The Role of Informal Drugs Sellers in Providing Health services in Darfur Region

Justice and Equality Movement (SUDAN)
Secretariat of Health Affairs
The Role of Informal Drugs Sellers in Providing Health services in Darfur Region Sudan- Descriptive Study
By: Dr. Al Wathiq B Ali HAMDABI (MD Community Medicine U of K 2001)
Member of Executive Bureau Secretary of Health Affairs:
Selling drugs outside the formal health sector is a common phenomenon in most African countries. In most countries including the developed ones it is acceptable to sell few medicines including analgesics for minor pain in supermarkets, but in most rural areas in Africa where there is low health coverage the informal drugs sellers (IDS) are the only health providers.
This paper is an extract from a descriptive study on the role of IDS which was conducted during the period April 2011- July 2012 in small villages and population gatherings in North Kutum areas , North Darfur State Sudan. The studies villages were namely: Amray, Anka, Bridik, Donki Hosh, Donki Wakhaim, Donki Mujwar, Muzbat, Karu, Furawia, leil , and Gorbura, and abuliha.
Objectives
The general objective of this study was to identify the role played by IDS in order to help planners to treat this phenomenon.
Specific objectives:
Explain the causes of the this phenomenon (selling drugs outside the health sector)
Identify the potential health risks of this phenomenon
Determine the possibility of including the IDS in the health system
Propose alternatives
Why Informal drugs Sellers are active:
The operational definition of IDS used in this study is a group of people (mainly men) with no or little medical background which doesn’t enable them to be included in the health system of the country, and who are selling drugs in Umdarwar markets (Dawarwar literally means rotating a term used for the weekly market day in most villages in Darfur. Where people move with their goods from village to another in a fixed agreed upon days a week.
Some IDS especially the ex community health workers CHWs has store drugs built of fixed materials nevertheless they use these stores only in the day of market in their villages where the rest of the week they rotate with their fellows from market to another where they demonstrate their medicines side by side with onions oils sugar ..etc all on the ground under the direct sun heat and light.
It is logic to believe that the IDS are active where there is no health facilities or licensed pharmacies. It was proved that this is really the main, but not the only reason.
In most studied villages there are no health facilities. Instead there is only wee functioning dispensary in Muzbat which is running by MDM (INGO) and the services is provided by a well expert and trained medical assistant supported by a trained village midwife. In some other two villages health facilities are partially functioning. In Karu and Furawia the dispensaries were not functioning during the period of the study. As far as all those villages are located in area controlled by rebellions movements (JEM and SLA) the GOS are putting many obstacles for the INGOs to visit , work and provide health and other services to civilians affected by war. For example it is not allowed for the INGOs to send surgical consumables to their clinics.
Other causes for the work of the IDS
Lack of health education where patients prefer to be treated by injections than tablets where most clinics are following their protocols, which strictly reserve injections for severely ill cases
Low time coverage as all functioning clinics are working one shift a day
Low patients’ compliance and satisfactions towards the available facilities.
Where do Informal Drugs Sellers get the medicine?
The available medicine in Umdawarwar markets was found to be very large in quantity and variety, but unfortunately not in quality.
The absence of health facilities definitely means the absence of and forms of supervision or inspection.
Two main sources of drugs were identified:
The medicine received from Al Fasher, The capital of North Darfur Region. These are generally a medicine of good quality which are manufactured in Sudan, Egypt or China. Some are manufactured in Saudia Arabia or ordan>
But unfortunately these drugs are transported in the ordinary commercial trucks with other goods exposed to sun light and heat.
The other source (which is the main one) is the drugs that illegally brought through the border from neighboring countries and originally manufactured in West Africa.
It is well known that most of these drugs are of a poor quality and almost all are not licensed in Sudan.
Drugs Items and Potential Harms
The most common items available were analgesics, antibiotics, anti malarial and others (Tablets, capsules syrups, drops creams and injections).
Most of the IDS are not acquainted either with the potential harms of the drugs they are selling or with the safety of their use during pregnancy and lactation.
It is worth to mention that a drug like Tetracycline which proved to be a harmful teratogenic and pass in milk of nursing mothers are commonly used for simple diarrhea or any mild form of abdominal discomfort.
Some wrong practices are common like receiving a weekly injection of a mixture of: Benzylpenicillin, Gentamycin, Vitamin B complex, and Hyoscine all in one 10 cc syringe.
Misuse of hormonal therapy are also common such as using Dexamethasone tablets to increase the weight
Proposed solutions:
The Informal Drugs sellers are always active where the is a vacuum in health services quantity or quality. The below mentioned solutions are proposed
Training of the current working IDS and through training reduce the number of medicines they are selling
Training of the IDS on health education
Increase population awareness and knowledge about the harmful use of unlicensed drugs by using the available media including the alternative media such as Radio Dabanga
Increase health coverage
Improve the quality of services in the available facilities
Provide ambulance services in difficult to access areas
N.B Detailed result of the study are available upon request