Getting medicines to the poor in Zambia
15 May 2008
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By Newton Sibanda in Lusaka
 Image courtesy of Phillipe Lissac/Panos Pictures
To get an idea of how the cost of medicines can hurt ordinary Zambians, step
into the Garden, a shanty area of the capital, Lusaka.
The first person I meet is Peter Mwale, a 30-year-old father of two, who ekes
out a living as a gas welder. He struggles to pay his rent, his children's
school fees and the family's food, and one of his greatest fears is that a member
of the family will fall sick.
"Often, hospitals just give prescriptions because they have no drugs. It's not
like in the past when we could go to hospital and get drugs. The only drugs we
can get are Panadol (a painkiller) and Flagyl (for diarrhoeal diseases).
"You have no option but to look for money to buy the drugs you need," he
explains. "Unfortunately, the drugs in chemists' shops are expensive."
Drugs or food?
The result, says Peter, "is that some people just give up and don’t get better,
and may even die. Others resort to visiting traditional healers.
"Sometimes you have to make a choice between drugs and food. You can't just take
drugs without food," he observes.
Jennipher Chapu, a market trader, is one of those who has resorted to
traditional healers – "even though we have been advised to seek medical
attention from hospitals and clinics" – because they are cheaper than modern
medicine and conventional drugs. It is not simply that traditional healers’
charges are lower: they are also negotiable and can often be paid in the form of
possessions, such as chickens.
A widow with five children, 40-year-old Jennipher describes the cost of drugs as
"a nightmare".
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No guarantee of quality
Wendy Kanyanta, a 33-year-old widow, agrees that drugs in private pharmacies
are unaffordable for most people.
Wendy recalls the time she took her son to the clinic and had to buy expensive
drugs when her son was diagnosed with malaria. "I had to rush to buy drugs
because there was nothing in the clinic. The drugs cost about K40,000
(US$1=K3,400)," she says. K40,000 is equivalent to the average weekly wage for a
road worker or casual worker. It is about one-fifth of a teacher's weekly wage.
On the other side of the counter, pharmacist Linus Mwamba says that although
customers have the option of buying cheaper generic drugs rather than brand-name
products from South Africa and Europe, "the quality of cheaper generic drugs
cannot be guaranteed."
He says that most of his customers buy the cheapest medicines – and he warns
that the combination of poverty and high drug prices carries another risk:
customers buying antibiotics sometimes try to save on money by not completing a
course of treatment.
"I have seen situations where people ask to buy half of the course and promise
to come back, but they never return."
The cost, for individuals and society, can be high - in the form of the growth
of antibiotic resistance.
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Meeting demand
Ministry of Health spokesman Dr Canisius Banda points out that the drug
supply situation in the country has improved significantly and that life-saving
drugs for major diseases such as HIV and AIDS, TB and malaria have not been out
of stock for two years. However, he acknowledges that, as a result of increased
demand, shortages have occurred.
"After user fees were scrapped, for example, attendance at hospitals and clinics
went up and so did demand for drugs." Sometimes it was simply a logistical
issue, with drugs ordered but not yet delivered.
Theft of drugs was also a problem, he says, and the Ministry established special
committees in hospitals and district health management teams to curb the
practice.
"Pilfered drugs can end up in private pharmacies," he admits. "Earlier this
year, government drugs were discovered in private pharmacies in Solwezi, in
North Western province, and in Nakonde, a northern town on the Tanzania border."
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Corruption costs lives
The executive director of Transparency International Zambia, Goodwell Lungu,
confirms that his organisation has received reports in the past about medicines
from the public health system finding their way into private clinics.
Bribery in the health system results in higher drug prices, he says, and a
lack of patient information about services and medicines - about where and when
they are provided, about who provides them and the procedures to be followed -
creates an environment in which corruption can flourish.
"In human terms, corruption can cost lives," Lungu emphasises.
But the picture is not wholly gloomy.
He points out that a survey showed that Lusaka residents perceived major
improvements in terms of accountability and transparency in health service
delivery compared with other services.
And the Medicines Transparency Alliance (MeTA) is showing the way ahead:
"Transparency International Zambia feels that the concept of the Alliance of
bringing together various stakeholders - the private sector, civil society, the
government and other interest groups - has the potential to improve transparency
in the medicine supply chain and will ultimately improve the lives of all public
health service providers and beneficiaries."
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Note for editors
The newly launched Medicines Transparency Alliance (MeTA) will bring together
government, business and civil society to share information and analysis about
the problems around the supply of medicines in Zambia, including their quality,
availability, price and promotion, and work together to explore possible
solutions. This is part of a global effort, initially funded by the UK
Department for International Development (DFID) in collaboration with the World
Health Organization (WHO) and the World Bank to encourage greater transparency
and accountability around the procurement, supply and use of medicines. MeTA
will work initially in seven pilot countries – Ghana, Jordan, Kyrgyzstan, Peru,
the Philippines, Uganda, and Zambia.
For further information, please contact:
MeTA Secretariat, 112 Malling Street, Lewes, East Sussex, BN7 2RJ, United
Kingdom. Tel: +44 (0) 1273 486861; Fax: +44 (0) 1273 478485. E-mail:
info@metasecretariat.org.
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