IRIN Focus on efforts to curb the vending of medicines

From painkillers to antibiotics, just about any medicinal drug can be had on the streets of Mali’s towns and villages. The process is easy. You simply go up to the vendor and describe your pains. In a flash, he or she dives into a plastic bag, whips out a bottle of pills, reels off its healing properties, hands it over and pockets your money. Chances are the vendors knows absolutely nothing about the chemicals from which the pills are made, or about potential side effects since none are pharmacists not do they have any licenses to sell drugs. Yet, they and their counterparts elsewhere in West Africa administer a large percentage (estimates range from 30 to 60 percent) of the drugs sold in the subregion. Pharmacists in Mali are spearheading a campaign against unlicensed drugs. “Street drugs kill,” is the slogan they have been using to make people aware that such medicines are a major public health risk. "These drugs are a great danger which is tolerated by the people and the government," says Dr. Deidia Diallo, president of the Order of Malian Pharmacists. Why the proliferation of unlicensed medicine vendors? One major argument people put forward is poverty, says Diallo. They say they have to do something to earn a livelihood. "Before, people would raise the argument of proximity and accessibility," she adds. "This is no longer true today. At every corner you have a drugstore where you can find all kinds of medicines. Even the price argument is no longer valid because of generic drugs." The drug vendors’ clients think differently. Street drugs "are very efficient, cheap and can be bought even singly", a secondary school teacher told IRIN. "I use them (street drugs) whenever someone in my family is sick. Let me give you an example. My daughter was sick so I took her to the health centre. The doctor gave me a prescription that amounted to more than CFA 7,000." "Do you know how much I used to cure her? Less than CFA 1.500 with these people (the vendors)." A housewife told IRIN she always bought her drugs from the same woman. "I don't know where they get their drugs," she said, "but you find them with extraordinarily efficient drugs." The informal trade in medicinal drugs is anything but disorganized. Wholesalers smuggle in the drugs from countries such as Nigeria or Guinea, while retailers sell them on the street. "Sometimes when you go to the pharmacy you don't find some drugs, but you never have that problem in the street," says Sadio Samake, a student at the University of Mali. "You can even buy a single tablet if you want, which is not possible in pharmacies," he adds. For Dr Abdrahamane Tounkara, secretary-general of the Ministry of Health, "the regular provision of drugs is an essential component of a health care system that works satisfactorily, and their accessibility is one of the tangible symbols of the quality of health care”. He stresses that it is necessary to make sure people have easy access to quality drugs at affordable prices. This has been a cornerstone of Mali's public health policy in recent years, according to the health authorities. One measure to improve access has been to allow pharmacists to replace costlier medicines with cheaper, generic ones as long as they are also effective. Twelve wholesale distributors import generic medicines into Mali. All such imports are authorised and controlled by the national drug administration. Despite such measures, however, the illicit sale of drugs has become, within a decade, a major danger for people's health, according to Diallo. Drugs, she says, should be prescribed solely by pharmacists and only to people with prescriptions. All drugs sold in Mali, she adds, should be authorised and checked regularly by the relevant health authority, as per state regulations. Diallo says she is worried by the negative spinoffs of informal drug vending such as the development of resistance to antibiotics due to the misuse of medicines. "I am very serious when I say that resistance to antibiotics is posing a lot of public health problems," she says. Pharmacists themselves have been accused of encouraging the illicit market by selling expired medicines to the street vendors. However, Diallo does not believe such claims. "I don't think someone who has taken an oath would do that," she says. "Every professional knows that he or she can be prosecuted by a disciplinary commission and his/her license can be withdrawn if found guilty." A national commission has been created in Mali to fight the illicit sale of medicines, but it is yet to develop its plan of action.