Bitter Pills:Medicines & The Third World Poor | Page 154

is little need to introduce controls on marketing practices. In these circumstances
manufacturers may abandon promotional activities as they stand little chance
of influencing doctors' prescribing habits. This has been the experience of
Mozambique, where only a few manufacturers still have local sales representatives.
Most Mozambican doctors are committed to the new direction of health policy
and have little time for visiting sales reps. <77)
But where the private market still flourishes and doctors are free to prescribe any
drug they choose, controls on marketing practices are essential. However, despite
the need, only a minority of Third World governments have adopted measures
comparable to those enforced in Europe and the US. The UNCTC singles out Egypt
as a country that has adopted "effective regulations on marketing practices". Some
controls are stricter than in developed countries. "Although brand name products
... are allowed on the Egyptian market, advertisements are confined to professional
journals and samples to professional bodies. No advertisements are allowed for overthe-counter products. Information on each drug is checked for accuracy by a
government agency." (78)
The Costa Rican Government has also introduced strict controls on the promotion
of both prescription-only and over-the-counter medicines. Sanctions against
companies that break the rules have been written into the legislation, so that a
company violating advertising standards can either be fined or have the registration
of its products revoked. (791
A number of countries have tried to ensure a balanced flow of information to
prescribers. In Sri Lanka, government doctors are sent a quarterly publication,
The Prescriber, started in 1966 by the National Formulary Committee. The
Prescriber aims to combat the effects of manufacturers' promotion, for instance
by providing comparative assessments of new products as against much cheaper,
well-established drugs. (80)

HEALTH EDUCATION
Currently one of the most neglected areas of policy appears to be government
attempts to impress on people that there are alternatives to medicines. Most
governments carry out some limited health education work. In Costa Rica, for
example, the Ministry of Health has prepared special leaflets for the public warning
against self-medication.(81) But few governments take advantage of the potential
of mass-media advertising campaigns on popular mobilisation to promote
preventive health. One of the exceptions is the Sandinista Government in Nicaragua
which has organised 'Jornadas Populares de Salud' - 'days of mass mobilisation'
- as part of its strategy for getting people to take more responsibility for their
own health. (821

Mozambique and Sri Lanka are amongst the countries that have adopted the most
comprehensive policy changes. The political climate in Mozambique, a socialist
country, has been crucial to the Government's success in challenging doctors'
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