Bitter Pills:Medicines & The Third World Poor | Page 155

prescribing freedom. In most other countries this is vigorously defended. Members
of the country's Portuguese medical establishment who might have opposed the
new drug policy left Mozambique after independence. Professor Mazargao of
the Technical Committee for Therapeutics and Pharmacy stresses that the limited
drug list can only be implemented "through political understanding. It cannot
be compulsory, it must be understood." (83)
By contrast, in Sri Lanka the programme of rationalisation was carried out "in
the face of much opposition from the pharmaceutical industry and their agents
in Sri Lanka. Some of this opposition was channeled through doctors even up
to the Formulary Committee", according to Dr. Bibile, who was Chairman of
the State Pharmaceuticals Corporation.(841 But the positive results of the policies
adopted in Sri Lanka are clear. Whereas other Asian countries such as Bangladesh
and Nepal were spending 44% of their health budgets on drugs in 1976, but only
covering a minority of their population, Sri Lanka was able to meet about 80%
of its people's needs. Moreover, according to a 1979 WHO report, "In Sri Lanka
the expenditure on drugs constitutes about 7.5% of the total health expenditure,
probably reflecting the strict control exercised by the state on drugs allowed to
be used in state medical institutions and in the private sector". <85)
But the majority of developing countries have yet to implement significant controls
in the drugs field. The difficulties, not least their unequal relationship with the
big foreign manufacturers, have led a growing number of developing countries
to look for strength in numbers. Neighbouring countries have joined forces to
analyse common problems and mobilise their pooled resources in achieving
solutions. In the words of Dr. Mahler, Director General of WHO, "Nothing will
work more in this area than the joint effort of countries to exchange technologies,
information and experiences and jointly boost their bargaining positions". (861

REGIONAL COOPERATION
Developing countries are actively cooperating over joint drug policies within a
number of political, economic and regional groupings. Many of these regional
initiatives are backed with financial and technical support from the UN agencies.
Under the broad umbrella of the Non-Aligned Movement a succession of
resolutions has been passed calling for comprehensive policy changes to be
implemented. At their meeting in Colombo in 1976, the Non-Aligned countries
agreed to start work on setting up new regional cooperative pharmaceutical
production and technology centres, known by their acronym, COPPTECs. Each
region would have its own COPPTEC to coordinate regional policy, exchange
of information, pooled procurement and the setting up of local production.(87)
To date many of the proposed regional initiatives, including the COPPTECs,
are still in their planning stages. It is obviously unrealistic to expect countries in
the same region which may have major political differences to implement joint
policies without considerable difficulties. But countries of every political
complexion are increasingly stressing the need for positive action within regions
and sub-regions, a mood underlined by delegates to the May 1982 World Health
Assembly. (88)
160