[Access to essential medicines in Africa: a global approach].

Establishment of programs to assist procurement of antiretrovirals (ARV), antimalarials (ACT) and antituberculosis drugs led to careful evaluation of the performance of national central medical stores purchasing essential medicines. Substandard central medical stores were excluded from support programs and procurement was carried out under the responsibility of UN agencies. This situation underscores the need to develop local competencies and to consolidate national procurement infrastructures. The Association of Central Medical Stores for Essential Drugs (French acronym, ACAME) with the support of the French Cooperation Agency is working to improve the performance of national central medical stores. The main components of ACAME's program are multidisciplinary training for members, exchange of experience and consolidation of work tasks, notably for its progressive purchase policy, that must be based on consensus selection of suppliers. The creation of FIAM/UNITAID offers a glimmer of hope for sustained financing and for ensuring delicate supplies (second line and pediatric ARV, ACT) with which Central Medical Stores wish to be associated. Focus on supply tends to overshadow other issues affecting rational use of medications. Indeed deviations can be found in effective application of cost recovery and in the pricing mechanism for peripheral medications. Prescription of generic drugs and their availability in hospitals is still a problem notably for outpatients and patients with chronic illnesses. Outlying storage facilities need to be upgraded to ensure that pharmaceutical products acquired according strict quality assurance requirements remain stable. The presence of a thriving and dangerous illicit market will require stronger action from national authorities and better coordination between sectors.