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."
