Au-delà de la régulation étatique - La gouvernance du marché informel de la santé : Cas des médicaments au Zaïre

Informal structures of health care — whether traditional or modern — constitute a significant part of the health sector in all developing countries. Yet much of the debate on institutional reform focuses almost exclusively on how to lower cost, and increase efficiency and quality of service, within the formal sector. Thus it fails to address many of the problems faced by ordinary people who need medical treatment but do not have access to formal public or private institutions.

During 1996, Kizito Nsarhaza studied the structure of social relations and conventions underlying the informal market for medicine in Kinshasa. There are numerous parallel marketing circuits for such products (including contraband, non-authorized sales, stolen or discarded products from hospitals or government health services, and remnants of humanitarian aid). Nsarhaza focused on buyers and sellers of medicines in the central market of Kinshasa, exploring how people confront the uncertainties implicit in informal markets for highly perishable and therefore potentially harmful products.

He found elements of informal "governance" based upon the need to sustain social relations and retain the trust of partners in various forms of exchange. There was, however, little official regulation of the market, and it tended in any case to be ineffective. Civic associations, which might have played some regulatory role, were weak and underdeveloped.

The paper ends with a call for better research on such informal markets in the field of health, so that ways can be found to provide protection for those who must rely upon them for crucial products and services.