Availability of pharmaceuticals in sub-Saharan Africa: roles of the public, private and church mission sectors.

Although the availability of pharmaceuticals is critical for both curative and preventive health care, drugs are, at best, sporadically available in governmental facilities in sub-Saharan Africa. The religious missions and private sectors are more successful than the public sector in obtaining and distributing drugs. The public sector operates under a myriad of constraints inherent in a bureaucracy; the religious missions have the advantages of better management and access to foreign currency; the private sector is innately efficient. Donor assistance to increase the availability of drugs in the public sector has included support for revolving drug funds, national drug services, the improvement of management techniques, and the local production of pharmaceuticals. None of these interventions has been notably successful. In 1987, UNICEF presented The Bamako Initiative--a proposal to launch an internationally-financed fund for essential drugs for sub-Saharan Africa. However, the proposal is unrealistic in anticipating that the requisite resources and/or hard currency can be raised to support the proposal. As the private sector is a more efficient distributor, it is recommended that the private sector be given responsibility for the distribution of drugs. Nonetheless, some governmental controls will be necessary to ensure that essential drugs are available at the least cost to the consumer.