Examples from Senegal, Zambia, and Cambodia

It is easy to find out that the prices people pay for drugs in many countries vary tremendously, but not so easy to know the pathways that drugs travel and the costs incurred along the way. Descriptions of the flow of drugs from manufacturer to consumer, and the price mark-ups that accompany each transaction, are scarce or nonexistent for Africa and Asia. The IOM Committee asked Management Sciences for Health (MSH) to document the flow and prices of antimalarial drugs in a sample of countries. The information summarized here is taken from their report (Shretta and Guimier, 2003).

MSH gathered information directly for this report in Senegal, Zambia, and Cambodia, all poor countries where malaria is a major health problem (see Table 1-1 for basic economic and health indicators for the three countries).

Malaria in Senegal, Zambia, and Cambodia

The entire population in Senegal is considered to be at risk of malaria; the disease is mesoendemic in some areas to hyperendemic in others. Malaria is the leading cause of morbidity, in 1996, the reason for 32 percent of outpatient consultations (27 percent for those under 5 years age, 39 percent for those over 5 years).

Malaria is endemic throughout Zambia and continues to be the leading cause of morbidity and mortality, especially among pregnant women and children under age 5. Malaria accounts for 36.7 percent of all outpatient attendance, 62.1 percent of inpatient admissions, and 10.3 percent of pregnant women seen at health facilities.

About two million of Cambodia’s 12 million population are at risk of malaria. The worst affected are ethnic minorities, temporary migrants, settlers in forested areas, plantation workers and others who live in the country’s hilly forested environments and forest fringes. In 1995, malaria and fever accounted for a quarter of outpatient attendances (42 percent in highly malarious areas), 6 percent of hospital admission (over 30 percent in malarious areas), and 15 percent of reported deaths (over 50 percent in endemic areas).

Drug Flows

In all three countries—and typical of most other malaria-endemic countries in Africa and Asia—drugs flow into the country and to consumers

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