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Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance
in Europe by nongovernmental organizations (NGOs), and resale of prescribed medications not taken by patients (full or partial doses). Prices in the illegal market can be 30 percent lower than in the private sector, which makes them attractive to middle class as well as poorer customers, with or without a prescription.
Apart from the registered suppliers, drugs are also supplied by some “cross border” traders (usually illegally) within the Common Market for Eastern and Southern Africa (COMESA) and the Southern African Development Cooperation Conference (SADCC) region.
The illegal market is supplied largely by pharmaceuticals smuggled across the border from neighboring countries, sold by an estimated 2,800 illegal drug sellers nationwide (Ministry of Health of Kingdom of Cambodia, 2001b). In Phnom Penh, there are an estimated 495 illegal drug sellers, compared with 298 registered pharmacies and drug sellers.
Availability of Antimalarials
The public network provides four antimalarial drugs (amodiaquine, chloroquine, quinine, and SP), which come in nine different presentations, forms, and dosages. In the private sector, there are 13 compounds sold in 89 presentations, forms, and dosages.
In the face of widespread chloroquine resistance, in 2003, Coartem was named as the official first-line drug. Coartem has been introduced into pilot districts, but because of cost, SP (which is cheaper), is available in most other places. Although no longer provided through the public sector, there are still considerable sales of chloroquine in the private sector. In addition, more than a hundred different brands, presentations, and forms of antimalarials are available in the private market as branded products, generics, and branded generics, representing about 14 different compounds. Artemisinin products are freely available without prescription in this sector, as monotherapies and combinations.