Bitter Pills:Medicines & The Third World Poor | Page 150

Priority was given to training scientists and engineers, estimated to number about
22,000 in 1978. Production in the public sector is now closely integrated with seven
factories engaged in formulation, one producing basic chemicals and other
packaging materials. Any raw materials that cannot be produced locally are
imported by the state trading corporation. (581
The Egyptian drug industry is still dependent on foreign manufacturers for production
equipment and chemical intermediates. Foreign expertise is needed to produce some
speciality drugs which are produced under licensing agreements or joint ventures with
some major research-based companies. But because of the size and market power
of the nationalised industry, Egypt is in a better bargaining position than most
developing countries to obtain technology on favourable terms.(59)

DISTRIBUTION
Many developing countries are attempting to improve public drug distribution
through extending the primary health care infrastructure. But the logistics of
transport, storage and administrative back-up remain problematic in most.
Some countries have set up efficient distribution systems ensuring that public
dispensaries receive the drugs they require. In Papua New Guinea, for example,
detailed procedures have been established to avoid wastage. The aid posts and
health centres supply information to one of six regional stores on their requirements
and current stocks. The pharmacist in charge of the regional store then sends in
a printed order form for the region's requirements to the central medical store,
giving a stock-in-hand figure for every item on the list. This allows the central
store to make an accurate assessment of the country's overall needs and prepare
tenders. (60)
The extent to which governments control private drug distribution is heavily
influenced both by political considerations and the availability of drugs through
the public sector. For example, after the expulsion of the French in 1954, North
Vietnam imposed strict controls on private retailers. Despite the controls,
overcharging by drug sellers was widespread because of the serious shortage of
drugs. Decentralised health services had already been established during the nine
year struggle for independence, so the state system could provide people with an
alternative to buying drugs over the counter. Consequently the Government
decided to ban all private drug sales and incorporate existing pharmacies into the
state system. A Vietnamese doctor explains: "The pharmacists' interests were
taken into consideration, but the people's interests were to be the,first
consideration." (6I)
The difficulties of controlling private drug distribution in non-socialist countries
can be considerable. Many countries have laws banning over-the- counter sales
of drugs that should be sold on prescription. In practice, these are virtually
impossible to enforce. Attempts have been made to control private sales by issuing
licences only to qualified pharmacists. This is the case in El Salvador where licences
to sell drugs are restricted to pharmacists or idoneos (salesmen with a formal
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