IMPROVING ACCESS TO MEDICINES USING THE PRIVATE SECTOR, AN INNOVATION THAT MALAWI HAS NEVER TRIED.

by David Kulemela

Most Malawians especially in the rural areas rely on the public facilities to access health care services. This pose a very big challenge to both the government and the people themselves; the government has to pump in very big chunk of its budgeted money into health while the people have to often travel some distance before they get to a facility and to get the required treatment (usually medicines) is another. In the 2008/09 budget, Malawi government allocated mk31.4 billion to the health sector which was the second largest allocation in the budget. In the recent years, generally there has been improvements in the public health sector medicines availability which has also resulted in people easily accessing them. This does not mean that the role other non-formal players in the health sector has to be overlooked.

Malawi, like many developing countries, most people access their medicines from retail drug sellers, which constitute the largest group of recognized (although often unaccredited and unregulated) outlets for non-prescription drugs. Though care-seeking patterns differ according to culture, geography, wealth and health condition often people buy medicines from the most convenient source. Pharmacies and drug stores and private clinics are mostly found in urban centres, leaving the rural lacking and vulnerable. The availability of many retail drug sellers illustrates the potentially broad impact of improving the quality of products and services in retail drug outlets can have in order to ensure access to essential medicines. The retail drug sellers are largely untrained and therefore customers are not counseled on or sold the proper medicines, dosages or quantity to effectively treat common ailments including malaria.

The vast potential that could be exploited in partnering with these retail drug sellers is an area that Malawi has not tried out unless I am to be corrected. Considering the fact that the country has few pharmacists, who are recognized as the only cadre who can run a pharmacy business, this would offer an opportunity to many Malawians to access at least better quality pharmaceutical care services. For example Tanzania recognized this potential in the early 2000s and it conceptualized and introduced the “accredited drug dispensing outlets (ADDO)” aimed at improving access and quality of medicines to people living in the rural and peri-urban areas using a combination of training, marketing, commercial incentives, supervision, inspection and support strategies to transform the retail drug selling business into a regulated, profitable ADDOs, providing a range of quality drugs and professional services including referrals to underserved populations. These also serve as a platform for public health interventions like distribution of ITNs, condoms, information education and communication (IEC) and behaviour change communication materials. I do believe Malawi can also do something about these retail drug sellers whom our dear Pharmacy, Medicines and Poisons Board (PMPB) usually chestise without even trying to reach them with education (oh! eduQuation).

Remember that low availability of essential medicines in the public sector coupled with readily available but poorly regulated private sector drug sellers pose a major challenge in ensuring access to quality essential medicines and dispensing services in developing countries. Private-Public Partnerships that use innovative approaches example ADDO model in Tanzania are an important step in addressing this challenge. (Aziz Maija, ATIC News vol 4, issue 4 December 2008).