized hospitals (HS),”
reveals Mohamed L’Hadj, director general of health ser-
vices and hospital reform.
Algeria is also seeking to be a first mover in the
region for pioneering homecare and has already treat-
ed more than 26,000 patients in this manner during
initial pilot studies. “The new bill legitimizes this
pathway, which can be considered as synonymous
with individualization of treatment and delivers mani-
fold social and economic dividends by decreasing hos-
pitalization duration, reducing the risk of hospitals
contracted infection and doing away with the need for
many patients to make often arduous journeys back

COVER STORY
Pressing Ahead
and forth between care institutions. It represents a Unsurprisingly this is music to the ears of the inter-
win-win-win for payers, practitioners and patients” national drug developers who are acutely aware of
declares L’Hadj. the importance of generating efficiencies so as to free
These efforts go hand in hand with concerted up more funding for financing innovative therapies.
attempts to professionalize hospital management and “I think I speak for all of my peers when I say that
optimize core activities such as procurement to make bioMérieux resoundingly welcomes this step… the bot-
better use of the resources available. “The moment has tleneck today is the two divergent leadership styles in
come when we need to start thinking outside of the box charge of Algerian hospitals: strict business managers
and prove ready to embrace more enlightened meth- with little appreciation or understanding of the work-
odologies for how we go about the day-to-day task of ings of the life sciences sphere or physicians with the
delivering healthcare,” urges Minister Hasbellaoui. requisite scientific know-how, but not the fundamental
INTRODUCING ALGERIA’S PARA-STATAL AND REGULATORY ACTORS
Algeria’s youthful pharmaceutical landscape includes an array of state-controlled entities of an industrial

or commercial nature alongside more conventional regulatory apparatus.
THE NATIONAL AGENCY FOR A newly established independent administrative authority whose primary task
PHARMACEUTICAL PRODUCTS is supporting the needs related to the registration of medicines and medical
(ANPP)
devices. The agency is mandated to provide a crucial link in monitoring the
control of quality, safety, efficacy and referential value of pharmaceutical products
and medical devices for the use of human medicine.
PASTEUR INSTITUTE ALGERIA The IPA enjoys exclusive import and distribution rights for serums and vaccines.
(IPA)
It plays a critical role in epidemiological surveillance: acting as the national
reference point for the identification of infectious and parasitic disease and
tasked with the development of tools and training schemes to counter these
disease categories.
NATIONAL LABORATORY Algeria’s national pharmaceutical regulator undertakes quality control and
FOR CONTROL OF evaluation duties alongside research and training functions. It also enjoys
PHARMACEUTICAL
PRODUCTS World Health Organisation (WHO) status as an Africa and the Middle East –wide
(LNCPP) reference laboratory.
CENTRAL PHARMACY The PCH is responsible for the acquisition, stockage management, regulation and
FOR HOSPITALS supply of pharmaceuticals to the country’s public health institutions. It is also
(PCH)
charged with maintaining strategic and contingency stocks and itself engages in
local production.
SAIDAL Created in April 1982 following the restructuring of the Algerian Central Pharmacy
(PCA), SAIDAL became a public company in 1989 following the implementation of
economic reforms. Based in Algiers, state-run SAIDAL is the largest pharmaceuticals
group in the country and ranks among the biggest in Africa.

COVER STORY
Pressing Ahead
managerial nous. Ideally, we should space… Already we offer such services on a small scale
be trying to cultivate a new cadre to some of our private lab customers and are exploring
of professionals well-versed in both ways to expand this out into the institutional setting.
skill sets,” suggests the French So far, the Ministry has proved to be highly receptive to
firm’s area business manager for such a concept,” explains Oka-Bousbia.
the Maghreb, Nadia Oka-Bousbia. Getting Algerian professionals onto courses at the
Interestingly, bioMérieux is university campus at the Montcelard estate in Lyon can
NADIA now looking to partner with the be tricky because of visa and cash conversion issues, so
OKA-BOUSBIA
Algerian authorities in an attempt their bespoke solution for Algeria has actually been to
country manager
Algeria & North
to somewhat plug this gap by lev- bring the French seminars and workshops to Algiers.
Africa, bioMérieux eraging the company’s links with “So far, the results have been very positive indeed:
its Mérieux Université to provide the Mérieux Université’s programs break down barriers
professional development training between the scientific, industrial and academic worlds
for healthcare practitioners. “The Mérieux Université is and deliver up the sort of holistic training that enables
a 40-year old center for collaboration and training for healthcare and life sciences professionals to become
Institut Mérieux companies that is also open to external higher achievers in executing their day-to-day tasks.
companies and institutions. The purpose is essentially For example, we provide mentorship and support to
to develop talent, improve organizational efficiency and managers to promote teamwork and inter-entity col-
entrepreneurial leadership, as well as to promote a cul- laboration and furnish them with the tools to adroitly
ture of excellence within the life science and healthcare handle challenges of continuous change,” she asserts.
SADZ.SA.18.09.0320

COVER STORY
Pressing Ahead
TWEAKING THE innovative drugs where the medi-

REGULATORY RULEBOOK cal risk is not covered,” he proudly
confirms.
At the same time, Algeria’s social Such a move would certainly rep-
security apparatus has been pull- resent a significant step forward
ing out all the stops to devise fresh but putting in place these capabil-
mechanisms thorough which ities is no easy task. “There is an
DJAOUAD patient access to latest generation, entire arsenal of managed entry AMINE SEKHRI
BRAHAM
BOURKAIB
sophisticated medicines can be tools that incorporate risk sharing country manager,
secured without jeopardizing the and pay-per-performance elements Roche
former director
general of social long-term financial viability of the that could potentially be harnessed
security public health apparatus. to eke more value out of the financial resources being
“We needed to formulate and deployed, however, most of these solutions presuppose
define another set of rules that may be slightly more a functioning Health Technology Assessment (HTA)
complex, but in exchange we will open rationally the mechanism, data collection and IT infrastructure so
access to innovative drugs and will share with pharma- as to be able to track and measure mission fulfilment.
ceutical companies a financial risk and prevent budg- We all know that slashing prices is not the best way to
etary drift. From now on, we will be able to imagine achieve effective public health provision, but the author-
contracts based on price and volume with an annual ities will point out that they have few ready-made alter-
expense limit,” recounts Djaouad Braham Bourkaib, natives to turn to, so the onus is on companies like us
former director general of social security at the Ministry to help them mature their embryonic HTA apparatus as
of Labor. “Furthermore, we are starting to offer perfor- speedily as possible,” concedes Roche’s country manag-
mance-based contracts as a way of delivering access to er, Amine Sekhri.
The “Plan Cancer”: A Sandbox for Experimentation

While Algeria has been making clear headway in the war against cancer (rates of fatality for colo-
rectal cancer have decreased by half within only five years, and patients with metastasized lung
cancer are now living three times longer than previously), the country’s much-acclaimed National
Cancer Plan has also been winning plaudits for transforming Algerian healthcare. “Strategically,
we can say that the Plan in itself has a been something of a role model for the country and show-
cases what could potentially be achieved in other therapeutic areas. Born out of a crisis around
the obsolescence of radiotherapy centers back in 2009, we have unexpectedly managed to use
the initiative as a vehicle for redefining treatment pathways,” reminisces the program’s director,
MESSAOUD Professor Messaoud Zitouni.
ZITOUNI
— The American biotech, Amgen, for example, has been partnering with the authorities to introduce
head, Cancer Plan biomarkers. “We equipped the Mustapha Pasha hospital with advanced equipment and training
in the discipline of next generation sequencing of cancers. This ultimately helps personalize diag-
noses, and provides access to targeted therapy, and better prescribing of drugs… Our products are expensive, so
we want them to be used properly on the correct patient and the correct diagnoses,” recounts Radwa Terbeche, the
Algerian affiliate’s general manager.
Roche, for its part, has been at the forefront of establishing a national cancer registry and is playing an active role in
developing accreditation of the cancer research centers through PACT program. “Putting in place the register has
been absolutely fundamental because it helps extrapolate the data necessary to understand the dynamics of cancer
in the country and demonstrates the possibilities for personalized care that are opened up by mixing science with
data. This is precisely the sort of game-changer that may one day enable Algeria to leapfrog forward and accelerate
its development path in life sciences,” argues Roche’s Amine Sekhri.

COVER STORY
Pressing Ahead
Janssen’s Loic Galmard voices expensive treatments in the Algerian health system, at
very similar concerns about the around DZD 1.1 million (USD 9,300) per person per
shortcomings of the current setup. year. Diabetes is the cause of 65 percent of renal failure
“Though we detect a strong desire in Algeria. It’s simply massive. High blood glucose rep-
on the part of the authorities to resents 21 percent of all cardiovascular disabilities, yet
introduce HTA methodologies incredibly we are still struggling for reimbursement,”
to be able to gain better visibility laments Novo Nordisk’s corporate vice president for
LOÏC GALMARD
around the value and performance the Maghreb Region, Jean Paul Digy.
country manager, of specific biologics, the existing That said, the state machine has slowly but surely
Janssen
data collection and processing been bolstering its capabilities. Social Security is in the
capabilities are generally insuffi- midst of putting in place a medical big data system to
cient. For example, currently no one really knows how afford greater visibility in real time of the results of the
much it costs for a patient to receive one day of treat- contracts; a new regulatory body, the National Agency
ment for prostate cancer or for schizophrenia in an for Pharmaceutical Products (ANPP) has been estab-
Algerian hospital and that, in turn, makes it very diffi- lished as a counterpart to the National Laboratory for
cult for companies to compile pharmaco-economic evi- the Control of Pharmaceuticals (LNCPP); and pilot
dence and calculate how a specific drug can generate programs have already been launched in the cities of
savings,” he warns. Sétif and Oran, where some 17 percent of polyclinics
Moreover, the absence of this underlying supporting are now using digital medical records.
infrastructure is having tangible negative consequenc- Decision making by the payer has also become notice-
es for patients. Certain specific novel medicines that ably more discerning. “Sometimes we also ask for drug
could potentially wield a huge impact are not mak- efficiency to be tested every six months, or for reimburse-
ing it to market or receiving the necessary reimbursement to be re-approved periodically. For instance, some
ment because of these deficiencies. “There is a drug patients develop resistance to the medication and no
that is now becoming a leading therapy approved by longer benefit from Interferon beta drugs – used in mul-
the European Association for the study of Diabetes tiple sclerosis as disease-modifying drugs in the hope of
(EASD) and the American Diabetes Association (ADA) reducing the frequency of relapses and slowing the pro-
which reduces cardiovascular death by 22 percent and gression of the disability. The thing is that these drugs
minimizes progression towards renal failure by 22 are very expensive, so we want to verify together with
percent, cutting the need for dialysis, one of the most healthcare professionals and be certain that the patient

9
COVER STORY
Pressing Ahead
Ground-breaking advances in medicine

are only meaningful when they reach the
people who need them.
Access to healthcare is a multi-dimensional

challenge; specific to the country and
local healthcare system. At Roche we
are partnering with local stakeholders to
develop tailored access solutions that really
make a difference to people.

COVER STORY
Pressing Ahead
is still benefiting from the treatment Algeria’s overtly protectionist pharmaceutical manu-
before continuing to pay for some- facturing policy has long proven troublesome for their
thing useless” reveals Bourkaib. operation. “Importing life science technology into
Greater scrutiny can equally be Algeria can certainly pose quite a challenge: The amount
witnessed in the fact that positive of time taken to secure customs clearance is generally
reimbursement decisions are now around six weeks compared to a two week average in the
increasing tied to specific indica- region and this applies to both finished products and
DORIA OUGHLIS tions with a proven improvement of spare parts,” explains bioMérieux’s Nadia Oka-Bousbia.
general manager medical service rather than issued as For example, media plates used in microbiological
North West Africa, blanket approvals for treating mul- assays have a total lifespan of two months and thus
Lilly
tiple illnesses. cannot be imported in Algeria. “When it comes to per-
Innovative drug producers with ishable products, for instance, there are strict rules in
best-in-class products, meanwhile, tend to be more than place that stipulate that an item cannot enter the mar-
happy to enter into such agreements in return for ensur- ket if the remaining shelf life is lower than 66 percent of
ing that their therapy actually reaches the market. “As a the product’s total lifespan. For products like molecu-
company, we are very sensitive to the needs of the state lar biology reagents, this can have serious implications:
apparatus to make the national health system more a reagent might still have 1.5 years’ worth of shelf life,
financially sustainable. We therefore put much thought but because the total lifespan is 3.5 years, it is denied
into bringing products to the market that can help take entry. These laws ultimately prevent us from distribut-
costs out of the system and achieve better pharmaco-eco- ing certain products that would be highly beneficial for
nomic performance,” posits Doria Oughlis, general man- Algerian laboratories and hospitals,” she laments.
ager for North West Africa at Lilly. However, the Algerian authorities justify such policies
in the name of cultivating their own industrial drug fab-
rication base. “One of our core mandates and socio-eco-
nomic responsibilities is actually to promote and foster
INDUSTRIAL POLICY: STRONG-ARM domestic manufacturing of drugs, both by indigenous
STRATEGIES Algerian outfits and international companies that have
settled in Algeria, and, to this effect, our reimbursement
While efforts to build an HTA infrastructure have been policy explicitly privileges homegrown therapies,” coun-
roundly applauded by international drug developers, ters Djaouad Bourkaib of the Social Security.
EASE OF DOING BUSINESS

Source: World Bank
By ease of: doing business (2017) starting a business (2017)
1 25 50 100 125 150 175 200

MOROCCO
EGYPT
TURKEY
TUNISIA
JORDAN
ALGERIA
LIBYA

COVER STORY
Pressing Ahead
is no denying that this was an

ONE OF OUR CORE MANDATES AND especially difficult period for the
SOCIO-ECONOMIC RESPONSIBILITIES IS local affiliate,” remembers Malika
Benmouffok, the company’s coun-
ACTUALLY TO PROMOTE AND FOSTER
try manager. “Prior to the sudden
DOMESTIC MANUFACTURING OF DRUG importation ban we were on a very
Djaouad Bourkaib FORMER DIRECTOR GENERAL,
good growth trajectory and had
SOCIAL SECURITY
been registering an annual turno- ISMAEL
CHIKHOUNE
Matters reached a crescendo in the summer of ver of around USD 20 million, but,
president & CEO,
2017, however, when the Algerian Ministries of Trade, in one fell swoop, our revenues took US-Algeria Business
Finance and Industry, unexpectedly imposed sweeping a nosedive. Then, in July, there was Council (US-ABC)
import restrictions on any incoming pharmaceuticals some relaxation in the regulations
and medical devices for which there was some sort of and we were granted a quota on cephalosporin imports
domestically manufactured substitute, ostensibly with because local manufacturers were failing to cater to
a view to preventing currency flight at a time when the the full demand of the domestic market. Nevertheless,
national economy was deteriorating. “The episode was despite this slight respite the situation remained chal-
frankly emblematic of the type of risks that foreign lenging for us, because cephalosporin antibiotics
businesses can run into and which can render it diffi- accounted for some 70 percent of our imports and we
cult to stick to long-term business strategies,’ exclaims realized we were going to have to change tack if we were
the US-ABC’s Ismael Chikhoune. “I personally believe to deliver on our targets of entering the top ten compa-
the government would have done far better to have nies by sales value by 2023,” she confides.
consulted with the industry first, because quite a large Tabuk’s leadership ultimately calculated that the
number of foreign enterprises unfortunately found logical way out of this impasse would be to adapt the
their business models invalidated practically overnight business model and orientate more towards local man-
and if there is one thing that is almost certain to scare ufacturing. “My global management board answered
off potential investors, it is an uncertain operating quickly to the Algerian economic situation by commit-
environment where there is little or no predictability,” ting to invest in manufacturing and made the leap in
he reflects. good faith for the good of the Algerian patient… We
The experience of Tabuk Pharma is perhaps illus- have thus resolved to produce cephalosporin antibiotics
trative of the conundrum facing many MNCs. “There in dry form from our existing in-country facility at Blida
DIAGNOSTICS IS POWER
#pioneeringdiagnostics

COVER STORY
Pressing Ahead
and will be targeting a potential of strategies years ago and are now benefiting from early
20 million packs or more per year mover advantage; those that are coming late to the pro-
to maintain our intended profita- cess and are scrambling to restructure their business
bility,” she confirms. models; and those that are still too timid to establish
“We respect and follow the polit- a local production footprint and risk becoming ever
ical decisions that are taken for the more marginalized to the extent that they may even
good of the country and are sym- find themselves locked out of the marketplace alto-
MALIKA pathetic to the authorities’ agen- gether,” surmises IQVIA’s Hocine Mahdi.
BENMOUFFOK
da: at the end of the day, they are One company that certainly did anticipate the need
country manager,
Tabuk Pharmaceuticals
the sentries and guarantors of the to invest in a facility was Sandoz. “The government’s
public health of the nation and we zeal for rendering Algeria a pharma manufacturing
admire the way they are endeavor- powerhouse actually preceded the oil price decline, and
ing to strike a balance between economical constraints, dates back to a pre-2014 promise to ensure that at least
patients’ needs, administrative and production delays 70 percent of national drug consumption could be met
and industrial realities,” insists Benmouffok. by in-country production, thus the sort of measures
Many MNCs keen to protect their market position- that came into force last year should not really have
ing thus find themselves being compelled to engage in been a total surprise to anyone. The oil prices merely
some form of local production. “Given the sheer inten- accelerated the pace of a project that was already well
sity of the protectionism that we are witnessing, there in motion. Consequently, as early as 2015, the Sandoz-
are clearly considerable incentives to investing deep Novartis group had already committed to investing
into the market and establishing in-country manufac- some USD 35 million in upgrading our legacy facility
turing capabilities. The way I interpret it, firms stand in Oued Smar,” points out Mourad Ishak.
to gain a lot from embarking down this path and con- “Essentially, we realized the inherent fragility of
versely have much to lose if they do not,” analyses being too reliant on imports and hence struck upon
Janssen’s Loic Galmard. a formula whereby Novartis Technical Operations
“You can almost divide the multinationals into (NTO) in Oued Smar would centrally manage our
three baskets: those that prepared their localization manufacturing operations across both our innovative
Algerian Manufacturing: Stepping up into the Big League

No pharma MNC has been more willing to invest so deeply in Algeria than longtime market lea-
der Sanofi. “A few years ago, we decided that, after a few years of sustainable growth, the time
was ripe to invest in a high-grade industrial complex capable of manufacturing different forms all
the way up highly sophisticated products. The new six-acre facility is earmarked to manufacture
more than 100 million units per year with an investment of over EUR 85 million (USD 98 million).
When officially opened in October 2018, the factory will rank as the largest industrial complex
of pharmaceutical production and distribution in Africa,” proudly reveals the Algerian affiliate’s
managing director, Haissam Chraiteh.
HAISSAM
CHRAITEH The French multinational already owns two existing production plants – one located at Oued
— Smar specializing in solid forms, and another in Ain Benian dedicated to liquid forms. Chraiteh,
country chair, notes that Sanofi’s “continuous investment in local production will considerably enhance our
Sanofi capacity for local manufacturing and thus ensure domestic availability and security of supply of
our products in large volumes.”
He concludes, “All in all, this is a great statement of Sanofi’s long-term engagement in Algeria for patient welfare.
Furthermore, with the support of authorities, this industrial complex will also be able to develop new forms and
new ranges of products in the future.”

COVER STORY
Pressing Ahead
medicines and generics divisions, with the goal of fur- extremely developed for basic drugs, it is markedly less
ther improving efficiency. Nowadays, we locally man- so for high potency products such as many oncology
ufacture a wide range of products in the cardio-met- drugs. To overcome this, MNCs must invest heavily in
abolic therapy area including the Tareg®/Diovan®, technology transfer. There are essentially two alterna-
Galvus® and Exforge® ranges. Moreover, the recent tives: either you sign a commercial agreement, where a
big-ticket investment to revamp the NTO plant will CMO is handed the opportunity to update their facil-
not just expand production capacity but install state- ities and integrate fresh know-how and technology in
of-the-art technologies and equipment that open the the short to mid-term, or you invest directly in estab-
door to producing high sophistication innovative med- lishing your own plant in conjunction with an indige-
icines in-country,” concludes Karim Harchaoui, coun- nous JV partner,” notes Janssen’s Loic Galmard.
try manager of Novartis. Some companies, including Abbott, have calculat-
ed that they simply do not possess enough Algerian
market demand to justify setting up our own propri-
etary manufacturing facility, so they opt for the con-
THE SCRAMBLE TO LOCALIZE tract-manufacturing pathway. “The limitation with
third party manufacturing (TPM) is that you can only
Embarking on a localization strategy is no small mat- be in control of the entirety of the other parts of the
ter, however, especially if you are an innovative drug value chain when the factory is registered under your
company with an international reputation to main- name,” explains the company’s general manager for
tain. “While in-country manufacturing in Algeria is Francophone Africa Cluster, Mohamed Benali Khoudja.
TAKE CARE
OF YOUR HEALTH
http://www.tabukpharmaceuticals.com/
Our core lies in quality, performance, +213 (0) 23 30 86 35
and courage Eurl Tabuk Algérie Bois des Cars 2 N159 Dely Ibrahim, Alger

COVER STORY
Pressing Ahead
“Today there are reportedly some risky to enter into partnership with.
92 facilities in Algeria, yet many of TODAY THERE ARE There are, at a minimum, ten to
them are operating at only around 15 sites that possess the requisite
REPORTEDLY SOME 92
30 percent of their capacity. There high-quality standards. They there-
FACILITIES IN ALGERIA,
is thus a real need to feed these fore tend to be keenly sought after
facilities. Having MNCs like us
YET MANY OF THEM ARE by the MNCs scrambling to local-
mop some of that spare capacity up OPERATING AT ONLY ize,” he points out.
is truly beneficial for the country. AROUND 30 PERCENT OF IQVIA’s Hocine Mahdi very much
However, we think the authorities THEIR CAPACITY concurs. “The handful of indige-
need to revisit how this translates Mohamed Benali Khoudja ABBOTT nous contract manufacturers that
into legislation. I have been trying have managed to attain internation-
to pitch the idea to the Minister of other words, it would create a virtu- al quality standards are left holding
Health that entities like ours that ous circle,” advocates Khoudja. the cards because they can choose
are getting our products made and Identifying a suitable CMO part- from an unprecedented number of
assembled by local players should ner can also be tricky. “Not all the business proposals,” he observes.
gain the same status as the owner 90 odd facilities in Algeria are GMP Less than a decade ago, those mul-
of the manufacturing plant. That approved. There are some big play- tinationals requiring the services of
would incentivize localization, trig- ers, such as Biopharma, but you Algerian CMOs would have encoun-
ger job creation and tech transfer also have a multitude of smaller tered few players that matched their
and end up in a more efficient use players with questionable quality quality requirements or stand-
of existing in-country facilities. In standards that would be way too ards and thus would have had to
Liaison Bureaus: An Endangered Breed

International pharma firms operating in Algeria under should therefore not be wholly surprised if their renewal
the “bureau de liaison” (liaison office) structure were requests are now denied,” he clarifies.
handed a wake-up call in February 2018 when the An-
glo-Swedish drug developer AstraZeneca was summari- One company that has benefited from having a bureau
ly forced to close its doors after the expiry of its work de liaison for the past four years and is now awaiting a
license. Many of the more than 350 bureaus in the coun- decision on renewal is the American biotech, Amgen.
try came into being in 2009, in the wake of the introduc- “In our discussions with the authorities, we have argued
tion of the 49/51 percent rule governing foreign invest- that the bureau de liaison structure when applied to
ment which has led the Ministry of Commerce to fear the life sciences domain should be regarded more as
that the proliferation of these offices conceals a desire a scientific office. In other words, we would like to see
to circumvent obligatory JV and partnership rules. a completely new kind of arrangement created outside
the existing legislation. Unfortunately, this framework
“The current crackdown has come about because many does not exist at this moment in time. We are there-
multinationals have gone against the original spirit of fore carefully monitoring developments and will adapt
the legislation and after a decade of operating are con- accordingly,” discloses Radwa Terbeche, the general
tinuing renew their rep office statuses so as to avoid manager.
the need to partner with an indigenous firm or set up
an Algerian company,” opines Ismael Chikhoune of the Abbott’s Benali Khoudja wholeheartedly agrees. “The
US-ABC. “Algerian law is actually crystal clear on the authorities need to understand that the real added va-
matter: after two years you can renew your bureau sta- lue of highly innovative drugmakers in a country like
tus once, for a further two years. In other words, the Algeria is purely intellectual: we are here to train the
structure is intended to be temporary and gives a fo- doctors, build a strategy, and to deliver up innovation
reign entity a grace period to work out the optimum rather than to build factories. What we require is a very
business strategy prior to localization. Pharma compa- bespoke structure, in other words a scientific office,”
nies that have been playing hard and fast with the rules he insists.

COVER STORY
Pressing Ahead
devote considerable time to con- facility. One key consideration will

ducting due diligence. Nowadays be how to source the human capital
overall standards are far higher needed to staff your site and then
and the challenges are different. there is also the tricky matter of
With so many MNCs scrambling to identifying an appropriate indige-
have their products manufactured nous JV partner under the obligato-
in-country, the power balance has ry 49/51 percent ownership rules,”
GUILLAUME shifted to the new cohort of indig- counsels Roche’s Amine Sekhri. MARKO
SEILLIER ACKERMANN
enous CMOs who are so flush with AHK’s Marko Ackermann is quick
director general, director general,
demand that they can afford to pick to point out the standard of poten- German-Algerian
Servier
and choose their clients. tial local JV partners in Algeria is Chamber of Commerce
and Industry (AHK)
“Moving from importation to pro- actually rather higher than many
duction currently takes a minimum of two years for a international investors’ expectations.
given product. Yet, over time, we have developed skills “Typically, candidates are more interested in technology
and trained teams in order to accelerate this process of and know-how transfer than in pure financial investment
know-how transfer. It definitely requires investments but which they are often easily able to source locally anyhow.
following localization, you can finally become a real com- In the pharmaceuticals sector their main objective is often
petitor in the market,” recounts Servier’s director gener- to scale the manufacturing value chain and therefore to
al, Guillaume Seillier. acquire the capabilities and the competencies to produce
The business model of third-party manufacturing, fur- ever more complex molecules,” he notes.
thermore, remains a viable pathway because there are few The 49/51 percent JV ratio still presents a stumbling
restrictions to importation of raw material. “Contrary block, however, for many firms: especially for SMEs often
to finished product, we have never faced problems with reluctant to cede that amount of control. “It can seem
importing active pharmaceutical ingredients (APIs), unduly risky to hand over such a large share of the busi-
since it is the strategy of the Ministry to support local ness especially if you have a well-known brand reputation
production of medicines, says Seillier. to manage, even though there are work-around solutions
Opting to establish your own proprietary plant, how- to preserving a controlling stake such as by diluting the
ever, carries its own challenges. 51 percent share across two JV partners,” he admits.
“There are a lot of parameters and variables to consid- In spite of the manifest complexities of developing a
er in a project like this above and beyond securing the production footprint, many of the better-known phar-
requisite financing and the physical construction of the ma MNCs have not been deterred and have ultimately

COVER STORY
Pressing Ahead
elected to take the plunge. Pierre not deliver any real value-add in terms of “know how”
Fabre’s managing director, Nawel and tech transfer. Hence, we decided to bring innova-
Baba-Hamed notes that the derma- tion in the form of manufacturing Decapeptyl®. This
tology specialist launched a JV with has several indications. The main one is for the hormo-
Algerian partners in May 2018 for nal treatment of locally advanced metastatic prostate
the commercialization and produc- cancer that can be now injected subcutaneously too. A
tion of medicines. “It will operate plant dedicated to Decapeptyl® will be a true innova-
NAWEL BABA- under the 49/51 rule. The project tion, and a first for both Algeria and Africa. We will also
HAMED
will benefit from a EUR 15 million continue to forge partnerships with local companies.
general manager,
Pierre Fabre
(USD 17 million) initial investment We view it as important to deliver tech transfer to local
and we will produce several phar- companies, which will aid the development of the local
maceutical forms (tablets, liquids…) industry and assist with indigenous efforts to scale the
with the aim of being able to pro- value chain,” he asserts.
duce the majority of our portfolio
locally in the mid-term,” she assures.
Dar Al Dawa, meanwhile has THERE IS AN EXPECTATION ON THE
committed USD 20-25 million for PART OF THE AUTHORITIES FOR
a plant that will include the manu- INCOMING MULTINATIONALS TO
ADLANE facturing of eye-drops. “The output INVEST MATERIALLY IN THE COUNTRY
SOUDANI volume will depend on the num-
Adlane Soudani IPSEN
president and ber of products we manufacture.
managing director,
Ipsen Pharma Algerie
We already have 16 products being Ipsen is particularly keen to be perceived as a true
SPA produced. The first one entered the partner that is fully engaged and embedded in the
market in August, following mar- socio-economic fabric of the host market. “It is impera-
keting authorization and, by 2019, we will manufacture tive for us to deliver on the scale, and in the time frame
between 30-40 products locally with the goal of releas- that we promised,” declares Soudani. “Ipsen is keen to
ing a new product onto the market every two months,” demonstrate that we walk the talk. Managing expecta-
announces the general manager, Noureddine Issad. tions on all sides is paramount.”
Interestingly, the French oncology-focused midcap,
Ipsen, stands out for pursuing both localization strate-
gies concurrently. “It is quite a common trend nowadays
within the Algerian market for international drug devel- FIT FOR EXPORT?
opers to begin by teaming up with a local CMO, before
seeking to build up the infrastructure for independent Barely a decade ago, Algeria was importing almost all
local production, so, back in 2014, we formed an agree- of its pharmaceuticals, but thanks to the ever-greater
ment with AT Pharma (Hydra Pharm Group), a credible state protection for local manufacturing and the way
domestic player that was responsible for the manufac- in which successive administrations have compelled the
turing of our flagship gastroenterology drug, Smecta® multinational drug developers to localize their produc-
as our first stepping stone to full localization. Our rather tion, the country can nowadays supply upwards of 50
distinctive approach, however, is to deploy parallel strat- percent of national drug consumption. Given all of that
egies: we will maintain our longstanding local partner- domestic capacity, the logical next step will be whether
ships, while, at the same time, acquiring our own facili- Algeria can successfully transition over to becoming a
ty,” divulges the firm’s general manager Adlane Soudani. pharma exporter. “We are quietly confident that Algeria
“There is an expectation on the part of the authorities is well on the path to being considered a production
for incoming multinationals to invest materially in the platform and launchpad for exports into other parts of
country. We figured that investing in yet another facil- Africa and well beyond as we can lay claim to significant
ity producing classically synthesized molecules would capacity, good quality and low prices,” affirms Rachid

COVER STORY
Pressing Ahead

COVER STORY
Pressing Ahead
Kerrar, general manager of Algerian manufacturing pharma manufacturing space needs to be better
outfit, Beker, which already has a fledgling export arm rationalized. For certain categories of drug or thera-
up and running. “I notice quite a few surprised gazes peutic area there is a surfeit of capacity and facilities
coming our way with regard to our recent move into are not running to their full potential. In other areas
exportation, but I truly believe this is a sign of things there is not enough supply to meet demand. It’s a mix
to come more generally,” he says. of duplication and gaps. Greater export orientation
The path to export, however, appears to be long would, of course, represent one way of alleviating this
and tortuous. “When taken as a whole, the Algerian situation. El Kendi started production one month ago
All Aboard the Biosimilars Bandwagon
With the pharmaceutical import bill The primary bottleneck up until now has, of course, been
having almost topped USD two bi- the absence of specific legislation for biologic-based
llion in 2017 mainly on the back of products so companies like Amgen and El Kendi have
high price tag biologics, many in- been busily interacting with lawmakers and health offi-
dustry insiders consider biosimilars cials with a view to helping prepare the ground for their
to herald one of the most effective eventual arrival. “As a responsible industry stakeholder,
ways of containing costs without di- Amgen has been participating in consultations with the
minishing the quality of healthcare government on drafting a biosimilar regulation, provi-
SOFIANE ACHI
provision. “People nowadays un- ding international experts to these consultations to offer
—
director general,
derstand the vital role that generics new perspectives so that we can implement suitable le-
El Kendi play in freeing up capital to spend on gal structures right from the start,” reveals Terbeche.
latest generation innovative thera-
pies and exactly the same logic holds Already a momentum is clearly underway. “Rather than
true for biosimilars as well… We be- blocking access entirely the authorities have instead in-
lieve greater biosimilars penetration troducing more stringent legislation for new drug requi-
will be a prerequisite for reducing rements, so there has been a work-around solution and
the national drugs bill and for fashio- temporary fix prior to the introduction of some kind of
ning a financially stable public health bespoke registration pathway which we are expecting to
system that can continue to deliver be published at some point in 2019,” she clarifies.
upon its objectives and, as such, we
RADWA
are staunchly committed to making The regulatory apparatus has been busily trying to get
TERBECHE
—
this happen,” reflects El Kendi’s So- up to speed. “We recently sent a team to Argentina to
director general, fiane Achi. inspire us to establish an industry of biosimilars. The goal
Amgen is a transfer of technology that will allow us to be up-
Amgen, meanwhile, has selected to-date and to follow or even anticipate future develo-
Algeria as one of its priority mar- pments in this area,” details Abdelaziz Gharbi, director
kets for launching biosimilars. “We general of the LNCPP.
will, for sure, be participating in the
first wave of biosimilar products El Kendi, meanwhile, is even evaluating different op-
launched here... The normal time tions about how to transfer part of the added value
for registration from submitting the related to manufacturing biosimilars to its Algerian fac-
application to receiving permission tories. “We want to enrich the debate and play our role
is 24-36 months, although we are in raising the awareness of the users, doctors, pharma-
A. GHARBI
working to optimize these timelines. cists, authorities, and patients. Two to three years ago,
—
director general, The beauty of biosimilars is that they biosimilars carried a big question mark and seemed
National offer a significantly more cost-friend- unrealistic. Nowadays there is a much better unders-
Laboratory ly pathway to delivering latest-gene- tanding and a clear roadmap going forward. El Kendi
of Control for ration innovative medicine,” says the has positioned itself right at the vanguard and we seek
Pharmaceutical company’s general manager Radwa to play a lead role in shaping the new environment,”
Products (LNCPP) Terbeche. declares Achi.

COVER STORY
Pressing Ahead
in a new facility. We have a massive spare capacity and GOING ALL OUT IN THE
we need to find a way to use it. In our calculation, the WAR ON CANCER
only way to work at full capacity would be to export –
precisely the strategy that we have opted for,” contem- “Market access is always going to
plates Essam Farouk. be noticeably simpler when you can
With products now being registered for export to manage to build a bridge to state
no fewer than five Middle Eastern markets as well as health priorities: we already bene-
to Europe, Farouk is conscious of El Kendi’s respon- fit hugely from our participation in RACHID
sibility as an ambassador and standard bearer for the the National Cancer Plan and feel KERRAR
“made in Algeria” brand, but believes that his compa- this is a great opportunity for the director general,
ny’s own successes in broadening its horizons will be local affiliate to establish a back- Beker
a tough act to follow for the rest of the local industry. bone in onco-hematology,” states
“When exporting, it is critical to have access points Janssen’s Loic Galmard.
to other markets. Often Algerian companies do not Not surprisingly other big play-
possess this and thus struggle to make it onto the ers have been tilting their portfo-
international stage. What’s more, many home grown lios in that direction. Pierre Fabre,
Algerian drug developers are family owned firms and for instance, has designated oncol-
tend to be reluctant to engage in the types of mergers ogy as a focus area and is looking
and acquisitions required to develop the scale where towards providing a comprehensive
they can export. Given that we possess sister compa- range of treatments spanning ther- ESSAM FAROUK
nies abroad, for example in Jordan, should we seek to apies for breast, lung, blood and president, El Kendi
launch a product in Jordan, we simply must harness bladder cancers. “Year in, year out,
our local affiliate’s apparatus to launch it. This is the our pharmaceutical division spends
beauty of the El Kendi business model which sets us around 50 percent of its R&D budget on oncology, so
apart from our peers,” he reasons. it makes perfect sense that we start doing more in this
Currency controls can also pose a formidable obsta- area in Algeria,” explains general manager, Nawel Baba
cle. For the companies without a presence in an export Hamed. “Our next step is to launch a new targeted
market, this can be problematic whereas El Kendi, therapy in melanoma. The European Commission has
owing to its unique structural setup, as both a home- just granted marketing authorization for the combina-
grown Algerian entity and part of the Jordanian MS tion of Braftovi and Mektovi for the treatment of adult
Pharma Group, can deploy its sister companies to pro- patients with unresectable or metastatic melanoma
mote its products and bring in foreign currency. with BRAF mutation and our expectation is very much
to launch in Algeria in 2020. We have already launched
a local epidemiological study on melanoma,” she adds.
GENERIC PENETRATION IN ALGERIA 2013-2017
Novartis Oncology meanwhile has been pushing new
Source: IQVIA boundaries by conducting oncology-focused clinical
research within Algeria. “We are only the second com-
47.72% 47.60% pany in the country to be engaged in this type of activ-
46.61% ity for this specific therapeutic area and that is testa-
45.45% ment to the on-going efforts of the standalone business
45.10% unit… We are thus providing the opportunity to use our
products with patients, at both second and third study
stages,” discloses Moncef Bouabid, the Oncology BU
country head. He even foresees a point in which his
company will be able to enable Algerian patients to
access sophisticated technologies like CAR-T. “The ben-
2013 2014 2015 2016 2017 efit of this therapy is that the treatment doesn’t require

COVER STORY
Pressing Ahead
onsite provision. Instead the blood can be sent to the

laboratory, modified in the laboratory, and returned to IN THE SPACE OF JUST THREE
the patient. The challenge within the country will be YEARS (2015-17) THE NUMBER OF
about the monitoring and follow up treatments, but we ACCELERATORS DOUBLED, LEAVING US
are confident that this can be, at some stage, surmount- WITH SOME 75 PERCENT OF MARKET
ed,” he reassures. SHARE Mourad Belkheyar VARIAN
Even medical device players have much to gain with
radiotherapy specialist, Varian Medical Systems, stand- linked by optical fiber with Varian’s main training hub
ing out as a major success story. “We currently have 36 in Switzerland, to mentor Algerian and African doc-
linear accelerators that provide stereotactic radiosur- tors and physicists. “There is a great need to train local
gery and precision radiotherapy, to maintain across the experts in how to handle this technology so the author-
territory. In the space of just three years (2015-17) the ities asked us to accompany them in that effort and we
number of accelerators doubled, leaving us with some were more than happy to oblige,” he explains.
75 percent of market share, and that doesn’t even take Indeed, with Algeria now possessing much better
into account the pending orders to address, once our hardware than ever before, but still suffering severe
facilities are ready to receive our equipment,” exclaims shortages in trained technicians to operate specialty
acting general manager, Mourad Belkheyar. equipment and devices, top medtech players are now
In fact, business has been so good and the state so setting about the arduous task of training up a new
supportive that the company agreed to a request to cadre of homegrown experts. “We have parachuted in
establish an in-country state-of-the-art training center, 9 experts in clinical education for costly and complex
Projecting Influence
As the African continent inches ties across the Middle East & Africa axis by championing
towards pharma regulatory con- and mobilizing combined initiatives to fight and prevent
vergence with a roadmap already regionally common diseases including Rabies, Leish-
agreed upon to establish an African maniasis and mosquito-transmittable diseases,” affirms
Medicines Agency (AMA) that shall Zoubir Harrat, general manager of the Institut Pasteur.
promote the adoption and harmo-
nization of medical products regula- Sanofi’s Haissam Chraiteh meanwhile recalls specialists
tory policies and standards, Algeria from other North African nations visiting specifically to
ZOUBIR is widely expected to be readying its observe the rollout of mobile diagnostic vans for breast
HARRAT candidacy in a bid to host the new cancer screening and how “the country is fast-becoming
— secretariat. “One very much gets the a benchmark that neighboring health authorities will
director general, sense that our nation is gearing up seek to emulate and replicate.”
Pasteur Institute to become a regional role model for
of Algeria
life sciences. You only have to look “Algeria has forged strong relationships with other Afri-
at the gathering momentum behind can states, so the groundwork is already in place. The-
plans to base the Pan-African Super Regulator out of Al- re is also the wealth of knowledge, and infrastructure,
giers, to feel that we are finally beginning to step out of which renders the country well suited to a position of
the shadows and assert ourselves,” suggests Lilly’s Doria hegemony,” he adds, all the while noting that there will
Oughlis. be strong competition from South Africa.
It would certainly appear that on multiple levels that Al- “Our nation definitely possesses the means, the whe-
geria is now starting to be more proactive in projecting rewithal, and the human resource to lead others, but one
its influence. “These days there is a concerted effort on country cannot carry such ambition on its own if there is
the part of the state to assume more of a leadership po- not some sort of consensus across the region,” reminds
sition and contribute to multi-nation initiatives. Institut Senator Chachoua, no doubt referring to North Africa’s
Pasteur has explicitly been trying to ramp up our activi- longstanding failure to integrate and coordinate policy.

COVER STORY
Pressing Ahead
TOP 20 PHARMA COMPANIES IN ALGERIA
SANOFI 458.6
EL KENDI 254.1
NOVO NORDISK 239.1
HIKMA PHARMA 167.3
GLAXOSMITHKLINE 150.6
PFIZER 112.3
MERINAL 104.4
SAIDAL 85.0
PHARMALLIANCE 84.9
BEKER 79.3
ASTRAZENECA 73.1
BIOPHARM 67.9
MERCK SERONO 58.8
ROCHE DIAGNOSTICS 57.7
MSD 54.7
NOVARTIS 53.8
ASCENSIA DIAB.CARE 48.9
LIFESCAN 46.8
BIOGALENIC 45.4
Sales for 2017 (USD millions)
IPSEN 44.2
Source: IQVIA

COVER STORY
Pressing Ahead
machines, such as MRI and scan- Most interesting of all however, the company has
ners, in order to optimize their use been promoting healthcare digitalization as a way to
by medical staff and we have also swiftly plug some of these pressing local skills short-
opened up a dedicated Advanced falls. “Digital Healthcare solutions can be of particular
Applications Centre for in-coun- benefit to health facilities because they can create col-
try training purposes,” reveals laborative care networks, reduce up to 20% of storage
Mehdi Ferdjioui, general man- costs and optimize images archiving and also provide
MONCEF ager for North West Africa at GE an opportunity for radiologists to save up to 19% of
BOUABID Healthcare. their working time,” explains Ferdjioui.
Algeria oncology “We organize regular events on “Globally, there is a lack of radiologists compared to
BU country head,
Novartis specific technologies; for example, medical needs, which contributes to the outsourcing
training 50 people every weekend all of radiography analysis from developed countries to
year round on our dual ultrasound developing countries. This tool can be used to bridge
systems, and we are also partnering with Scientific this gap internationally but can also be used to pool
Societies in continuing training in several care are- resources in one country,” he reasons. “The great div-
as such as oncology and cardiology, so as to improve idend of digitalization is it can deliver collaborative
patient’s outcomes. This emphasis on proximity and platforms that enable hospitals to resolve complex cas-
continuous training is very much in line with the goals es that they cannot treat with the resources available to
laid out by the government’s Cancer Plan and the new them. GE Healthcare has thus built a platform called
Sanitary Law introduced this year,” he continues. GE Cares where doctors can stay up to date with the

COVER STORY
Pressing Ahead
latest clinical trends, get access to training on new tech- Tunisia or even much of Europe for that matter. As
niques and share information on cases with colleagues soon as you start to factor in the rapid population
in their respective fields, and this platform has been growth and the epidemiological shift, then the enve-
launched in Algeria this year as a pilot for Africa and lope of opportunity to get involved with this market is
can be used by our partners.” immense. Moreover, Algeria is also very much an outlier
within its region when it comes to the willingness on
the part of the state to engage in public private partner-
ships. The hard-nosed fact is that we don’t have PPPs on
MAGNET FOR REGIONAL HEADQUARTERS issues like patient and practitioner education in the oth-
er North West Africa cluster states and it is testament
Interestingly, for all the idiosyncrasies of the Algerian to the vision of the Algerian ministry of health that we
marketplace, multinationals are increasingly choosing are able to roll out such programs here,” she continues.
Algiers as a regional headquarters. “Algeria has tradi- “Making Algeria the sub-regional hub has its advan-
tionally not always been considered the obvious loca- tages and disadvantages. Traditionally, many MNCs
tion for situating a regional office, but though a mul- have regarded the comparatively open and liberalized
titude of administrative and logistical hurdles remain, economies of Tunisia and Morocco as more welcoming
the logic for doing so is becoming ever-more apparent,” to foreign investment and more aligned with interna-
explains Doria Oughlis of Lilly. tional norms so have preferred to place their headquar-
“Firstly, the market is growing at a frenetic pace, ters there. However, we saw things rather differently,”
which is certainly not the case in either Morocco or recounts bioMérieux’s area business manager for the

COVER STORY
Pressing Ahead
Maghreb, Nadia Oka-Bousbia. “The sheer size of the added value. This is not the sort of place where you can
Algerian market, the volume of entrepreneurial opportu- direct things remotely from afar. It is essential to be phys-
nities and maturity of the public health system all render ically present to fully understand the local dynamics and
it strategically and commercially interesting and present engage with right people. Because this is a complicated
a pretty compelling business case.” market it, quite naturally, requires extra attention. For
Abbott’s Francophone Africa Cluster head, Mohamed example, Algerian market access issues take up approx-
Benali Khoudja has come to the same conclusion. imately 75 percent of the entire regulatory affairs work-
“From a business standpoint, it’s a no brainer to build load of bioMérieux North Africa, therefore it is logical
the greatest presence in the largest market, which, for to want to base the area’s regulatory affairs resources
us, is Algeria by quite some way. The country today rep- in Algiers rather than in Tunis or Casablanca,” reasons
resents some 45 percent of our French African market Oka-Bousbia.
sales alone with a turnover surpassing 35 million and is “Already the local market stands out for the diversity
the uncontested mega-market in the region: not only in of global, regional and local operators present. In certain
terms of size, but also in terms of strategic relevance as respects, we have the characteristics of a mature market,
the interface between north and south.” such as the existence of a universal health apparatus,
Then there is also the argument that Algeria requires a whereas in other aspects, such as our level of access to
more embedded presence precisely because of the intri- innovation, we look much more like an emerging market,
cacies and complexities of this mammoth, but technical- so firms like us really need to come up with a special for-
ly difficult marketplace. “We calculate that our stronger mula and bespoke business model. The classic, one-size-
presence on the ground here in Algeria generates greater fits-all template simply won’t work here,” argues Oughlis.
Chronic Diseases: Evolving Attitudes
Moncef Meklati, Merck’s general ma- Indeed, Merck has significant experience in collabora-
nager for North West Africa, on evol- ting with governmental authorities, especially in terms
ving attitudes to chronic diseases in of risk-sharing agreements, which Meklati hopes will be
Algeria and the need for continued brought to bear in Algeria. “We are closely collaborating
emphasis on public-private partners- with the authorities on a variety of matters,” he notes.
hips. “Some discussions are about R&D while others are fo-
cused on clinical trials and access to new medications. In
Despite economic challenges in re- general, every exchange aims to find an optimized way
MONCEF cent years, the Algerian state has to further improve the healthcare situation in the country
MEKLATI continued to prioritise healthcare. together.”
— Merck’s Meklati notes that “Algeria is
general manager, quite unique within its region in terms Meklati continues, “We also have a great deal of inter-
Merck of its healthcare system, showing we- national experience when it comes to risk-sharing agree-
ll-established universal coverage with ments. We can surely share this expertise while adapting
free access to patient care. The government is willing to it to the Algerian context. Algerian patients are suffering
develop self-sufficiency, and by doing so, will dramatically from diseases that characterize developed countries.
decrease the costs of importation in order to continuously When it comes to diabetes, hypertension and endocri-
improve access to pharmaceutical products.” nology, Merck is continuously raising awareness through
various activities during which the importance of early de-
Within this governmental focus on health, Meklati highli- tection and early treatment for patients is emphasized to
ghts the importance of public-private collaboration. “The avoid more serious complications at a later stage. Many
new Health Bill will help find win-win solutions to streng- of these efforts are supported by the authorities and the
then partnerships between private and public actors,” he medication is usually reimbursed by Social Security. The
states. “We need to think of risk sharing for instance, in government has made significant efforts to make these
order to make sure that there is real added value for the treatments affordable for patients, and therefore strongly
patients and an improvement of treatment.” encouraged the industry to settle and grow locally.”

COVER STORY
Pressing Ahead
IQVIA’s Hocine Mahdi, however, perceives a sub- it you have to have to have a certain
tler dynamic at play when it comes to headquartering. amount of patience and resilience.”
“If you look at the fine details, you will discover that A certain amount of courage also
many positions and functions in these companies are appears to be a pre-requisite. “Unless
still based in Tunisia and Morocco, even if the General you are willing to take the risks, you
Manager is located in Algiers. That is simply because of may not be rewarded here,” warns
the administrative and logistical difficulties that a move Sandoz’s Mourad Ishak.
to Algeria involves,” he reflects, pointing to the lack of Entering with one’s eyes fully KARIM
easy transport connectivity to neighboring states, obsta- open would also seem to be essen- HARCHAOUI
cles around currency exchange for paying international tial. “We perceive a lot of companies country manager,
Novartis Pharma
employees, and the delays of up to four months in secur- making missteps in the sense that Services
ing work permits and visas. “Algeria has uncontestably they rush headlong into an invest-
asserted itself as the main powerhouse in the region ment without fully understanding
and it is true that the other Maghreb markets have been the mechanisms and dynamics of the market, so it is
struggling badly, but the perception counts too. If peo- pretty important to first figure out what is going to be
ple consider more liberal countries like Morocco are bet- expected of your company in terms of the local regula-
ter for living then we are more likely to be able to attract tions, before entering under false pretenses,” reminds
the international quality talent that we need to those Reda El Baki, president of the French-Algerian Chamber
countries. In short, Algeria has a bit of an image prob- of Commerce and Industry (CCIAF).
lem that stems not just from a troubled history that is Rewards can be vast, but they obviously have to be jux-
thankfully now behind us, but by being too insular and taposed against the risks. “We do not really recommend
inward looking,” he concludes. Algeria to small companies that are starting to export
for the very first time. This is the sort of market that is
best left to old hands who have sufficient experience.
There are many potential pitfalls, but the biggest one is
WHO DARES, WINS the regulatory uncertainty. The rules of the game are lia-
ble to change midway through the game and that means
Where does all of this leave international investors vis- that, as a business, you have to have deep enough pock-
à-vis the freshly assertive Algerian marketplace? The ets and enough time and patience to be able to weather
growth potential of the market is very high, especially any delays that you might experience,” counsels AHK’s
in the pharmaceutical and medical device sectors. “The Marko Ackermann. “The bottom line is that this is no
numbers do not lie. We’re staring at a population that place for newbies. This is certainly not the sort of market
is forecast to reach over 72 million people by 2050 and where you can saunter in, make a fast buck overnight
where the demographics will be structurally skewed and then withdraw. The businesses that tend to succeed
towards those population groups – essentially zero to six are those that have the perseverance to be here for the
year-olds and 60 to 80 year-olds – that consume a dispro- long haul and will invest the energy, time and effort in
portionate amount of medicines. And, it’s not just that building up trust locally,” he concludes.
there are more and more people requiring treatment, but The Social Security’s Djaoaud Bourkaib is, however,
the expectations of the market are on the rise as well,” optimistic that Algeria’s pharma market can continue to
speculates AHK’s Ackermann. grow and gain even more influence within its region. He
This means that though the market might be tricky posits, “We want Algeria to become a regional market.
to navigate, it can herald big rewards for those who If our neighbors are buying, the Algiers factory will be
dare and manage to go about it in the right way. “Make able to respond to the need. Not only is Algeria a more
no mistake that Algeria is what we refer to as a VUCA interesting local market, but it is a potential center of
market: one that is characterized by high levels of vol- commercial influence. There are challenges to be met,
atility, uncertainty, complexity and ambiguity,” stresses but the authorities have made many decisions to facil-
Novartis’ Karim Harchaoui, “so to make a success out of itate this.”

ONCOLOGY
Messaoud Zitouni, National Cancer Plan
A MAN WITH
A PLAN
Prof. Messaoud Zitouni, head of the Algerian Nation-
CANCER HAS TO BE TREATED AS AN
al Cancer Plan, highlights the Plan’s main advance-
ments since 2015 as well as the gaps to still address. INTERDISCIPLINARY AREA, BECAUSE
IT TOUCHES SO MANY DIFFERENT
FIELDS IN MEDICINE.
Mesaoud Zitouni
NATIONAL
both very far from corresponding to a specialty stand-
CANCER PLAN
ard of care.
What developed countries have established is that
HCLS: Three years after the launch of the Cancer cancer has to be treated as an interdisciplinary area,
Plan, what has it achieved so far? because it touches so many different fields in medicine.
MESSAOUD ZITOUNI (MZ): Overall, we see that While Algeria has only recently made this a topic, this
the Cancer Plan has had a positive effect. It has been a pluri-disciplinary approach now lays at the heart of our
great strategic achievement for Algeria in that it was strategy. Interdisciplinarity—as implemented in France
the first of its kind. for instance—is the only way to change the pathway of
What makes it original is that it was in part ordered care and overcome the bureaucratic machine of admin-
by the president of the Republic himself, and sub- istration in Algeria.
sequently adopted by the ministries in 2015. The
President himself decided there would be a piloting HCLS: What role do you see for foreign multi-
and follow-up committee for the Cancer Plan, and that national drug developers in helping to further the
it was to be inter-sectorial. I was charged with coordi- objectives of the national cancer plan?
nating the committee and spent the first two years put- MZ: In Algeria, we view cancer as an important field,
ting in place all the needed procedures. but the advancements are fast and so disruptive, that
It was important that the country’s highest authori- we have no other choice than following behind the
ties felt responsible for the Cancer Plan, and the strate- developed countries. I like to draw the comparison
gic success came from that incentive, as well as from the between Muslims going for pilgrimage to Mecca, and
fact that for the first time since independence, we wit- oncologists going to ASCO and returning with the lat-
nessed such great mobilisation of healthcare profession- est scientific knowledge about innovation, a knowledge
als. I think this is beneficial for all involved, society and that needs however to be contextualised and adapted
patients, but also the professionals, who, for the first for each country following its own realities.
time, see that their work is actually finding fulfilment. When it comes to our relationship with industry, I
also think we can benefit from partnerships with the
HCLS: To what extent has the Plan managed to private sector as they rely on extensive knowledge.
redefine treatment pathways for cancer? AstraZeneca for instance has been long involved in
MZ: We are seeing important improvements in new breast cancer. However, I feel that, until now, we have
pathways for cancer patients. Previously, cancer was been pursuing a communication strategy that is too
being treated in an archaic and anachronic manner fragmented. Algeria has to take a more global stance,
and was viewed as an acute or transmittable disease in uniting as one voice in discussions with pharmaceuti-
the pathway, hence diagnostics and treatments were cal companies.

COVER STORY
Pressing Ahead

ONCOLOGY
Novartis
CATCHING UP
ON CANCER
With the Algerian government having made coun-
tering cancer a national priority, Novartis has
stepped up its oncological offering in the country
– establishing an autonomous oncology R&D unit
and working on innovative access programmes to
ensure that Algerian patients can receive the latest
M
generation of cancer treatments.
oncef Bouabid, the Novartis Oncology In terms of the company’s R&D

country head for Algeria, feels that work, Bouabid notes that “Novartis
Novartis is helping to drive a new con- is already performing clinical
ception of cancer and of healthcare research in oncology in Algeria. We
within the Ministry of Health and more are only the second company in the
broadly among patients. He asserts that, “cancer is mov- country to be engaged in this type
ing from a fatal to a chronic disease. As patients’ surviv- of activity for this specific thera- MONCEF
BOUABID
al rates are increasing, they need to better understand peutic area and that is testament
country head,
their pathology, and the adverse events they will have. to the on-going efforts of the stan- Novartis Oncology
We want to show the government the best practice in dalone mini division dedicated to
countries such as the US and the UK as well as across oncology and haematology.”
the EU. Originally the Ministry of Health’s only aim was Bouabid continues, “We are providing the opportu-
to reduce the health bill but changing the way in which nity for patients to use our products at both the second
cancer is treated in Algeria is realistic with the right pro- and third study stages. Novartis Oncology also con-
cess. It is pharmacoeconomic and it is worldwide.” tinues to handle small-scale projects locally including
HOW CAR-T THERAPY WORKS

Source: Novartis; Business Insider
+
STEP 1 STEP 2
A doctor removes white blood The cells are taken to a manufacturing facility
cells from cancer patient
STEP 5 STEP 4 STEP 3

The cells are administered to The reprogrammed cells are The cells are reengineered to recognize
the patient sent back cancer cells and wipe them out

ONCOLOGY
Novartis
IF WE TAKE THE EXAMPLE OF CAR-T,

NOVARTIS WILL ASK THE GOVERNMENT
TO PAY ONLY FOR THE SUCCESSFUL
THERAPIES, WHICH TEND TO CONSTITUTE
80 PERCENT OF THE TREATMENTS.
Moncef Bouabid NOVARTIS ONCOLOGY
phase II and phase III clinical trials. There are also some increasing its prices. We are patient-oriented, so are
other projects requested by local key opinion leaders making big efforts to guarantee patient access.”
(KOLs) to use the products themselves when they Concretely, Bouabid clarifies, “One strategy we are
want to register new projects. Finally, there are specific employing is local manufacturing... This is something
research assignments, more often than not handled by new in Algeria and is a top priority for Novartis. Under
local oncologists. We assist them wherever possible.” the umbrella of Novartis Technical Operations (NTO),
However, ground-breaking products in oncology do our plant near the airport that was in the past produc-
not come cheap. The first CAR-T cell therapy, tisagenle- ing only for Sandoz in Algeria, is now being upgrad-
cleucel (Kymriah) – a treatment for children and young ed and reconfigured to additionally produce oncology
adults with B-cell acute lymphoblastic leukemia devel- products.”
oped by Novartis – has been priced at USD 475,000 for “Moreover, Novartis is also trying to give more than
a one-time treatment. This leads to a justifiable fear that is received in the country, something which is uncom-
this treatment and others like it may simply be too costly mon in the pharma industry. If we take the example of
for a developing country such as Algeria to afford. CAR-T, Novartis will ask the government to pay only
Bouabid is keen to highlight the ways in which for the successful therapies, which tend to constitute 80
Novartis is working to sidestep these cost issues, point- percent of the treatments. We will also look at an access
ing out that “Novartis has understood the issues in the program for patients who cannot pay. Furthermore, we
market with prices for a long time. Recently US President will provide a product if it is requested by the govern-
Donald Trump tweeted a thank you to Novartis for not ment, but not currently available in the country.”

RADIOTHERAPY
Mourad Belkheyar, Varian
RADIATING
INSIDE AND OUT
Mourad Belkheyar, acting director general of Varian
Healthcare Algeria lifts the lid on the progress Alge-
ria has made in its quest to bring the most advanced
radiotherapies to Algeria. He discusses the critical
role of Varian healthcare in training engineers, oper-
ating, and maintaining such complex machinery, to
improve the prognosis of Algerian patients.
HCLS: How has the market for radiotherapy and has visited Algeria twice already, meeting the Ministers
particle accelerators evolved in Algeria? and the President of the National Medical Oncology
MOURAD BELKHEYAR (MB): In the world, Association. They saw the market potential first hand.
there are two main manufacturers of radiotherapy When our merchandiser first installed an accelerator
equipment: Varian, with 70 percent of market share in in Algeria, 800 km south of Algiers, nobody believed it
Algeria, and the Swedish company Elekta. Siemens was was possible. The challenge was hard to meet, finding
once in the running, but they abandoned the therapeu- the human resources, addressing maintenance needs,
tic activity to focus on diagnosis only. and managing the spare parts flows. Still, Varian proved
In the beginning of the 2010s, Algeria had an obvi- itself and ever since 2012 has eased the pain of the pa-
ous lack of particle accelerators to treat its patients. tient population in the South of the country.
Consequently, the Ministry of Health decided through
the 2014-2019 Cancer Plan to properly equip the coun- HCLS: What has been the impact of the 2014-
try with therapeutic machines. Having assessed the 2019 Cancer Plan?
need, they concluded that 36 accelerators had to be MB: With the Cancer Plan, we answered every tender
purchased. Half were awarded to Elekta, and the other call, won a number of them, and honored the corre-
half to Varian. sponding contracts. Our global management knows
The Ministry of Health has constructed 12 Anti- the extent of the need here and they invested their time
Cancer Centers across the country. Each of them is and money long before the unveiling of the National
equipped with 3 accelerators, for a total of 36 machines: Cancer Plan. Engineers, project managers, application
18 machines for Varian, 18 machines for Elekta. This experts are all Algerian nationals, trained by Varian,
contract was signed in 2014, and 4 years later Varian genuine carriers of Varian expertise.
has already delivered 9 machines in 3 different Anti- Today, our team covers the whole country and even
Cancer Centers, 2 of which have already been treating outside of Algeria: in Maghreb, on the African conti-
patients for over a year now. The third one will open in nent and even in Europe, for training or maintenance.
a few weeks. For example, our application specialist trains operators,
doctors and physicists in France, Switzerland, Bulgaria,
HCLS: How did Varian become market leader Tunisia and Morocco. Our project manager is currently
for radiotherapy in Algeria? in charge of Nigerian projects, and our technicians were
MB: Varian has their very own management strategy sent to assist colleagues installing machines in other
as part of the corporate culture. Varian and its top man- African countries. Varian in Algeria is very much radi-
agement are highly attentive to client needs. Our CEO ating inside and outside the Algerian border.

CEO PROFILE
Essam Farouk, El Kendi
CEO PROFILE
BIG TICKET INVESTMENTS

An Egyptian with almost over 25 years of experience in the pharmaceutical industry, Essam Farouk took
the reins as the CEO for MS Pharma in 2012. Coming to Algeria in 2006 following his appointment to
E
director general of MS Pharma’s local subsidiary El Kendi, a role he still holds, he has steered El Kendi
and onto a path of considerable success.
l Kendi is now in the one of the leading healthcare groups

top two pharmaceutical in MENA region and emerging mar-
companies in Algeria, kets within ten years, with a specific BY THE BEGINNING OF
and the market’s leading focus on the highly branded emerg- NEXT YEAR, WE WILL
generic provider. Despite early chal- ing markets. “El Kendi alone already HAVE CONDUCTED SOME
lenges, Essam Farouk credits some holds registrations in 6 export mar- M&A ACTIVITY INSIDE
of this success to “an unconven- kets: Jordan, Saudi Arabia, Europe, EUROPE, WHICH WILL
tional market entry, which allowed Sudan, Iraq, and Turkey. Given that CONSTITUTE OUR FIRST
El Kendi to operate like a home- we possess sister companies abroad EVER EXPANSION OUTSIDE
grown, local outfit, bringing with through MS Pharma, to export, OF MENA.
it its own particular benefits. For a we simply harness our local affili-
start, the government could see that ate’s apparatus, the beauty of the El remains certain that Algeria’s lead-
we were thoroughly committed to Kendi business model”. ing position within MS Pharma will
the Algerian market and were put- Perhaps his most significant not diminish, the origin of 70 per-
ting down roots for the long haul”. ambition concerns expansion. cent of its total sales. Farouk con-
Through El Kendi, Farouk has Planning enlargements both inside cludes that Algeria is, and will con-
overseen one of the largest industri- and outside the Middle East and tinue be, “the jewel in the crown”
al investments in Algeria’s pharma- North Africa, he is seeking to com-
ceutical field – opening a USD 100 plete MS Pharma’s portfolio with-
million plant at the industrial zone in the MENA region by expand-
of Sidi Abdellah (Zeralda). Not con- ing across the Gulf, setting up
tent with this alone, further invest- new manufacturing facilities in
ments have been made, “There are Saudi Arabia and making future
new projects underway including acquisitions in Morocco and the
the twin plant whose work is in the UAE. However, Farouk is now eye-
final phase” he reveals. ing up markets further afield for
Farouk holds a dual role, lead- MS Pharma, positing that “by the
ing both El Kendi and the regional beginning of next year, we will have
pharmaceutical group MS Pharma, conducted some M&A activity
a platform combining national affil- inside Europe, which will constitute
iates of El Kendi, UPM, MS Pharma our first ever expansion outside of
Iraq and their affiliates for rap- MENA”. The specific markets he is
id access to neighboring markets targeting are awaiting announce-
ESSAM FAROUK
such as Morocco, Tunisia and the ment within the next few months.
DIRECTOR GENERAL, EL KENDI
French-speaking African countries. Despite new target markets across
He aims to establish MS Pharma as Europe and the MENA, Farouk

MANUFACTURING UPGRADES
Sofiane Achi, El Kendi
LOCAL
CHAMPION
Sofiane Achi, general manager of El Kendi, one of
Algeria’s leading pharma manufacturers, discusses
recent performance, manufacturing upgrades, and
being a role model for the industry.
Sofiane Achi
EL KENDI
strength of El Kendi is that from the first day we decid-
ed to go for cardiology, CNS, urology and other areas of
HCLS: Tell us about the performance of El Kendi. significant unmet need. That is very distinctive, because
SOFIANE ACHI (SA): Today, El Kendi stands as Algeria is undergoing epidemiological transition, and
number two on the market. We are still very proud of we deliberately targeted areas where we identified gaps
being the first private investment actor in pharmaceu- in the market for chronic disease therapies. When the
ticals production and have been building further upon company was created, we decided to go unquestionably
this legacy. Last September, we extended our facilities for specialisation. It was of course a challenge, because
and opened a new plant, we are doubling production manufacturing these products implies having consider-
capacities in solids and we will be able to produce three able expertise and know-how.
times what we are producing currently in semi solids On top of it, we had to “shape” the market, because
and liquids. doctors and patients were not aware that generics were
Currently we have a market share of 8 percent, with a a viable option to treat these conditions. It was not an
goal to reach 9% by the end of this year. We are going to easy job. We worked to develop the usage, informing doc-
continue our growth, and our ambition is to assume a tors and patients about generics, about the quality of our
leadership position within the Algerian market. It will not products. Today when I see millions of our products sold
be easy, but the hallmark of people working in El Kendi is every month, it is a testament to the success in getting
that we are always up for a challenge. You know the say- into the market. Algerian patients are now completely
ing “target the moon, if you don’t reach it you will end up confident in the products that are locally manufactured.
in the stars”. So let’s target the moon and we’ll see.
I am very excited about my transition from Boehringer HCLS: We hear that the target of meeting 70%
Ingelgeim to this new role within El Kendi. I believe that coverage of domestic needs by Algerian implanted
I can contribute a lot of experience, which will comple- firms is gradually becoming a reality, but that the
ment the very talented team of young professionals part of the market dealing with classic, synthetical-
here. They are the future of our company. ly produced small molecules is reaching saturation.
Tell us more about these upgrades to your factory. Does this imply that local companies will have to
When we talked 4 years ago, the company had set an start doing biotechnology as well if progress is re-
objective to go into injectables, how is that progressing? ally to be made?
We are working on it, there will be an announcement SA: The pharmaceutical industry in Algeria is a good
in the upcoming weeks about this. For the time being, example of success. 10 years ago we were importing al-
we manufacture solids, semi solids and liquids. The most everything. That changed, thanks to the efforts

MANUFACTURING
MANUFACTURING UPGRADES
UPGRADES
WE SHALL NOT STAY IN THE COMFORT

ZONE, WE NEED TO FIND A NEW
ENERGY AND STAY INNOVATIVE.
of the government and the investors. Currently, we are ty, therefore we try to support local communities, at
above 50% of local coverage. The target of the govern- various levels. We interact with everyone, and not only
ment is to reach 70% of local manufacturing. El Kendi physicians and pharmacists. We help the student for
surpasses that, since our local production represents 95% instance, we provide them with tablets, books, etc.
of our business in Algeria and importation represents Our programs also include the training of doctors,
05% only. Now when we import, we import medicines pharmacists, the sponsoring of local scientific congress-
that are not manufactured in the country, with high es, outbringing the development of general knowledge
quality and affordable prices. We will continue in the that is necessary in any developing country.
same direction. Going down the route of biologics is the
natural next step for the most sophisticated cohort of HCLS: What products are you planning to
indigenous Algerian pharma manufacturers. Given that launch?
El Kendi was constructed here on Algerian soil, we are SA: First of all, we will launch our new plant and
somehow local as well despite the fact that our owner- optimize our industrial capacities. We will continue to
ship derives from abroad. Our aspiration is to be leading invest in the same therapeutic areas. We are also man-
the pack as a locally implanted entity that clambering ufacturing products for hospitals. We are now launch-
up the value chain and entering the world of biologics. ing products for the PCH. For me, the new challenge is
to go for new formulations, and to launch them suc-
HCLS: How would you describe El Kendi’s social cessfully in the country.
and national impact, as the second largest employer
in pharma? You are a role model in terms of address- HCLS: What do you see as your biggest obstacle
ing modern diseases, in terms of quantities pro- ahead?
duced but also in terms of rising up the value chain... SA: We shall not stay in the comfort zone, we need
SA: We surely add some value to the Algerian mar- to find a new energy and stay innovative. The biggest
ket. We have 1200 employees, plus, when you take into risk when you have been successful is to start resting
account indirect employment, you end up with a fig- on your laurels. We are adamant that we will not allow
ure more or less three times that. We pay taxes and are complacency to set in. We need to review our plans and
happy to do so, as it is our contribution to the coun- work on our different projects with a new momentum.
try’s wellbing. We pay for energy and other services. We My role is to keep what is positive, improve what needs
favor local suppliers and service providers because we improvement, wherever necessary, and to bring about
consider that priority should go to the local market. a new vision and a new strategy that will take the com-
We also possess a strong sense of social responsibili- pany to new heights.

THE MIDDLE EAST CONNECTION
Malika Benmouffok, Tabuk Pharmaceuticals
TAILOR-MADE STRATEGIES
Malika Benmouffok, Algeria country manager of Tabuk Pharmaceuticals, explains the Saudi company’s
story in Algeria, its partnership strategy and the disruptiveness of recent import restrictions.
HCLS: What is Tabuk’s story in Algeria?
MALIKA BENMOUFFOK (MB): We arrived in
Algeria in 1997 with imports only, before partner- CLEARLY, ALGERIA
ing with the Central Pharmacy of Hospitals (PCH) in IS A SPECIFIC
2004. We had a renewed vision of Algeria and wanted MARKET.
to invest in the country. In 2010, Tabuk came back
with the stated purpose of building a plant and Malika Benmouffok
manufacturing locally.
TABUK PHARMACEUTICALS
Firstly, we would only import and market around
ten of Tabuk’s products in Algeria. Then in 2014, the was a victory. The Algerian market is both exciting and
Minister authorized us to go forward. We had a spe- stable enough to plan for the future.
cific investment fund of about USD 20 million and
Tabuk built a plant in Blida, which is now up and HCLS: Is the fact that you are a Middle Eastern
running. Tabuk has its own business development, firm advantageous to you? Does that mean that
and its own R&D department based in Jordan: our you understand the Algerian market better?
company maintains a spirit of innovation, we devel- MB: Clearly, Algeria is a specific market. Our policy is
op new molecules and galenic forms. very clear when it comes to drug prescription: Algeria is
In Saudi Arabia, Tabuk is one of the largest phar- very much inspired by the French model, while Tabuk
maceutical companies, and its Algerian plant is one has a more Anglo-Saxon identity. Entering here, we
of four plants in the region. The Algerian site will made sure that our approach here would be more in-
mostly produce dry forms. Given the present situ- spired by French and European ways. The Algerian pa-
ation and the market limitations on certain antibi- tient has a tendency to think that every original drug
otics, due to the entrance of local players, we decid- has got to be French or European, and everything gener-
ed to produce antibiotics in dry form as well, since ic is Arabic. Ten years ago, even European generics were
cephalosporins are our historical and core activity, struggling. Then we entered an economic context that
something we have really mastered. brought about change.
The mindset has changed, so our patients and doctors
HCLS: How strategically important is this Al- are no longer opposed to generic drugs. For a long time,
gerian affiliate to the group in terms of growth many multinational companies marketed their original
and revenues for instance? drugs to the physicians only, and not to the final users
MB: Algeria carries a huge potential, and it will - the patients, or even the pharmacies. With this shift in
continue to do so in the future, despite Algeria being economy and culture, doctors have started to recom-
quite a challenge as a country to settle in. We find mend generics. Patients have followed their advice, so
it to be very exciting. Every day is different. As the these companies have had to change their strategies. A
environment evolves quickly, the line between risks few years ago, some laboratories for instance would nev-
and opportunities is often blurred. We planned for er make marketing efforts towards patients, and others
an opening in January with no imports yet, and after would never have targeted doctors in their promotion
everything we were granted an import quota, which campaigns. Now we work both sides of the market.

COMPANY PROFILE
Saidal
COMPANY PROFILE
SAIDAL:
TIME TO CHANGE?
T
he Algerian government’s emphasis on and reduce the dependence of the national econo-
local production has opened up new my of hydrocarbons. Moreover, Algeria must, in the
opportunities for local firms. At the fore- next ten to 15 years, reach the phase of Industry 4.0
front to capitalise on this policy has been (Automation and AI in industry), currently being
the 80 percent government- owned pharma compa- implemented around the world”. The government
ny Saidal. A specialist in the field of generics, Saidal’s hopes that Saidal and its partnerships with interna-
current portfolio includes 215 medications in all dos- tional companies will expedite the import of techno-
age forms and dosages, represented in 21 therapeutic logical transfer, training, and know-how from abroad,
classes. Even more impressive may be Saidal’s produc- to take the Algerian economy into this new era.
tion capacity, managing six individual plants, more In spite of the government’s strong ambitions for
than any other pharmaceutical company in Algeria. Saidal, it has not been without organizational prob-
Furthermore, Saidal have reaped the rewards of lems, seeing four different CEOs in the space of three
Algeria’s strict rules on local investments which make years. The first change came in November 2015 after
taking on local partners mandatory. the group suddenly lost more than a dozen senior exec-
The company currently holds six international part- utives. The most recent reshuffle came almost a year
nerships, most notably with Sanofi, Pfizer, and Novo later in December 2016, after the partnership between
Nordisk. The partnerships with Pfizer and Sanofi have Novo Nordisk and Saidal was labelled catastrophic.
developed into joint ventures and the agreements con- There is a fear that Saidal faces significant managerial
tinue to develop. Country head of Sanofi, Hassam instability and is failing to meet the expectations of its
Chraiteh revealed their plans to further enhance coop- government owners.
eration with Saidal, “At the end of last year, we signed Such chronic instability within Saidal is visible in the
an agreement with Saidal to localise vaccines. This will words of their international partners too. Corporate Vice
be our second partnership with Saidal, with whom we President for the Maghreb Region at Novo Nordisk, Jean
interact frequently.” Paul Digy notes that, “There can be difficulties working
THEY SEEM TO HAVE A FOCUS ON BUILDING FACTORIES RATHER THAN

SELLING MEDICINE. PERHAPS THEY ARE APPLYING TOO MUCH ENERGY IN
AREAS THAT ARE NOT THEIR SPECIALTY.
Saidal’s rise in recent years is partly the result of the with Saidal and it can at times be challenging to under-
Algeria government’s push to diversify its economy. stand what their long-term goals are. We would like to
According to the Algerian Minister for Industry and work with them to expedite their development. In addi-
Mines, Yousef Youfsi, “The President of the Republic, tion, they seem to have a focus on building factories
Abdelaziz Bouteflika, has repeatedly stressed the rather than selling medicine. Perhaps they are applying
need to boost industrial activity to diversify exports too much energy in areas that are not their specialty.”

INVESTMENT
The Middle East
THE MIDDLE EASTERN

INVESTMENT WAVE
Key recent investments from Middle Eastern companies into Algerian Pharma.
Saudi company Tabuk Pharmaceuticals invests USD 20 Saudi player Jamjoom secures landmark tie-up with
million into a plant in Blida (2014) Algeria’s HUP (2017)
“We arrived in Algeria in 1997 with imports only. Then Tabuk Algerian pharmaceutical laboratory Huppharma entered into
partnered with the Central Pharmacy of Hospitals (PCH) in partnership with Saudi counterpart Jamjoom Pharma to open
2004. We had a renewed vision of Algeria and wanted to invest an ophthalmology drug factory in Constantine (400 km East of
in the country. In 2010, Tabuk came back with the stated pur- Algiers).
pose to build a plant and manufacture locally. First, we would The industrial unit will have a production capacity of 250 mil-
only import and market around ten of Tabuk’s products in lion eye-drops bottles per year, according to APS. Established
Algeria. Then in 2014, the Minister authorized us to go forward. under the 51-49% rule regulating foreign investment in Algeria,
We had a specific investment fund of about USD 20 million, the Saudi-Algerian firm will need an initial investment of USD
and Tabuk built a plant in Blida, which is now up and running.” 130 million.
Malika Benmouffok, country manager, Tabuk

Pharmaceuticals
Jordanian Hikma receives MoH approval to establish

injectable facility in Sidi Abdullah (2018)
“By the end of 2018, we will be the only private company
Emirati firm Julphar consolidates its manufacturing with four plants in Algeria and the Sidi Abdullah facility will
partnership with the PCH by introducing its innovative be our fifth, with an initial investment of USD 40 million USD.
MEBO-Scar technology to Algeria (2016) We will depend on our experience from our injectable plants
“Julphar’s mission is to improve patients’ quality of life in the in Portugal, Germany and Italy, mirroring these experiences to
MENA region and the MEBO portfolio dedicated to wound and manufacture injectables in Algeria.”
scar management helps us achieve this mission. As Algeria is
one our most strategic markets, we have decided to introduce Ma’mon Alaraideh, Country Manager, Hikma
MEBO Scar to Algeria to complete the MEBO portfolio and to
help Algerian physicians improve their patients’ quality of life.”
Hosam Badr, marketing director, Julphar
Jordanian Dar Al Dawa’s first product manufactured in

Algeria (2019)
“I am confident that we can gain a substantial market share.
There are only two other companies willing to produce eye
Jordanian outfit ACDIMA signs a partnership agreement drops. We decided to shift to eye drops before the compe-
with Saidal (2017) tition. Moreover, this is a significant opportunity to grow the
This agreement consists of the creation of a joint venture brand of Dar Al Dawa and build our reputation amongst doc-
between the two parties which will be in charge of carrying tors and patients.”
out compliance studies of generic drugs with the originators
in Saidal’s new bio-equivalence centre in Hussein Dey (Algiers). Noureddine Issad, general manager, Dar Al Dawa Algeria

LOCALIZATION STRATEGIES
Haissam Chraiteh, Sanofi
THE EARLY
MOVER
Haissam Chraiteh, country chair for Sanofi Algeria,
expands on Sanofi’s ground-breaking foothold in
Algerian local production, and how its partnership
with the authorities ultimately manifests itself in
better provision for patients.
HCLS: How would you de-

scribe Sanofi’s legacy in Algeria?
HAISSAM CHRAITEH (HC):
Looking at Sanofi over the last
27 years, we were an early mover
in embracing the concept of local academy, supporting the build of foundations for
production way before localiza- future advancements in clinical research within
Haissam tion became enshrined as a core Algeria. We are simultaneously working with medical
Chraiteh government priority. We strongly professionals to improve the quality of life of patients,
SANOFI believe that being close to the pa- providing nutritional education and awareness on
tient helps us better serve the local how to best avoid complications. Our engagement
needs. We also believe that the tal- has been total.
ented Algerian workforce allows us to manufacture our Our partnership with the authorities is based on our
product locally with the same high quality standards as mutual trust and goals to improve the life of Algerian
those that we have worldwide. patients. We have a long heritage in Algeria and we try,
whenever we can, to make a difference in people’s lives.
Beyond the treatment itself, our purpose in Algeria is
WE ALSO BELIEVE THAT THE TALENTED empowering the lives of those who have health chal-
ALGERIAN WORKFORCE ALLOWS US lenges by protecting, enabling and supporting them,
TO MANUFACTURE OUR PRODUCT so they can live life to its full potential.
LOCALLY WITH THE SAME HIGH
QUALITY STANDARDS AS THOSE THAT HCLS: How do your projects link in with the
WE HAVE WORLDWIDE. Algerian authorities’ bold ambition to make the
country a biopharma hub?
Most of all, our participation in the country health- HC: Sidi Abdellah has actually been designated one of
care economy has been multifaceted. We also believe those spots where a potential future biopharma cluster
that healthcare is a right for everyone when you live in can take root. Ambitions of this magnitude take time
city suburbs or in rural areas. We have set up projects in to materialize and the first step is about putting in the
preventative medicine with the mobile clinic allowing foundations and a supporting ecosystem. Sanofi has
to perform diagnostics for diabetes and cardiovascular again been quick out of the starting blocks to embrace
diseases in remote areas. the long-term aspirations of the Algerian authorities.
Beyond our commitment to the Algerian economy We took decisive steps to localize the state-of-the-art
and our strive to reduce inequality between urban and production with latest generation therapies. We believe
rural areas we have also launched a clinical research that it is fundamentally important to align closely with

LOCALIZATION STRATEGIES
Haissam Chraiteh, Sanofi
the ambitions of the local stakeholders and that means ties a benchmark that other countries will be seeking to
not only the government, but also the rest of the health- emulate and replicate.
care industry. We are very keen to understand health-
care needs on the ground and be at the forefront of HCLS: How far is Algeria in the life sciences sec-
driving this spirit of innovation. This is a country with tor from becoming a role model for the region?
massive expectations. As a health journey partner, we HC: Algeria is already at the stage where it projects
aim to be that true partner that supports the country in leadership. Algeria has forged strong relationships with
manifold ways with its development trajectory. other African states, so the groundwork is already in
place. There is also the wealth of knowledge, and in-
frastructure, which renders the country well suited to
WE BELIEVE THAT IT IS assuming a regional leadership role in the life sciences
FUNDAMENTALLY IMPORTANT TO domain. Other countries will be competing strongly to
ALIGN CLOSELY WITH THE AMBITIONS host the new pan-African Medicines Agency, but Algeria
OF THE LOCAL STAKEHOLDERS is most definitely a strong candidate.
HCLS: Can you give us an example of some of

your initiatives for healthcare prevention? ALGERIA IS ALREADY AT THE STAGE
HC: Our two mobile clinic dedicated to diabetes WHERE IT PROJECTS LEADERSHIP.
and cardiovascular can diagnose a patient in a couple HCLS: What do you want to be remembered for
of hours, instead of someone waiting a longer period as country chair of Sanofi in Algeria?
and having to travel from an area to another to under- HC: My objective is to see how we can move the needle
go tests. This delivers a real benefit when it comes to for Sanofi in Algeria two or three steps further. The lega-
simplifying care pathways, because ordinarily a citizen cy will be perhaps the industrial footprint and breaking
would have had to visit several specialists before they new ground in Africa for the production of innovative
would get to the point at which the test would be per- products. I am a pharmacist by background and training,
formed. We have specialists from other African coun- so I want to be sure that I have done something that will
tries who come and observe how these mobile clinics be of benefit to the patient and public health. If I can say
operate as a sharing best practice, which demonstrates that we have contributed to do something positive for
that we are fast becoming a role model and our activi- them, I will be very satisfied with my legacy.

SNAPSHOT IN FIGURES
Health Comparison
RATE OF CHANGE IN NUMBER OF YEARS OF HEALTHY LIFE LOST DUE TO OBESITY*
-4.0
-3.0
ALGERIA
-2.0
-1.0
0.0
1.0
*calculated using DALY

2.0 methodology
Incidence of unhealthily high Body

3.0 Mass Index (BMI) is on the rise across
the African continent
4.0 Source: University of Washington, IHME, 2017
NONCOMMUNICABLE DISEASES IN MENA (% OF TOTAL DEATHS)

87.5
TUNISIA
85
82.5 EGYPT
80
77.5
MOROCCO
75
72.5 ALGERIA
70
67.5
65
2000 2010 2015 2016 Source: World Bank
COMMUNICABLE DISEASES IN NORTH AFRICA (% OF TOTAL DEATHS)

25
MOROCCO
20
ALGERIA
15
EGYPT
10
TUNISIA
5
0
1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 Source: World Bank

INDEX
Including advertisers
Advertisers
COMPANY NAME PAGE
Abbott 35, 36, 41 National Agency for Pharmaceutical

Products (ANPP) 11, 27, 30
Amgen 29, 36, 37, 40
National Cancer Plan 17, 29, 48
Aktouf Medical 6, 20, 21
National Laboratory for Control of
Algerian Society of Medical Oncology 20, 21
Pharmaceutical Products (LNCPP) 2, 11, 27, 30, 40
Algerian Society of Pharmacy (SAP) 2, 6, 26

Novartis 35, 41, 44, 47, 50, 51
Beker 6, 40, 41
Novo Nordisk 30
bioMérieux 27, 28, 32, 33, 45, 46

Pasteur Institute Algeria (IPA) 27, 42
Boehringer Ingelheim 2
Philips Healthcare 6, 20, 21, 49
Central Pharmacy for Hospitals (PCH) 27, 56, 58

Pierre Fabre 6, 26, 37, 38, 41
El Kendi 2, 22, 24, 40, 41, 53, 54, 55

Roche 2, 29, 31, 37
French-Algerian Chamber of Commerce

Saidal 27, 57, 58
and Industry (CCIAF) 47
Sandoz 24, 26, 34, 47, 51
GE Healthcare 18, 19, 44
Sanofi 2, 6 24, 34, 42, 57, 59, 60
German-Algerian Chamber of Commerce
and Industry (AHK) 17, 37, 47 Servier 36, 37, 53
Ipsen 25, 38 Tabuk Pharma 33, 34, 35, 56, 58
IQVIA 24, 34, 36, 47 US-Algeria Business Council (US-ABC) 2, 17, 33, 36
Janssen 2, 24, 30, 34, 35, 39, 41 Varian 42, 52
Lilly 32, 42, 45
Merck 6, 44, 45, 46
Photo © cover: Mahjoub Ben Bella ‘Chorégraphie’ (2015) Artsper.com | Photo © page 2: Rachid Koraichi. ‘Scrutineer Of The Hidden Passion’ (1985) Sotheby’s, Doha | Photo © page 4: Zoulikha Bouabdellah | Photo
© page 6: Pixabay. Public domain. | Photo © page 14-15: Silent Syncrony. Samtab Mamiab Gallery. | Photo © page 16: Abdelkader Benchamma. | Photo © page 17: Mahjoub Ben Bella | Photo © page 18: Amel
Benmohamed. | Photo © page 20-21: Kader Attia | Photo © page 23: Crocodiles verts, 2012 (detail) Mahjoub Ben Bella. L’exposition à l’Hospice Comtesse en 2013 (Lille, France) aramanegallery.com | Photo © page
48: Abdallah Benanteur. Watercolour, ETNA (2003) Galerie Claude Lemand Benanteur. | Photo © page 50-51: Freepik.com | Photo © page 52: Kader Attia ‘Grand Continua’ (2017) | Ilustration © page 54-55: Miriam
León | Photo © page 56: Abdelkader Benchamma. | Photo © page 58: Amel Benmohamed.
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EXCLUSIVE INTERVIEW WITH ONCOLOGY: THE SCRAMBLE TO A MILESTONE

MESSAOUD ZITOUNI, HEAD OF A SPECIAL REPORT LOCALISE HEALTH REFORM

PRESSING AHEAD PAGE 23

ALGERIA FEBRUARY 2019

Djaouad Braham Bourkaib, former director general of social security

Senator Louisa Chachoua, president of the Health Commission at the Senate

Essam Farouk, president, El Kendi

Haissam Chraiteh, managing director, Sanofi

Loic Galmard, country manager, Janssen

Amine Sekhri, country manager, Roche

Mohamed L’Hadj, DG of health services and hospital reform

Farid Benhamdine, president, Algerian Society of Pharmacy

Ismael Chikhoune, president of US-Algeria Business Council

Bachir Batel, Boehringer Ingelheim

The staff of the Ministry of Health, Population and Hospital Reform

for their continuous support, enthusiasm and encouragement in the

2 Healthcare & Life Sciences Review: Algeria www.pharmaboardroom.com

Report Director: Roxane Höck 52 RADIOTHERAPY INTERVIEW

www.pharmaboardroom.com Healthcare & Life Sciences Review: Algeria 3

Djaouad Braham Bourkaib

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6 Healthcare & Life Sciences Review: Algeria www.pharmaboardroom.com

We are present in more countries than anyone else.

We speak directly with healthcare leaders and

We are ready to share their insights and experiences

MACRO HEALTH INDICATORS

ALGERIA: BUDGET BALANCE BETWEEN 2012 TO 2022* IN RELATION TO GDP

8 Healthcare & Life Sciences Review: Algeria www.pharmaboardroom.com

TOP 20 PHARMA COMPANIES TOP 20 LOCAL PHARMA MANUFACTURERS

ALGERIA TOTAL PHARMA MARKET GENERIC PENETRATION IN ALGERIA (2017)

Generic products Non categorized

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HEALTH BUDGET 2013-2017 DOCTORS PER 1,000 INHABITANTS IN NORTH

PROPORTIONAL MORTALITY IN ALGERIA

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EVOLUTION OF ALGERIAN PHARMACEUTICALS AND HEALTHCARE SYSTEM

2018 Passing of the new Sanitary Law

Implementation of the ANPP 2017

2016 Adoption at the ministry council of the healthcare

Creation of National Agency for Health Equipment

Government’s 5-year plan (2009-14) declares

Liberalization of the pharmaceutical sector:

Private healthcare provision permitted for first time 1988

Creation of the Algerian Central Pharmacy (PCA):

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HCLS: What can you tell us about the Algerian

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instance. That system is actually build some new modern infrastruc-

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REALITY BITES: THERE CAN

he spill over of austerity measures into the Algerian life science

GE Healthcare’s relationship with Algeria has

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BOOM TIME FOR