Fakes and quacks: public demand for better healthcare


Purity’s brother died of tuberculosis. A year later, she started feeling very weak, had a terrible pain in her chest and rapidly lost weight. The nearest hospital was 10 miles away and her family could not afford the transport.

Afraid and anxious, she went to a local medicine shop and described her symptoms. The man there did not offer or advise her to have a test. From the array of brightly coloured boxes sweltering in the heat, he selected an antibiotic with writing in a foreign language. Purity bought as much of the supply as she could afford.

Purity died six months later. She did not know what the medicine was. She had no knowledge of her illness.

While governments across the world seek universal equitable healthcare, the reality is different. More than 50% of the world’s poorest people access medical care through village doctors, hospitals, shops or traditional practitioners. Public health across Africa and Asia is weak, so unlicensed, cheap private health care is booming.

This is deeply concerning. Many unregulated outlets lack the equipment, quality drugs and knowledge, which can result in misdiagnoses and even fatality. It is estimated that in some countries 50% of drugs are counterfeit. A recent survey of seven African countries found that between 20% and 90% of all anti-malarials failed quality testing.

This is where the private and public sector must work together. Governments need to improve regulation and control, while offering an enabling environment for private health care to operate legitimately.

This will reduce inappropriate or harmful treatment and counterfeit drugs, which kill nearly a million people every year. The public sector needs the myriad of small independent pharmacists and village doctors as they cannot reach everyone themselves. The independent providers need governments to make it easy for them to do the right thing.

It is unrealistic to expect training for every health worker or unlicensed businessperson to stick to government regulation and provide quality health care, so we must create public demand; enable people like Purity to have basic knowledge on what tuberculosis is and how to treat it, or at least to ask the right questions. Give people like her the ability to question her treatment and seek a second opinion. Public demand for quality medicines and treatment will pull ropey businesses into line.

Technology can help, too. In Kenya, a smart phone with an app capable of scanning medicine packets to detect fakes is given to the heads of communities, and in India, free interactive health services are delivered to people’s mobile phones.

Bridging private sector and governments, and ensuring communities hold both parties to account will save lives.