Many researchers in developing countries have described drug use as “irrational”, documenting cases of ineffective, unsuitable, suboptimal or unsafe prescribing, supply and/or consumption of pharmaceutical products. Drug use in these countries is influenced by many factors: health and drugs policy determines the legal frameworks for drug use and its regulation; the organisation and processes of healthcare provision affect access to professionals and drug therapy; and there are commonly big differences in the availability of drugs and services between regions (notably urban and rural areas). Provision and uptake of care are limited by financial constraints on the part of governments and individuals. Problems of access to objective product information, the role of the pharmaceutical industry in production and marketing, the prevalence of counterfeit products, and the difficulties of regulating professional practice and product quality are well recognised. In sub-Saharan Africa traditional and western medical practices commonly operate side by side: drugs are used in the context of local health beliefs, cultural traditions, and individuals’ perspectives and preferences regarding the appropriateness of different courses of action and drug use.

Interventions to …