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    070003
    Peer Reviewed

    Supply and use of essential drugs in sub-Saharan Africa: some issues and possible solutions.

    Foster S

    Social Science and Medicine. 1991; 32(11):1201-18.

    The 3 drug distributing systems in Africa, private commercial, private non-profit, and public, are described, and issues involved in improving efficiency and rational use are exposed. The private pharmacy sector in Africa is largely located in cities, with retail prices multiples of those charged for name brands in the West. It includes pharmacies, drug shops, injection rooms, and drug peddlers, who obtain their supplies from wholesale and retail sources, and frequently pilferage from public supplies. The private non-profit system, largely missing health agencies, are often well-managed by regional drug procurement associations. The public sector consists of government and para-public enterprises and their distribution facilities. Supplies are limited, especially at the end of the transport chain, because of deficit financing and logistical obstacles. It is best to employ expatriate managers who are immune to local corruption. The most effective points to improve efficiency in drug supply are in procurement: to select generic drugs, take advantage of credit for certain brands, avoid non-essential, low priority, and expired drugs. Great savings could also be obtained by sound logistics, proper storage, and avoiding local purchase of emergency supplies. Rational use of drugs can be improved by consistent, conservative prescription, kits for managed care, and for AIDS especially, management protocols. Most African countries have their own pharmaceutical production facilities, but these have lost money because of the high cost of imported raw materials, technology and personnel. These facilities could best be used to formulate or re-package generics bought in bulk for local needs, to produce intravenous fluids, and to make simple products such as ointments at a profit. It might be efficient to produce essential drugs under regional agreement and quality control, avoiding duplication. Some concerns peculiar to Africa are self-medication, "cultural re-interpretation" of Western medications by users and traditional practitioners, sparse populations without transportation infrastructure, counterfeit drugs, and an entrenched informal system of private sales of non-essential and ineffective therapeutic agents. AIDS is an added burden to an already strained health system.
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