Planning for Microbicide Access in Developing Countries

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Planning for Microbicide Access in Developing Countries

Figure 4: Private expenditure on health as % of total health expenditure in 2001(Source: WHO 2004a)costs (Bulatao 2002). Many developmentagencies, especially US Agency for InternationalDevelopment, have made efforts to expandthe role of the commercial sector inproviding contraceptives in order to promotesustainability.However, the private sector is not a panacea.Regulatory capacity, quality assurance andenforcement are weak in most developingcountries (Institute for Health SectorDevelopment 2004). Low quality of drugs andpoor prescribing and dispensing are pervasiveproblems in the private sector (WHO 2004a).This is particularly true in rural and peri-urbanareas, where medicines are primarily sold bychemical sellers and general stores that areoften unlicensed and have staff with littleor no training. Counterfeit drugs also pose aproblem: 70 percent of antimalarials in SouthEast Asia and over 50 percent of all drugstested in Nigeria were found to be counterfeit(Institute for Health Sector Development 2004)and contained little, no or the wrong activeingredients. In addition, high price markupsare common and can present a seriousaffordability barrier to the poor (Ewen and Dey2005).The private sector already plays a major rolein the delivery of health commodities andprovides important distribution outlets forPLANNING FOR MICROBICIDE ACCESS IN DEVELOPING COUNTRIES: Lessons from the Introduction of Contraceptive Technologies 19

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