Bitter Pills:Medicines & The Third World Poor | Page 141

CHAPTER 9
HEALTHY SOLUTIONS
Third World National
and Regional Policies
IN EARLIER chapters we focused on policies and practices that harm the poor
and inevitably facilitate the misuse of drugs. Of course, the picture is not uniformly
bleak. Third World policy-makers are acutely aware of the problems. Some,
notably in Sri Lanka, Mozambique and a variety of other countries, have pioneered
constructive solutions. In this chapter, we look at some of them.
This means that there are workable blue-prints to revolutionise drug policies to
benefit the poor. Health planners in other developing countries can adapt them
to suit local needs. They can also call on technical assistance from UN agencies
like WHO, UNCTAD and UNIDO, that have helped devise many of the new
strategies. Already these policies have led to major improvements. For example,
the use of generic names, restricted drug lists and buying by competitive tender
have succeeded in cutting costs massively and increasing supplies of vital drugs.
On the face of it, it may seem incomprehensible that such obviously advantageous
policies hav e not been universally adopted.
Yet there are powerful obstacles to change. The crucial one is lack of political
will. In the words of a senior WHO official: "Some authorities consider drugs
simply as consumer products which are subject to the laws of supply and demand."
1
'' Consequently, their drug policies relate more closely to the needs of industrial
and trade development than health development. (2) In many developing
countries health ministries are notoriously weak, compared with the more
influential ministries of commerce. But, if health-centred drug policies are to stand
any chance of being adopted, WHO and industry commentators stress that health
ministries must have bargaining power. "'
Most governments are under pressure not to rationalise their drug policies. As
the senior WHO official observed, "Pressure groups have arisen - particularly
among certain pharmaceutical industries and in sections of the medical professions
- which would prefer to see the status quo maintained". <4) Local and foreign
business interests lobby hard for any rationalisation to be confined to the public
sector, leaving the vast private market largely uncontrolled. (5)
In some cases policy-makers may themselves oppose changes. An anthroplogist's
observations on one African country could apply more widely: "It seems probable
that the delay in the adoption of the WHO directives concerning cheap essential
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