Wednesday, June 23, 2004

Diagnosing the health of Medicines

Medicines that are dispensed at the health facilities by both Government and private hands in Somaliland do need to check its health, suggested one of my Telesom friends. You must be wondering about two factors one is Telesom friend and Health of medicine. Isn’t that? In Hargeisa town one private telecommunication company named Telesom provides unlimited talk time on the telephone over a fixed charge of amount per month. So most of the people like us take this advantage and chat for a long hour on any topic. This facility also helps to make friendship with people both known and unknown and I call them Telesom friend.
I light heartedly replied to my telesom friend, all over world only few drug companies are in collapsing stage or already collapsed but majority of them are always with high fever if you see the stock exchange bar you can know. Most of the drug companies’ health is good. My friend annoyed with my reply and said we should not joke for everything. This is very serious concern for all of us. I kept quite. The phone line then got disconnected when I tried to reconnect but there was no signal available.

The Situation

In the country the provision of drugs is left to the hands private suppliers. Except UN agencies, who procure drugs for their programme from their own secure sources, all most all agencies including Government buys from local open market through an open tender. I do not have statistics to comply what percent of people gets UN supplied drug but I roughly estimate more than 90% people buy from outside.

The prevailing situation in this country is no one obtains free medicines except some vaccines and few other medicines in Government Health Centre. Everybody has to pay for medicines. Paying for medicines is not always easy for people mostly poor. Many poor say, sometimes paying for drugs is more painful that disease itself.

Drug choice by people and also service providers in both rural and urban areas is mainly rest on two things one is drug name and another is drug manufacture country name. the general perception among people and health professionals about drug is, supplies come from India, China, Pakistan (Asian country) are relatively less qualitative than supplies from European nations. Reasons may be some drugs really are effective or may be it is only perception or propaganda. What ever reason may be there in, the real pain in neck is most of drugs suppliers do not keep drug efficacy report or laboratory test report of all drugs with them and many buyers not only individual but also institutions do not ask for it.
It is not that drugs available in the market do not have proper documentation but it is simple error in part of people not seeking for it.

The cost of drugs

There is no single rate for any drug all over world. But for the people of Somaliland the drug price is exceptionally high and many times not affordable. It is obvious because all drugs are imported and there are lot of taxes and duties are levied on the drugs. By calculating everything and including profit margin definitely drugs will be expensive.

Essential drugs

Putting a lot of medicines both essential and non-essential on sale would definitely raise the overall price of the product. Because investment cost, any loss or damage, expire etc will add to it. But important thing about essential drug is there is no list of essential drug to follow by the Government and Private practitioners. Many drugs available in the health institutions and shops are not necessary at all and drugs prescribed by the doctor and pharmacists do not always follow essential drug category. Self medication and taking drugs from drug retail store is a practice and rampant in both the urban and rural area. This is may be because there is lack of doctors to appoint for each area, lack of access to doctor or hospital and may be people’s ignorance about the subject.

What we can do now?

In my understanding we should focus on four or five major areas,

First is develop essential drug list, supply only essential drugs to health centres and train health service providers on use of essential drugs and motivate doctors to prescribe essential drugs. Enforce the follow up system.

Secondly, Develop pharmaceutical formulary of drugs according to the requirement of the country. Categories them as drugs indispensable for general use, drugs reserved for specialists use and high risk drugs to be used only under strict protocols.
List of drugs only can be sold by doctor’s prescription.

Thirdly, Government can buy essential and other live saving drugs from world market in bulk. Government can take loan from any individual or aid agency or company and sell the drugs to Government institutions and private parties. Or Any aid agency can buy the bulk amount of drugs from international market by making international tender and sell to government and private and run the operation through a revolving fund managed by Government or NGOs.

Fourthly, Encourage individuals to set up drug manufacturing unit or any Multi National pharmaceutical companies to come and set up units in the country.

Fifthly, Government to ensure drugs coming to the country has proper documented and certified by the international or recognised lab.

After all it is our responsibility as Government, drug supplier, consumer, doctor, retail shop owner, health professional, administrator, planner and development organization to protect million lives of the country through an effective and quality service. It is our self conscience, professional ethics and morality that helps a country to move forward and shine.


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