One of the more interesting findings is that local regulators are not trusted to provide quality medicines by the majority of physicians in each city. Trust was highest in Dar Es Salaam (35%), and lowest in Nairobi (15%). These results are not surprising given what we know about drug quality in these markets, and perhaps it is at least encouraging that physicians in these cities are aware of the shortcomings of the national agencies allegedly protecting them and their patients.

And their own patients’ experience with poor quality medicines is also important. Between 22.5% and 47.5% of physicians knew of instances where at least one of their patients was harmed by a medicine, but as is typical in the West, in only a very few instances, was the reason for the harm established. While harm could have been caused by factors other than medicine quality, many physicians thought quality a contributory factor.

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Summary statistics (40 physicians)	Nairobi	Lagos	Dar
Survey
Introduction
I represent the Safe Medicines Coalition which is doing research on various aspects of drug quality. We are interested to discuss issues related to drug quality with you.
The (regulator) is responsible for ensuring that all medicines sold in (jurisdiction) are of good quality and that medicines deemed to be bioequivalent to the innovator product are indeed interchangeable with it.
1.      Do you believe that the (regulator) overseas product quality effectively?	15*	20	35
2.      Are there any products on the market that you do not prescribe due to safety/non-bioequivalence concerns? Please give examples	92.5	90	85
3.      Have you had patients who appear to react unexpectedly to a medicine? (would you care to estimate how many, what percentage?)	95	90	92.5
4.      Has a patient ever been harmed (had significant adverse reaction) by a medicine? (please identify condition and medicine)	35	47.5	22.5
5.      Did you discover the reason for the harm?	5	0	2.5
6.      Did you file an ADR report?	0	0	0
7.      Did you switch the patient to another version (brand/generic) of the same drug?	55	42.5	30
8.      Did you switch the patient to a different type of drug (because you assumed it was the type of drug that caused the problem)?	25	12.5	17.5
9.      Did you ever think the problem may have been with the quality/interchangeability of the medicine?	70	85	50
10.   Do you know how often your patients are switched from brands to generics, and between generics? Source of this information?	60	20	35
11.   Has a patient ever been (affected) harmed by a generic switch? How do you explain the problem?	75	55	35
12.   Do you know (% of patients) what specific medicine (specific brand or generic) your patients actually take?
13.   How many products (%) do you prescribe as brand only?
14.   Are there restrictions in your jurisdiction against switching classes of drugs? – Any drugs can’t be switched without your permission?	0	0	0
15.   Have you ever noticed certain brands of medicines (or production locations) that fail more often than others?	80	75	85
16.   How often (every day, week, month) are you asked by payers or pharmacies to switch generic?
17.   Have patients expressed concerns about their generics looking different from month to month? And if so how often (day, week month)
18.   Have you ever heard other complaints from patients about drugs?	90	95	85
19.   What is the primary source of your knowledge of product recalls?
Questions for LDCs–
20. Do you advise patients to buy specific innovator brands or generic brands? If so what medicine types?	75	90	85
21. Do you advise patients to buy from specific locations/pharmacies due to better known quality?	85	80	85
*All figures are percentages answering yes to the primary question. Some questions do not lead to answers that can be compiled into summary statistics

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Table 1. The above table is the summary statistics from the initial survey from three African cities, Nairobi, Kenya; Lagos, Nigeria; Dar Es Sallam, Tanzania. The detailed answers are still being compiled.