Bitter Pills:Medicines & The Third World Poor | Page 31

Many Third World countries lack administrators with the technical skills needed
to operate an efficient drug distribution system. To avoid wastage, officials
responsible for drug supply need to be in a position both to assess actual drug
requirements for the whole country, and to operate tight controls. In practice,
they are seldom in a position to do either. The extremes of climate in many poor
countries make the shelf-life of drugs a crucial factor. Bureaucratic inefficiency
and lack of understanding that medicines cannot be treated as ordinary goods
often means that drugs are left lying around in docks and airports, where the
ambient temperature may be 100 degrees fahrenheit. Lack of refrigeration facilities
and difficult transport compound the problems, so that the quality and potency
of some drugs may be seriously impaired long before they reach the shelves of
the rural health posts. For instance, this is often the case with polio vaccines
transported over long distances in unrefrigerated vans. A physiotherapist in Nigeria
finds that a number of the young polio victims she has to treat have cards showing
that they were "immunised". (29)
A recent study of medicine distribution through the public sector in south
Cameroon indicates the extent of wastage through inefficient record-keeping,
ordering, storage and transport. The Dutch anthropologist who carried out the
research calculates that because of the inefficiency of the central drug agency,
only about 65% of the medicines they should receive actually reach the health
centres. (30)
In some countries, because administrative controls are weak, drugs are stolen from
hospital and clinic dispensaries and given to relatives or sold on the black market.
In the capital of Bangladesh government hospital employees are known to be selling
medicines from the hospital stores to traders in the well- supplied Mitford market. l3 " In Zambia, in 1980, President Kaunda exposed a racket in which
government doctors and nurses were known to be selling drugs from government
clinics to private doctors who then sold them to their patients for three times the
price originally paid by the Government. (32>
A detailed study of drug availability in three primary health care units in rural
India relates the scarcity of useful drugs to wasteful drug purchases. The authors
of the study found that "most of the drugs purchased were by trade names which
were several times costlier than the equivalent drugs with generic names". An
uneconomic assortment of different brands of almost identical drugs were stocked
and "valuable resources were wasted in the purchase of drugs with doubtful or
limited therapeutic effectiveness, namely enzymes and vitamins". l331 By contrast
many of the most useful drugs were in very short supply. Consequently, on average
over 40% of patients were sent away to buy drugs not in stock. "Since there were
no chemists' shops at any of the primary health centre villages, the villagers had
to obtain them either from the city market or go without them." |341
Clearly, lack of money is only one cause of the serious shortages of drugs for
primary health care. Problems of mismanagement, wasteful purchases and
overprescribing have to be tackled to avoid even greater wastage as drug budgets
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