Bitter Pills:Medicines & The Third World Poor | Page 30

Bangladesh Government is particularly concerned by the exodus of doctors to
the Middle East "for better monetary gains". <23)
Most developing countries also suffer from a chronic shortage of trained
pharmacists, who obviously have an essential part to play in the safe and efficient
distribution of drugs. Like the doctors, many are creamed off by the private sector.
A British professor of pharmacology writes: "Of the pharmacists who qualify
either locally or overseas, very few enter government service. Most enter
commercial pharmacy practice in the larger urban areas. Thus, although many
students may train in pharmacy (at their country's expense), very few actually
become available to deal with the basic pharmaceutical problems of their
developing country." |241

PUBLIC DRUG DISTRIBUTION
Different countries break down their health expenditure in different ways so it
is difficult to make accurate comparisons of spending on drugs as opposed to
other health inputs. For example, expenditure on drugs for hospitals may be shown
under the hospitals budget, or under the national drug budget. Moreover, countryby-country comparisons are distorted by the fact that salaries are very much lower
in most developing countries. However, WHO calculates that, whereas most
developed countries allocate 10-20% of their health budgets for drug purchases,
some developing countries are spending over 40% of their health budget on
drugs.125'
There is little doubt that out of total health expenditure, poor countries allocate
proportionately more for drugs than many rich nations. However, in terms of
meeting actual needs, the funds allocated for drug purchases are often hopelessly
inadequate. For example, in Bangladesh the drugs budget in 1979 was equivalent
to £4.6 million, an expenditure of about 5p a head. (26)
Furthermore, the distribution of drugs, like that of health facilities, is highly
uneven.The situation in Tanzania is representative of other poor countries. The
Tanzanian Government's 1979 Evaluation of the Health Sector shows that the
main hospital in the capital is allocated 14% of the nation's drug budget. By
contrast, all the government dispensaries put together only receive 15%. Thus,
it is hardly surprising that little more than a third of the rural dispensaries were
found to have an adequate supply of medicines. (27)
Shortage of key drugs is a problem common to dispensaries throughout the Third
World, particularly in remote areas. But in some countries even the central medical
stores are known to run out of essential supplies. For example, the central
government stores in the capital of North Yemen sometimes exhausts stocks of
penicillin and folic acid. By contrast, large quantities of less useful medicines,
such as hormones, are freely available, and from time to time there is a glut of
a particular drug which is farmed out to the dispensaries because the expiry date
is close. (281
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