In Nigeria, around half of people who suspect that they have malaria do not see a physician. Instead, they purchase drugs directly from medicine vendors. But the malaria parasite is resistant to much of what they buy. In Bangladesh and India, informally trained village doctors provide most of the outpatient services to the poor. Antibiotics comprise 50% of all prescriptions in developing countries, and more than half are given inappropriately or in insufficient dosages.
The rapid expansion of health markets in Asia and Africa has made medicines, information and primary-care services available in all but the most remote areas. But it also creates problems with drug safety and efficiency, equity of treatment and the cost of care. Poorly trained practitioners often prescribe unnecessary pills or injections, with patients bearing the expense and the costs to their health. Counterfeit drugs are rife and drug resistance is growing. Bringing order to unruly health markets is a major challenge.