Drug poisoning is on the increase in Benin as in many countries. It can lead to potentially fatal conditions, including liver and kidney failure and heart attacks. At the National Hospital and University Centre in Cotonou on average 10 people a day arrive with kidney problems, and at least one a day dies - usually as a direct result of taking medicines bought on the parallel market. (When drugs find their way into outlets operating outside the legally authorised distribution networks, these networks are often referred to as “parallel distribution systems” and the sale of such drugs is known as the “parallel market”). Throughout the rest of the country an increasing number of hospital admissions and deaths are occurring because of drug poisoning.

A trader in Benin with a basket full of the illegal drugs which are causing health problems, putting additional strain on limited medical resources (Photo: WHO/Benin)

Yet in spite of the dangers, Benin’s National Office of Health Protection estimates that 85% of the population buy drugs on the parallel market. The most requested products are antibiotics, antimalarials and anthelmintics, and all are of doubtful origin. These counterfeit and often under-strength drugs generally come from Gabon, Nigeria, and certain Asian, European and North American countries.

The parallel market is controlled mainly by travelling sales people who have no training and lack all the necessary skills to dispense drugs. One study carried out in 10 localities counted 6,000 drug sellers, mainly women.

Involving the community

Such is the scale of the problem that Benin’s authorities decided to take action. In a public display of its determination to crack down on drug traders, the army and police seized and burnt several tonnes of drugs on sale illegally. In collaboration with WHO, the health authorities began a series of information and training sessions for community leaders on the potential dangers of drugs and their illegal sale. Religious leaders, shopkeepers, health workers, police, local government officials and educated unemployed young people are involved in the sessions.

Two hundred and ten people from the Departments of Mono, Atlantique and Oueme attended one awareness-raising meeting in April 1999 at Porto-Novo. Presentations highlighted the potential dangers of medicines, and the crucial role of the community in the fight against illegal drugs. Participants watched a new video on the subject, made by the Ministry of Health’s Information, Education and Communications section. They decided to set up three committees, charged with publicising the issue and putting into operation the recommendations made at Porto-Novo. A number of actions were agreed:

• taking effective action against those setting up parallel markets;

• ensuring effective and widespread enforcement of existing laws;

• strengthening border controls;

• monitoring drugs as they leave Central Medical Stores, to ensure they remain in the legal market;

• involving nongovernmental and community organizations in community awareness-raising activities;

• involving religious and other community leaders in the struggle against illegal drug sales.

Further meetings are being held in Benin, some targeting the police and military personnel responsible for cracking down on illegal drug sales, and others for community leaders. As with the Porto-Novo meeting, these will be organized by a nongovernmental organization, ARAMBE (Association pour la Recherche de l’Amélioration des Conditions de Vie au Bénin - Association for Research to Improve Living Conditions in Benin), in collaboration with the Ministry of Public Health and WHO.

Using the media

In August 1999, the Minister of Public Health, Professor Marina d’Almeida Massougbodji, held a press conference in which she attributed the widespread use of the parallel market to the previous absence of legislation, policies and strategies to combat the problem, and to lack of access to drugs through the authorised channels. Ignorance and the inability of the media to sensitise the population to the dangers of illegal medicines exacerbated the situation, although a series of radio and television broadcasts is being launched to remedy this.