Bitter Pills:Medicines & The Third World Poor | Page 142
medicines is also due to the fact that influential people will lose attractive privileges
when foreign pharmaceutical firms are forced to deliver medicines in a way which
is commercially unattractive." (6)
Despite the obstacles, many developing countries have introduced some controls
on both the public and private sectors. These range from 'paper tigers' - that look
good but change nothing - to measures that are actively enforced. We shall focus
here on some of the key policy options open to developing countries. But WHO
stresses that individual measures have only a limited chance of success. The
countries that have most successfully tackled problems of drug supply, use and
distribution are those that have adopted comprehensive national drug policies,
giving clear priority to essential drugs for primary health care. |7>
MAJORITY HEALTH SERVICES
Among the countries that have made the most impressive achievements in reaching
virtually the entire population with health services are China, Cuba and Vietnam,
and the less well-publicised success stories of Sri Lanka and Papua New Guinea.
Their approach has varied a great deal. For instance, whereas Cuba opted for
what one observer has described as a "super-professionalised and centralised
approach to health c a r e " , <81 China, Vietnam and Sri Lanka, with
proportionately far fewer doctors, have set up decentralised services run by
community-based paramedics.
On the communes in China, for example, where about 850 million of the
population live, health care is provided by 'barefoot doctors' (or village health
workers) chosen by the commune, which pays for their training. Workers have
been paying about one-twentieth of their average monthly income for free medical
treatment, and a small prescription charge for medicines. (9) This puts the richer
production brigades in a position to afford better services. But it does not rule
out the possibility of a poor brigade getting help from a richer one, if for exmple
one worker has rheumatoid arthritis and needs constant and costly injections.'""
Papua New Guinea has also succeeded in setting up decentralised health services
with a referral system. In contrast to China, it has a population of under 3 million.
But it has major communication problems with its people divided into different
ethnic and language groups, living in scattered and isolated settlements separated
by rugged mountains and jungle. These difficulties mean that about 10% of the
people still have no easy access to health care facilities, as they live some 2-3 hours'
walk from the nearest aid post. (ll) The health services are organised into various
tiers starting with the aid post, which serves a community of about 2,000 people.
The orderlies who run the aid posts receive 1-3 years' training and can handle
95% of the problems brought to them. More complicated cases are referred to
the nearest health centre, which acts as a referral point for a population of 10,000
to 50,000. They are staffed by orderlies and nurses who work under the supervision
of a health extension officer. Any patient needing an operation or complicated
in- patient treatment can be admitted to the provincial hospital. Treatment is given
free at the aid posts and most of the health centres. There are hospital charges,
but these are waived for children, the old and the poor.