The widely-condemned problems of stockouts and lack of certain drugs, sometimes some of the most commonly used ones, reduce the confidence of patients in the medical system, undermine their health and drive them towards parallel, illicit systems in order to find substitute products. Huge efforts have been made to improve national purchasing systems but it appears that the distribution system between the central point and local outlets is not so efficient, particularly in the public system. The following measures must therefore be taken, among others:
• Better knowledge of the process of selecting essential drugs and medicines at each institutional level in the health system.
• Recording the frequency of stockouts per type of drug and in particular, those which are necessary for women and children, the places where they occur most frequently and the reasons for such occurrences.
• Draw up a list of drugs intended for use by women and children which are rarely or never bought and analyse the reasons.
• Evaluations were carried out (WHO, Le Point, 1998-1999) in the 34 countries that have established fee-for-service systems and in the 17 sub-Saharan countries which use community working-capital funds; it is almost certain that these evaluations failed to take the gender variable into consideration. However, it may be possible to retrieve specific information from the data collected. If not, if this type of evaluation is repeated, this new variable will have to be included. Looking through the publications, it is clear that there are several evaluation and analysis tools to which the gender variable could be added. Precious time could be saved and dedicated to creating a relevant data bank. One of the major problems is the political will needed to rationalize and standardize, from the gender standpoint, a number of already-existing mechanisms at lower costs.
All these measures could but contribute to the much demanded improvement and refinement of pharmaceutical statistics.
On another level, the possibility of reviewing national drug policies should be considered in order to examine how women can be involved in the design, formulation and implementation phases and to take the necessary measures for such mainstreaming.