Government health officials said a revived campaign to abolish illegal pharmacies

and rid the country of counterfeit drugs had stalled in the courts despite cooperation

from the municipality and law enforcement authorities.

"The problem is that the [ministry] doesn't have the power to punish or fine

people who have illegal businesses," said Chroeng Sokhan, vice-director of the

Department of Drugs and Food at the Ministry of Health (MoH). "We need stronger

powers to punish illegal businesses and stronger collaboration from regulatory agencies.

But we don't have strong hopes that the courts can help us."

The MoH publicly announced in March that it would inspect and close some of the estimated

3,000 illegal pharmacies that provide questionable health care to millions of Cambodians

each year.

The objective of the MoH's committee to crack down on illegal medicines, which was

set up in 1999, is to improve drug standards and close illegal vendors. The campaign

received publicity recently after health officials spoke out against resistance they

encountered in the courts and, indirectly, at the Ministry of Justice.

A previous effort, launched in 1996, saw 27 cases sent to court, but only five made

it to trial. A few people were prosecuted, said Sokhan, but it was unlikely that

the pharmacy owners ever paid the fines. Many of the pharmacies resumed operating

soon afterwards.

"Law enforcement is not really effective," he said. "We don't have

much hope that this problem will disappear. When we abolish all of them, then we

can control the illegal outlets, but we cannot do that right now."

He said only five new cases had gone to court over the past sixteen months. No verdicts

have yet been issued, and two cases that were on the verge of being decided were

dismissed amid allegations of bribery. Sokhan despaired of any progress before the

July general election, but said the MoH would still submit court papers in the remaining

three cases.

A recent World Health Organisation (WHO) study found that the government's lax regulation

of the industry has allowed counterfeit and substandard drugs to flourish in Cambodia.

The Report on Counterfeit and Substandard Drugs, dated January 2002, found 10 percent

of pharmaceuticals on sale were fake while another 3 percent were substandard. Officials

said about half of the counterfeit drugs here are antibiotics.

Huge profit margins drive the trade in counterfeit brand name pharmaceuticals offered

at cut-rate prices next to legitimate drugs.

Sokhan said the report's findings were alarming. A study he had seen estimated the

value of the illegal trade, most of which comes from neighboring countries, at between

$50 and $100 million a year. Official imports, he said, were around $12 million a

year.

Fake drugs present a chronic public health problem because they encourage mistrust

of modern health care, jeopardize legitimate drug manufacturers and hit the poor

hardest.

A series of articles in Lancet, a British medical journal, highlighted the problem

in Southeast Asia where more than a third of malaria medications are thought to be

counterfeit.

The journal stated that in Cambodia, 90 percent of remote rural communities rely

on unqualified drug sellers for primary health care. The drugs are usually supplied

by wholesale pharmacies based in Phnom Penh that deal in smuggled, and often bogus,

medications. The study found more than 60 percent of the stores surveyed had fake

varieties of malaria medication on the shelves.

Part of the ministry's crackdown also involves a drive to register pharmacies. A

survey in 2000 found there were 892 licensed pharmacies in the country, and three

times that many without licenses.

Licensed pharmacies are required to be supervised by either a pharmacist, an assistant

pharmacist or a nurse, and must have adequate space and air conditioning. However

the rules only apply to new shops.

Traditional medicine shops, which hawk remedies such as dried mushrooms, roots, bark

and animal parts, were also warned to register with the ministry. The manager of

one traditional medicine shop near Psar O'Russey said government officials inspected

her store and told her to apply to the MoH "or they will arrest me and put me

in jail".

However Hieng Punley, the director of the National Center of Traditional Medicine,

said he was unaware of any police action.

"We just made an announcement to every shop to apply for legal registration,"

said Hieng. "In the future the Ministry of Health will order the Center to crack

down strongly on [traditional] pharmacies, but I cannot say when."