Getting Medicines to the Poor in Zambia

This article documents the results of face-to-face interviews in Zambia with citizen consumers, a pharmacist, a Ministry of Health (MOH) spokesperson, and the executive director of Transparency International Zambia on the subject of medicine availability and affordability in Zambia. Problems cited by interviewees include high costs of non-generic medicine; questionable quality of generic medicine; budget transparency in funding and sale of medicine; bribery and theft; and supply and distribution.

Those interviewed in the Garden sector of the capital, Lusaka, describe the costs of medicine as being prohibitive for the economically poor. Costs can force people to visit traditional healers and buy generic (not always reliable) drug brands. Sometimes the cost forces a decision between buying food and buying medicine. As described here, malaria medication can cost the entire weekly wages of transportation workers or up to 5 weeks wages of a teacher. In order to save money, some pharmacy clients will buy only half their prescription of antibiotics. This can result not only in ongoing illness, but also in antibiotic-resistant diseases.


Satisfying demand has, according to an MOH spokesperson, improved significantly - anti retrovirals for HIV/AIDS and drugs for tuberculosis and malaria had not run out in the 2 years prior to the interview; however, increased demand had resulted in shortages previously, particularly when hospitals and clinics dropped user fees, resulting in more attendance. Delivery and theft have been problems causing shortages. Special committees have been set up in hospitals and among district health management teams to address the problem. Bribery in the health system is reported to lead to higher drug prices. An environment of corruption can result from a lack of patient information about provision of services and medicines. A survey at the time of the article showed that Lusaka residents perceived improvements in accountability and transparency in health service delivery.


The executive director of Transparency International Zambia confirmed that his organisation received reports in the past about medicines from the public health system finding their way into private clinics. He noted that: "In human terms, corruption can cost lives.... Bribery in the health system results in higher drug prices,...and a lack of patient information about services and medicines - about where and when they are provided, about who provides them and the procedures to be followed - creates an environment in which corruption can flourish." He cites the strategy of the Medicines Transparency Alliance (MeTA): "Transparency International Zambia feels that the concept of the Alliance of bringing together various stakeholders - the private sector, civil society, the government and other interest groups - has the potential to improve transparency in the medicine supply chain and will ultimately improve the lives of all public health service providers and beneficiaries."