Complete Book PDF (4.12MB) - World Bank eLibrary

Health Sector Corruption in Ethiopia 43
WHO has assessed pharmaceutical governance in more than 20
developing countries and found that the greatest risks involved inspection,
promotion, and selection, as figure 2.4 shows (WHO 2009). 4
Regulation of pharmaceuticals. Ethiopia has enacted measures for regulating
and controlling the pharmaceutical sector. Ethiopia’s Drug
Administration and Control Authority (DACA) began operation in 2001
as an agency within the FMOH aimed at ensuring the safety, efficacy,
quality, and proper use of drugs. It is responsible for
• setting standards for drug quality, manufacturers, warehouses, and
dispensaries
• licensing clinical trials
• controlling the quality of raw materials
• registering and licensing drugs for use
• promoting appropriate use
• inspecting manufacturers (including foreign manufacturers who seek
to export to Ethiopia), health facilities, and pharmacies (whether
publicly or privately owned).
We did not hear any allegations of corruption in policy and registration,
and DACA appears able to exercise its authority: in several cases, it
rejected drugs procured by the FMOH and the PFSA for noncompliance
with safety, quality, or efficacy standards (Wolde 2009).
However, several interviewees reported that some pharmacies, drug
shops, and rural drug vendors sell restricted or illegal items and avoid
detection and penalties by learning about inspections in advance and
preparing accordingly. One informant provided a particularly pessimistic
view of the pharmaceutical sector, but we could not corroborate the
individual’s allegations that “at least 30 percent” of staff involved in regulating,
distributing, and managing pharmaceuticals engaged in some form
of abuse. The allegations do highlight the need for Ethiopia to pay attention
to the opportunities for staff to accept bribes for issuing licenses to
foreign or domestic manufacturers; awarding contracts; or certifying
pharmacies, health facilities, and warehouses.
Public and private pharmacies. Interviewees were also concerned about
the relationship between public and private pharmacies. Maintaining a
public practice gives pharmacists access to certain resources, such as
hospital clients, but they can generate more revenues in the private sector.
We were told that public pharmacists commonly refer patients to