WHILE many countries in Africa have adopted national drug policies these policies do nothing for the public they are meant to serve if they remain only written plans. Consumer involvement in implementing such policies is crucial in order to address the public’s real needs regarding health and medicines. In many cases countries have done little to make sure national policies address consumer’s health needs in a participatory and attainable way. The reasons behind these successes and failures, and strategies for ensuring consumer involvement in various aspects of these policies were the focus of HAI’s second regional workshop for Africa. Entitled Networking for Rational Drug Use in Southern Africa: Consumer Involvement in National Drug Policies, the meeting was held from 30 May to 5 June 1998. It brought 34 participants - including consumer activists, NGO representatives, drug information experts, journalists, pharmacists and clinical pharmacologists from 11 African countries - to Johannesburg, South Africa.

Consumer groups in many African countries are realising the value of health education. Here in The Gambia women gather to listen to health messages on the radio

Photo: WHO

In his introductory remarks to the workshop, Dr Harm Pretorious, Deputy Director-General of South Africa’s Department of Health, spoke about this critical period for his country’s drug policy. After South Africa’s first democratic elections in 1994, the Department of Health had revised its policy in order to remove all of the health sector’s past inequalities. The new policy was developed through broad consultation and included many stakeholders because of its far-reaching impact on all groups in society. The policy’s main objective is to supply essential drugs to the majority of the people at an affordable price, ensuring safety, efficacy, good dispensing practices and patient education.

Obstacles to overcome

However, discussions revealed that the national drug policies adopted by other countries in the region are less clear. Other problems also emerged. In many Southern African countries there is an acute shortage of public sector health care providers, especially pharmacists. This has a serious impact on the success of national drug policies. Key positions remain vacant and trained workers often leave for better-paid jobs in the private sector. Inadequate budgets, major local currency devaluations, drug shortages and emergency procurement damage the national drug policy’s possible impact. Rising drug prices make drugs inaccessible to many consumers in the region. Due to economic liberalisation, drug pricing is not effectively controlled by legislation and instead relies on market forces. Prices for the same drugs vary widely depending on where they are bought. Rational drug use goals are further upset by many countries’ dependence on donations - which are often sent in an uncoordinated way.

Yet there have been encouraging developments which will help to solve these problems. In Malawi and Lesotho, for example, donors have begun to contact church groups to ask if certain drugs are needed and they then send them in usable quantities. In Zimbabwe the Consumer Council is lobbying for legislation to control drug prices, and a number of groups attending the workshop have initiated a regional drug pricing survey to address unacceptable price variations.

Spreading the word

Despite so many constraints groups in the region are active in making consumers more aware of the issues involved in national drug policies. For example, the meeting heard that in Mozambique a new consumers’ organization has campaigned for rational use of drugs. The group, ProConsumers, has publicised the dangers of using expired drugs and broadcast radio programmes informing people about the dangers of buying drugs from the informal sector. Health Action Centre in Nigeria has relied on creative means to educate consumers, including traditional storytelling and drama presentations to point out drug hawkers’ tricks, such as changing expiry dates, copying labels and substituting ingredients. The Group makes any location a potential learning place, by meeting with consumers in their homes, at schools, in churches and market places, during women’s organizations’ meetings or on buses.

Before the meeting closed, participants discussed the next phase in HAI’s three-year project, Networking for Rational Drug Use in Africa. Plans are already well advanced for a third regional workshop, this time in francophone Africa.

A report of the workshop is available from: HAI-Europe, Jacob van Lennepkade 334T, 1053 NJ Amsterdam, the Netherlands.

Source: HAI News, August 1998.