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Pioneering essential drugs policy is under threat in Bangladesh

National policies on rational drug use were high on the agenda at the World Health Assembly in Geneva in May.

The world pharmaceutical market is worth billions of dollars to multinational corporations. Yet the drugs that flood into developing countries are often ineffectual, overpriced and at times hazardous to health.

The World Health Organisation (WHO) has played a key role in supporting governments that want to develop national drugs policies based on a restricted number of essential drugs.

It has stressed the need for equal access to medicines at an affordable price for all people as an overriding principle.

Bangladesh became the first country to act on WHO’s essential drugs concept and implemented a pioneering national drugs policy in 1982.

Within 10 years the country had saved $600m, and the proportion of drugs found to be substandard had fallen from 36 per cent to nine per cent.

But now the policy hangs in the balance as the government decides whether it should continue.

A review of the current policy begun by the current Bangladesh government early in 1992 has resulted in weakening of drug controls and the first inessential drugs — vitamin syrups — have already appeared on the market.

Dr A Rashid, president of the Bangladesh Drug Manufacturers Association, said: ‘Should poor people with an average per capita income of $210 be allured to take useless but costly tonics?’

Opponents of the policy say it has driven foreign investors out of the country.

According to recent Bangladeshi newspaper reports, the committee which carried out the policy review proposes that drugs for self-medication without prescription should be allowed.

It also wants price restrictions to be eased and suggests multi-ingredient ‘combination’ drugs should be re-introduced. Such combination drugs are often medically ineffective or inappropriate, and are frowned on by many British doctors.

WHO’s strong leadership on the better use of medicines to meet public health needs has been seen by some to be faltering, although in March a statement was issues by WHO director general Hiroshi Nakajima, saying: ‘We must remind policy makers, health authorities and economic advisers everywhere that access to essential drugs is the most important element of health services.’