[Why drug prices are high in sub-Saharan Africa. Analysis of price structure: the case of Senegal].

This article seeks to shed light on the reasons for the lack of correlation between the price of drugs in this very poor sub-Saharan country and the population's ability to pay for them. The analysis is based on: (i) a comparison between the wholesale (exclusive of VAT and other taxes) and government-fixed retail prices and the corresponding prices of the same drugs in their country of origin (France); (ii) a description of the price-setting mechanisms in Senegal in both the public and private sectors; and (iii) an evaluation of public-sector retail price in Senegal, by end users and prescribing professionals in both sectors. The study found that: (i) patient expenditure would be one-fifth as high if all the drugs in the sample were sold at their government-fixed public-sector retail prices; (ii) the most cost effective drugs are sold at fixed retail prices higher than those of drugs not reimbursed by the national health insurance in France because considered less cost-effective; (iii) the mechanism for setting public retail prices seems to be unrelated to public health objectives, does not consider specific population groups, target diseases, or the drugs' therapeutic value, and therefore cannot be considered an effective tool for implementing national drug policies. Instead, the incentives of this mechanism lead retailers to sell the most expensive drugs first, to generate the highest possible margins. It does not prioritize the essential generic drugs that health authorities have placed at the centre of their pharmaceutical policy.