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142 Fighting the Diseases of Poverty
Weak healthcare systems
Healthcare systems and associated infrastructure are vital for the
effective distribution of medicines. If healthcare systems are starved
of resources, it is unlikely that they will be able either to procure
necessary drugs or be able to employ sufficient numbers of doctors
and other trained personnel necessary to prescribe and administer
medicines.
The majority of low-income countries lack the basic infrastructure
required to distribute medicine successfully. Road networks are
often unreliable or non-existent, making it difficult to ensure a
constant supply of medicines to remote areas (Saleh & Ibrahim,
2005). Electricity is often unavailable, especially in rural areas;
where it is available, it is often supplied in an erratic fashion. This
increases the cost and difficulty of running refrigeration systems in
clinics and hospitals. As a result, vaccines are often not maintained
at sufficiently low temperatures to ensure product stability. Protease
inhibitors (used in second-line ARV treatments) are one example of
a drug that needs to be refrigerated (Kumarasamy, 2004), yet due to
erratic power supplies and other issues, it is impossible to ensure
constant refrigeration in the world’s poorest countries.
In this situation, it is extremely difficult to ensure the distribution
of the safe and effective medicines that have already been
developed to tackle the diseases of poverty. For example, a relatively
effective treatment for tuberculosis is Directly Observed Therapy
Short Course (DOTS), which requires between 6 to 8 months with
close patient monitoring to ensure compliance. ARV treatment for
AIDS sufferers also requires close supervision over the lifetime of the
patient. Even in the relatively efficient health care systems of highincome
countries, maintaining adherence to HAART (Highly Active
Anti-Retroviral Therapy) treatment during clinical trials is fraught
with complexity (Kumarasamy, 2004). Achieving such adherence in
poor countries with weak health care systems is practically impossible.
Intervention by global public health authorities and the provision
of public funds is not a guarantee that existing medicines will