Wang'ombe J K, Mwabu G M
Department of Community Health, University of Nairobi, Kenya.
Soc Sci Med. 1987;25(6):625-30. doi: 10.1016/0277-9536(87)90088-8.
Essential drug schemes in the Third World countries face many problems. These include dependency on imported drugs in the face of chronic shortages of foreign exchange, inadequate manpower and technical capability for selection and procurement of drugs, competition between generic and brand drugs, weak local drug procurement and distribution systems and inability to commence local manufacturing even in situations where there may exist comparative advantage. Many of these problems relate to each other and are compounded by the domination of the pharmaceutical industry by multinational firms. Third World countries are in a very weak position in the international pharmaceutical industry. It is suggested that the essential drug situation would improve in Third World countries if certain strategies and policies were adopted. These include: intensification of personnel training in pharmaceuticals, deliberate use of generic drugs rather than brand name drugs, the involvement of the public sector in the procurement and distribution of drugs, buying drugs in bulk, changing drug prescription and consumption practices through continuous education, changing or instituting regulations to guard against unfavourable patents and commencing domestic production of essential drugs where this is not in conflict with the principle of comparative advantage.
第三世界国家的基本药物计划面临诸多问题。这些问题包括：在外汇长期短缺的情况下依赖进口药品、在药品选择和采购方面人力和技术能力不足、非专利药与品牌药之间的竞争、当地药品采购和分销系统薄弱，以及即使在可能具有比较优势的情况下也无法开展本地生产。其中许多问题相互关联，并且由于跨国公司在制药行业的主导地位而更加复杂。第三世界国家在国际制药行业中处于非常弱势的地位。有人建议，如果采取某些战略和政策，第三世界国家的基本药物状况将会得到改善。这些措施包括：加强制药方面的人员培训、有意使用非专利药而非品牌药、公共部门参与药品的采购和分销、批量采购药品、通过持续教育改变药品处方和消费习惯、修改或制定法规以防范不利的专利，以及在不违背比较优势原则的情况下开始本地生产基本药物。
