Technology policy and planning in the Third World pharmaceutical sector: the Cuban and Caribbean community approaches.

There has been growing international concern over many aspects of the use and flow of medicines in developing countries. This article briefly reviews factors which have contributed to problems in this area including marketing and promotional practices of the pharmaceutical companies, rising drug import costs, and the unsuitability or poor quality of available drugs. This analysis is primarily concerned with policies that have emerged from efforts to alleviate such problems, to increase control over multinational drug companies, and to bring about changes in the technology transaction processes and in the pharmaceutical sector. It focuses on two cases: the regional cooperation scheme of the Caribbean countries (CARICOM) and the national-level policy of Cuba. It is shown that the CARICOM strategy has significant limitations, primarily due to its voluntary nature and lack of enforcement mechanisms for member countries. On the other hand, the Cuban approach has brought about positive effects and progressive changes, made through political commitment to achieve social benefits, and in conjunction with integrated broad reforms of the entire health system within a socialist framework. Thus, the problems and promises of such strategies are viewed in a context which emphasizes the prevailing forces of the global political economy. The lessons from this study, applicable to other developing countries, not only reveal important measures for the pharmaceutical sector, but also stress the ultimate need for strong commitment to enforce policies at the national level and for major structural changes, in order to adequately meet the health and medical needs of the people.