Training programmes, both basic education and continuing education, are the standard response to problems of capacity. But adequate capacity is unlikely to be developed by these methods alone. More innovative approaches are required:

• Many of the new skills required, such as negotiating skills, can be acquired only through experience. Organizations and individuals practising these skills, such as drug purchasing offices negotiating direct delivery or prime vendor systems, need the opportunity to reflect on and evaluate their experiences. International organizations may play a role in facilitating this.

• Capacity may be enhanced by increasing collaboration between the public and private sectors through, for example, the exchange of personnel between private firms and regulatory agencies and the use of private sector databases to help with regulatory efforts. To prevent conflict of interest, however, there need to be clear guidelines and structures for such exchanges.

• There are high fixed costs associated with many aspects of pharmaceutical regulation, and small countries will always find these difficult to bear. International collaboration may be a means to reduce the regulatory burden on individual countries. It could take the form of regional drug inspection agencies or mutual recognition agreements between drug inspection agencies.

• Legal, economic, planning and management skills in ministries of health need to be strengthened and augmented to manage new public-private roles. Traditional training programmes could contribute in this area.