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I would agree that giving more knowledge and adopting clinical guidelines may improve the quality of care. You mention the tendency by physicians to provide low quality service to drive patients to their private clinics, which I feel drives more and more people to bypass their service (at least via public health institutions for those who cannot afford their private fees) and knowing that for most people in sub-Saharan Africa, probably the first point of contact with the health system is via a community pharmacist, I feel empowering pharmacists to improve the interventions they bring to healthcare delivery should be a integral part of promoting the rational use of medicines. Poor service, coupled with high user fees, tends to increasingly drive patients to self prescription and here you will also find 'pharmacists' ready to oblige. You also mention the huge "rent" ie difference between the market price and value of the drugs. Given that the majority, about 90%, of the budget for drugs purchases in most sub-Saharan African countries are financed by donors (public funding), what role do funders programmes have in creating that false economy. One particular focus should also be what role local manufacturers can play in improving access to medicines and specifically, how funders programmes, some of which have no doubt been effective in reducing prices for therapies like ACTs, can also speak to local manufacturing concerns on the false drugs economy that perhaps some of these programmes help to shape. www.eahic.com