Bitter Pills:Medicines & The Third World Poor | Page 32

are increased. The most obvious consequence of rural dispensaries running out.
of drugs is that people stop going to them. Meanwhile governments have to go
on paying for health facilities that are under-used, and paramedics find it doubly
hard gaining acceptance as health educators when they cannot deliver basic
drugs.

PRIVATE DRUG DISTRIBUTION
The shortcomings of the public health sector and the relative and growing affluence
of a small sector of the population have encouraged the rapid growth of private
medicine in most developing countries. In Third World cities, in particular,
where those with the greatest purchasing power live, there is a concentration of private doctors and retail pharmacies, mostly run by nonpharmacists. In most Third World countries private drug sellers have also made
significant inroads into the rural areas and a largely haphazard, uncontrolled
system of drug distribution has evolved. A major problem in the rapid expansion
of the private drug market is that, whereas drug manufacturers and retailers have
been quick to develop the potential market in the rural areas, they have shown
insufficient interest in contributing either capital or technical expertise to
devel oping the necessary infrastructure for medicines to be distributed safely and
efficiently. Consequently, transport and communication facilities remain bad and
drugs are frequently dispensed by untrained salesmen and unlicensed traders. (35)
Private drug sales have boomed and dwarfed distribution by the public sector.
In some developing countries the value of drugs distributed through the private
sector is over 90% of the total. This is the case in Bangladesh, Nepal and North
Yemen. (361
Few Third World governments have succeeded in imposing any meaningful
controls on private drug sales. Consequently, medicines that can only be obtained
on a doctor's prescription in developed countries are freely available over the
counter or from street traders in poor countries. Whereas less than a quarter of
drugs sold in Britain are products that do not require a prescription, it is estimated
that in some developing countries up to 75% of medicines are bought without
prescriptions. |371
Drug control agencies in developing countries are generally very poorly funded
and understaffed, so they are in no position to carry out regular inspections of
drug stores or crack down on illegal sales. Some Third World governments are
also reluctant to regulate the sale of drugs too strictly, on the grounds that medicine
sellers may be providing the only source of treatment available especially to the
poor. A 1979 official report explains that in Bangladesh: "Restrictions regarding
prescriptions are not strictly enforced, particulary because of the small number
of qualified physicians in the country and the low level of medical coverage." (38)
There are potential benefits to be weighed against the risks in allowing some drugs
to be sold without a prescription. For example, in Bangladesh the contraceptive
pill is sold in pharmacies, general stores, even on market food stalls by people
with absolutely no medical training. One month's cycle costs about 1 p. A relatively
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