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90 Fighting the Diseases of Poverty
distribution where inventory management, security and information
systems were found particularly deficient. Alleged abuses in
service delivery by both health professionals and patients were
attributed to lack of controls in prescribing and supplying drugs to
patients.
Surprisingly, half of exit survey respondents had not received a
prescribed drug due to non-availability, an important indicator of
ineffectiveness (Cohen, 2002). Costa Rica’s strong record in health
care delivery and its relatively higher income, greater health
spending and education levels among developing countries
suggests the difficulty and challenges inherent in managing health
systems and drugs in particular.
Drugs tend to be a commonly “leaked” product given that it can
fetch a higher price in the private market. In Ethiopia users and
providers explained in focus groups the rampant stealing of public
sector drugs, their resale in the private market and the common
dealings in contraband medicines. They acknowledge the lack of
drugs in the public sector and the ready availability of those drugs
in private pharmacies and clinics. A health officer in Addis Ababa
noted that “most health workers are involved in such things [theft]”
attributing this to “outside temptations” and low pay of public
servants (Lindelow, Serneels and Lemma, 2003). Surveys in Nigeria
found that 28 PHC facilities had not received drugs from the federal
government in two years, and a World Bank study reported that les
than half the facilities in Lagos and Kogi states had government
supplied drug stock in 2001 (Adeniyi, 2001). In Costa Rica 32 per cent
of users indicated that they had prior knowledge of theft in government
pharmacies (Cohen, 2002), and in a hospital study in the
Dominican Republic comparing patient prescriptions and records of
administered drugs a significant proportion of drugs went missing.
The average leakage rate for drugs in Uganda was estimated at 73
per cent, ranging from 40 to 94 per cent across 10 public facilities.
High demand drugs, such as those to treat malaria, were the least
available to patients because health workers and the Health Unit
Management Committee members, the entities meant to provide