Studies on collaboration between NGOs, MoHs and WHO were conducted in Kenya, Malawi and Uganda. The criteria for selecting the three countries were as follows:

• in each country, NGOs are significantly involved in drug distribution and supply (more than 20% of total drugs distributed by NGOs);

• the countries are in the same region, so that later comparative studies will be easier to implement;

• the countries are of different size, in terms of both population and land area.

As can be seen in Table 3, the countries chosen meet the above criteria.

Table 3. Country information

Source: Economist Intelligence Unit, country profiles, 1996 and 1997.

Health expenditure in Kenya has been declining steadily in recent years. In 1996, annual per capita expenditure on health was approximately US$ 3.50. The country's national health strategy incorporates all government ministries, the private sector and NGOs with activities related to health.²⁵ The MoH is estimated to provide 60% of curative services, and NGOs and private organizations the remainder. Approximately the same proportions apply for provision of preventive services. Decentralization of the health sector has been taking place over recent years and the future structure of the health system, including the drug sector, is uncertain.

In Malawi, multiparty democracy has taken root, to which the country is now adapting. Following this change, a number of donors have started working with Malawi again. For example, the World Bank and the Dutch Government supported the Malawi Essential Drugs Programme (MEDP) until the end of 1997. As of January 1998, the Ministry of Health and Planning (MoH&P) has taken full responsibility for drug distribution. The annual health budget in Malawi is about US$ 5 per capita, of which an estimated US$ 1.25 is spent on drugs. Even though the amount spent on drugs is in accordance with WHO recommendations, drug shortages have occasionally occurred in the public sector. An acute shortage of drugs in May 1996, for instance, forced the MoH&P to carry out an international emergency purchase.

In Uganda, ongoing decentralization of the government system has been taking place. Thus with the country's health system, more authority is now being assigned to districts. Additionally, liberalization and decentralization of the health sector have created more opportunities for NGOs and the private sector, a situation recognized by the MoH in its new policy formulation, as outlined in a paper on collaboration with external partners (unpublished). However, within the MoH, there is a general feeling that a more explicit and operational policy is still needed, since many of the existing problems relate to the MoH's lack of resources. The government spends 4.8% of its budget on health care, which represents US$ 1.7 per capita. However, total health expenditure in Uganda, including that by NGOs and donor agencies, is estimated to be US$ 7.73 per capita. The proportion of health financing from external sources is estimated to be 70%.²⁶