Bitter Pills:Medicines & The Third World Poor | Page 134

VH AI is also taking practical steps to help its members obtain the drugs they need,
by negotiating a ten year contract with a small manufacturer in the State of
Maharashtra. The manufacturer is being asked to formulate 50 essential drugs,
gearing production and distribution to the specific needs of VHAI's members.
Costs will be kept down by ensuring that raw materials are purchased at competitive
prices, and because the scheme will cut out additional promotional costs. "9)

NEPAL HILL DRUG SCHEME
The problems of drug distribution are acute in Nepal, one of the world's poorest
countries, where the rugged, mountainous terrain makes transport extremely
difficult. Only half of the country's health posts are accessible by road, so drugs
and other supplies have to be carried on foot. These distribution problems and
the very small drug budget allocated to the health posts means that drug supplies,
which are delivered only once a year, will usually last no more than about 3 to
4 months. l20)
This means that for most of the year patients are forced to buy the drugs prescribed
for them in the health posts out in the private drug stores, which often charge
exorbitant prices and stock a mass of unnecessary drugs. With only 25 trained
pharmacists in the whole country in 1979, most pharmacies are staffed by totally
untrained sales assistants, who may have little understanding or interest in drugs,
beyond their sales potential. (2"
The Hill Drug Scheme was set up in eastern Nepal in 1969 with two objectives.
Primarily it aimed to improve the supply of low-priced essential drugs to the areas
covered, and to encourage safer drug use by giving retailers some basic training.
The success of the scheme hinged on its attempts to persuade selected retailers
to sell drugs more as a service to the community than as a means of making as
much profit as possible.
The project is coordinated by the Britain Nepal Medical Trust which bulk-buys
drugs both from the Nepalese manufacturers, Royal Drugs Limited, and from
companies in India. The drugs are then supplied to villages where there are
government health workers trained to prescribe them and distributed through
retailers specially selected with the help of local officials on the panchayats (village
or town councils). The retailers receive some basic training and undertake to
dispense only the essential drugs supplied to them. They also agreee to sell the
medicines at fixed prices, with a set 10% mark-up. The scheme was intended to
provide a back-up to health workers, allowing them to refer patients to these
retailers in the knowledge that they would not be overcharged or sold unnecessary
medicines. |221 In fact health workers have not shown a great deal of interest.
Over a dozen retailers have participated in the scheme at any one time and sold
medicines at much lower prices than the bazaars. But the scheme has had only
limited success. Its major problem is that retailers stand to make far less money
selling the limited range of basic drugs at fixed prices, than they would from
stocking the mass of over-the-counter remedies on sale in the bazaars. So it has
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