This study evaluated the capacity of the medicine pricing mechanism of the National Medicines and Poisons Board (NMPB), the medicine regulatory agency of Sudan, in controlling prices of imported medicines. The study was conducted between July and September 2008 and data on the 50 most sold medicines in 2007 were obtained from the records of the regulatory authority and pharmacies in Khartoum; 135 products were included. The cost and freight (C&F) prices of 23% of the selected medicines approved by NMPB were over 10 times the International Reference Price; 71% of these items were generics. The wholesale price of only 40% of the studied medicines was less than that approved by NMPB, while the retail price of 47% of medicines was less than that approved by the authority. The retail price of 11 of 12 originator medicines was equal to or more than their prices published in the British National Formulary. The price of the medicines distributed by Central Medical Supplies was about 2-fold their C&F price. The current pricing system is of limited benefit in controlling medicine prices in Sudan.1 Medicines and Poisons Board, Khartoum, Sudan (Correspondence to G.K.M. Ali: gamalkh@hotmail.com

Problem During the 1990s, the Sudan began several initiatives to establish new medicine-financing mechanisms as part of the health reform process. Initial seed stocks were provided to each hospital. Unfortunately these facility-based funds did not regenerate and the hospitals were left without funds for medicines. The Revolving Drug Fund (RDF) was established in 1989 to facilitate access to medicines in health facilities in Khartoum state. Approach This study used quantitative and qualitative research techniques to collect data from health-care providers and users to evaluate the experience of operating an RDF in Khartoum state. Data from personal observations and from archival and statistical records were also analysed. Seven health facilities were sampled for this research. Local setting The Ministry of Health has a policy to expand the RDF to the whole country and has already commenced roll-out to seven more states. This policy is based on the experience of the RDF within Khartoum state. Relevant changes Khartoum state has a high (97%) level of availability of essential medicines and this is attributed to the RDF. The RDF medicines were mostly considered affordable by users and very few (6%) patients failed to obtain the prescribed medicines for financial reasons. Lessons learned The RDF could be successfully replicated in other states of the Sudan and in low-income countries with similar contexts on condition that they meet success factors, such as gradual implementation, political commitment and availability of hard currency.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

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The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the aforementioned strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. The 2001 Pharmacy and Poisons Act and its provisions established the Federal Pharmacy and Poison Board (FPPB). All the authorities of the implementation of Pharmacy and PoisonsAct were given to this board. This article provides an overview of the impact of the pharmaceutical regulations on the quality of medicines on the Sudanese market from the perspective of the pharmacists working with drug importing companies. The information necessary to conduct the evaluation was collected from 30 pharmacists who are the owners or shareholders in medicines' importing companies. The participants were selected randomly. 89% of respondents considered the medicines on the Sudanese market generally of good quality. The design of the research itself may be considered inadequate with regard to selection process. However, the authors believe it provides enough evidence, and the current pharmaceutical regulations have some loopholes. The Pharmacy, Poisons, Cosmetics and Medical Devices Act-2001 and its regulation should be enforced. The overall set-up including the Act itself needs to be revised.