The Politics of Pharmaceutical Distribution : Pharmaceutical Policy and Chemical Sellers in Southern Ghana

Abstract

This paper examines the expansion of "biomedicine" through an analysis of pharmaceutical distribution and policy in southern Ghana. In particular, it focuses on the "chemical seller" as a unique pharmaceutical distributor. In this paper I illuminate three things: the main characteristics of pharmaceutical distribution in southern Ghana, the features and premises of Ghana's pharmaceutical policy, and the difficulty of expanding "biomedicine" as a concept for explaining the contemporary medical situation in that country. In the anthropology of pharmaceuticals, two features are noted for pharmaceutical distribution in Sub-Saharan Africa. First, there are many types of illegal pharmaceutical distributors. Second, hospitals and health centers lack pharmaceuticals. Pharmaceutical distribution differs however, in southern Ghana. There, illegal pharmaceutical distribution is rare, and both hospitals and health centers have adequate supplies of pharmaceuticals thanks to a distribution system centralized through various types of public stores and the principle of "cash and carry." Yet, it is the existence of chemical sellers that is the most distinct feature of pharmaceutical distribution in Ghana. They are unique pharmaceutical distributors, in that they are licensed by the government, yet have no formal education in the field of biomedicine. Indeed, they are the main actors in the distribution of pharmaceuticals in southern Ghana. While there are 1,126 hospitals and health centers and 1,088 pharmacies, there are more than 8,000 chemical sellers in Ghana. My study focuses on a town 'A' in the western part of the Eastern Region of Ghana, where I stayed for 12 months. Approximately 2,700 people over the age of 18 live in 'A', where cacao, oranges, palm, timber, diamonds and bauxite are the main products. Town 'A' has four chemical sellers and one health center. There are no hospitals or pharmacies. A chemical seller has approximately 160 clients per day, while the health center sees an average of 19.4 patients per day. One trend that has been the so-called "brain drain" of trained people - doctors, nurses, pharmacists - from the field of "biomedicine". There is such a shortage of people educated in "biomedicine" that constructing a pharmaceutical distribution system within their ranks is virtually impossible. As pharmaceutical distributors, chemical sellers have a complementary relationship with health centers. In health centers, the average cost of treatment is about USD5.00, and the duration of the waiting time is more than two hours. Meanwhile, the chemical sellers provide pharmaceuticals quickly and cheaply. Additionally, due to the fact that the number of customers purchasing anti-malaria drugs from chemical sellers is minimal, while the patients attending the health centers do receive anti-maralia drugs, we can speculate that patients and their families may choose between the chemical seller and the health center based on the severity of their illnesses. There is a close relationship between the state of pharmaceutical distribution in Ghana, as outlined above, and pharmaceutical policy. The Pharmaceutical Act presumes that chemical sellers are merchants - not healers - and therefore it is not necessary for them to be educated in "biomedicine" in order to be granted a government license. But, the administrative agency requires consultation and reference. And, chemical sellers do prescribe some pharmaceuticals for their clients in the same manners as nurses. I insist that we cannot understand such a situation as an expansion of "biomedicine." In medical anthropology, we objectify "biomedicine" as a system, which is composed of seven main factors: (1) medical treatment and care as action, (2) persons educated in or practicing biomedicine, (3)

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