Abstract
In some low- and middle-income countries, the national stores and public-sector health facilities contain large stocks of pharmaceuticals that are past their expiry dates. In low-income countries like Uganda, many such stockpiles are the result of donations. If not adequately monitored or regulated, expired pharmaceuticals may be repackaged and sold as counterfeits or be dumped without any thought of the potential environmental damage. The rates of pharmaceutical expiry in the supply chain need to be reduced and the disposal of expired pharmaceuticals needs to be made both timely and safe. Many low- and middle-income countries need to: (i) strengthen public systems for medicines’ management, to improve inventory control and the reliability of procurement forecasts; (ii) reduce stress on central medical stores, through liberalization and reimbursement schemes; (iii) strengthen the regulation of drug donations; (iv) explore the salvage of officially expired pharmaceuticals, through re-analysis and possible shelf-life extension; (v) strengthen the enforcement of regulations on safe drug disposal; (vi) invest in an infrastructure for such disposal, perhaps based on ultra-high-temperature incinerators; and (vii) include user accountability for expired pharmaceuticals within the routine accountability regimes followed by the public health sector.
Highlights
In many low-income countries, and some middle-income countries, the government’s budget for the health sector is too small to finance the national health system adequately
In Uganda, for example, the expenditure on health in 2014 was only 12 United States dollars (US$) per capita, i.e. about 35% of the value recommended by the World Health Organization (WHO), and the expenditure on pharmaceuticals was just US$ 2.40 per capita.[1]
To suppress the unregulated export – from high-income countries to lowerincome countries – of pharmaceuticals coming towards the end of their shelflives and other nonconforming medications, countries need to strengthen the enforcement of national policies and WHO guidelines on drug donations
Summary
In many low-income countries, and some middle-income countries, the government’s budget for the health sector is too small to finance the national health system adequately. Efficient stocking may be made difficult by deficiencies in the management of a supply chain or by poor coordination between a national supply system and the development partners or special programmes offering to supply pharmaceticals.[10] In most low- and middle-income countries, the supply of pharmaceuticals is centralized and one state agency is entrusted with the procurement, storage and distribution of pharmaceuticals to all public health facilities.[3,11] The network of public health facilities in any given country is often so expansive and complex that it is impossible for a single agency to respond effectively to the unique demands of each client. We review the various options available for mitigating the threats posed by expired pharmaceuticals to health systems and the environment in low- and middle-income countries
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