Senegal's black market for medicine

From IRIN, a story on the black market for medicine in Senegal.

In Senegal eliminating the sale of unregulated or counterfeit medicines will take better laws and law enforcement, but as long as poor people have children getting sick sales will thrive, experts and residents say.

Street vendors across the country sell products of questionable quality smuggled in from other countries - in many cases outright fakes - or hawk medicines sold to them by pharmacists seeking illegal profits. In both cases consumers are at risk.

Aboubakrine Sarr, president of the private sector pharmacists’ union in Senegal, said there are no statistics on the impact, but “the free-for-all illegal street sale of aspirin packets wreaks havoc”.

Aspirins, antibiotics, Viagra, painkillers, anti-parasitic pills and many others can be found anywhere - improperly stored and sold by people who cannot advise on dosage or side-effects.

Many Dakar residents are aware of the risks but people IRIN spoke to said they had no choice.

Asked what mothers do when a child falls ill, Adama Ndiaye, a mother of four in Dakar’s Pikine neighbourhood, told IRIN: “We lose our minds. We’ve got no money for prescriptions.”

A neighbour, Mariama Niass, who sells sweets and trinkets in front of her home, said: “You go to the doctor and let’s say you’ve set aside 300 CFA francs [64 US cents] for the consultation. Then the doctor prescribes medicines costing 10,000, 7,000, 3,000 CFA francs [$6 to $21]. You come back home. You see the children. And you haven’t yet prepared dinner. You must use whatever money you have to buy rice and other items for a meal... The medicines that are sold in the streets - we all have been advised not to buy them, but we have to, because we can’t buy prescriptions.”

Efforts fall short

In July the Economic Community of West African States, the World Health Organization (WHO) and the European Union published a guide to help states combat the unregulated sale of medicines, but there is a gap between international manuals and the reality on the ground.

“This is progress on the international scene but on the ground, we are forever taking one step forward, one step back,” the pharmacists’ union’s Sarr told IRIN.

Where pharmacists sell medicines to street vendors, some in the industry are calling for punishments similar to those faced by drug traffickers, but for now wrongdoers face minimal punishments and in some cases none at all, Sarr said.

“Punishments often are not even applied, because of lax enforcement or a kind of protection that exists among colleagues in the industry.” Between 2008 and 2010, five pharmacists were briefly suspended for collaborating with unauthorized sellers.

A bill regulating the pharmaceutical industry awaits debate in parliament.

Senegal does not have enough inspectors, according to Mamadou Ngom of WHO in Senegal.

There are just four official inspectors to check up on more than 1,000 pharmacies, three manufacturers and four wholesale distributors. Effective control would require five national inspectors as well as one in each of Senegal’s 14 regions, Ngom told IRIN.

Despite an apparent crackdown on the sales side - in 2009 the authorities shut down Dakar’s principal market for unregulated medicines, Keur Serigne Bi - sales continue, in that spot and many other marketplaces.

In Touba, one of Senegal’s main cities, several pharmacies have had to shut down because they can no longer compete with street vendors.

“It’s a problem that’s tough to manage,” Sarr told IRIN. “Still, on the positive side, religious authorities are beginning to take seriously the risk these unregulated products pose.”

Meanwhile, health officials are planning “awareness days” - in Dakar and four other regions - to talk with communities about the risk of buying unregulated medicines, according to Pape Amadou Diop, state director of pharmacies and medical laboratories.