"I always buy my medicine here, because in the hospital, you can only consult if you are lucky," said the 23-year-old. "I prefer to come to the +docta+ of the neighborhood", a nickname that designates the owners of these pharmacies, "it's faster and cheaper", she explains.

Stephen Liosso-Pivara-Bembe, 33, gives him pills for stomach pain.

Stephen Liosso-Pivara-Bembe, former medical student, in his informal pharmacy, on February 21, 2022 in Bangui, Central African Republic © Barbara DEBOUT / AFP

In a white coat, stethoscope around his neck, he says he was never able to finish his medical studies for lack of money. He works seven days a week in this pharmacy decorated with drawings of yellow capsules. A slogan in white letters proclaims: "Health first".

These informal pharmacies are vital for the poorest population of this Central African country, the second least developed in the world according to the UN and in civil war for 10 years. But there is a flip side to the coin: proliferation of poor quality or fake drugs, antibiotic resistance, illegal practice of medicine...

In the absence of an official census, AFP was able to count a dozen of these "mini-pharmacies" on the only avenue de France, a major artery of a disadvantaged neighborhood, in front of which long queues form daily, especially at the end of the day.

Access to care is very limited in this country, which suffers from a chronic shortage of qualified health personnel, equipment, and medicines.

Stephen Liosso-Pivara-Bembe, a former medical student, cares for a patient in his informal pharmacy, on February 21, 2022 in Bangui, Central African Republic © Barbara DEBOUT / AFP

The health system is on a drip of international aid, and about 70% of medical services are provided by humanitarian organizations, while 2.7 million people, half the population, are in need of health assistance, the UN estimated in 2022.

Free consultations

In the 5th arrondissement, Antoine Bissa, a 39-year-old nursing student not yet graduated, is installed between the drug shelves of his shop called "Bibi pharma".

He says he receives every day a hundred people "for injections or for medicines, until 23 p.m." An activity that is his only source of income, says this father of four.

Antoine Bissa, nursing student, in his informal pharmacy on February 21, 2022 in Bangui, Central African Republic © Barbara DEBOUT / AFP

Most come to treat malaria, fever, for antiparasitic treatment, or first aid, he lists.

It also offers "free consultations", and "cheaper medicines". But, "if it is serious, we indicate them the hospital for in-depth care," says Antoine Bissa.

Gilles Doui came to relieve muscle pain. "I have three children and my salary does not allow me to pay for drugs in pharmacies," says the 35-year-old civil servant who waits his turn on a bench and "prefers to pay for a few tablets rather than a whole box".

"We sell the drugs according to the means of each", to the unit if necessary, details Stephen Liosso-Pivara-Bembe, who sells for example the box of Vogalène 5,000 CFA francs (7.5 euros), against 7,000 (10.5 euros) elsewhere.

Antoine Bissa, a nursing student, prepares an injection against malaria in his informal pharmacy on February 21, 2022 in Bangui, Central African Republic © Barbara DEBOUT / AFP

Without recognition from the authorities, or authorization to practice, he says he supplies from Cameroon, Congo but also France.

Regulation

"We do not work in partnership with mini-pharmacies," says Romuald Ouefio, director of pharmacy and traditional medicine at the Ministry of Health. "They are in the informal sector and promote the proliferation of substandard or falsified medicines," he said.

Mr. Ouefio also points to "cases of antibiotic resistance".

Stephen Liosso-Pivara-Bembe, a former medical student, sells medication to a customer in his informal pharmacy, February 21, 2022 in Bangui, Central African Republic © Barbara DEBOUT / AFP

"We plan a dialogue in a few months with the owners to make them aware of the need to convert to other activities", a first step before "a very robust crackdown", he warns.

Jules Dawili, a laboratory technician from Bangui, admits that cases of resistance to antibiotics, including amoxicillin, for bacterial infections, and doxycycline, for the preventive treatment of malaria, are due to these over-the-counter sales or poor prescriptions.

But he does not support "100% the regulation" announced by the authorities.

"Some are competent," he said, adding that "the government could select them, make them pass tests and training to help health workers."

The government must "think carefully about this system that it wants to put in place. In a neighborhood, there are more than 20 mini-pharmacies, how many structures will he set up with what amount of drugs and how many staff to replace everything?" asks Stephen Liosso-Pivara-Bembe.

Customers in front of the informal pharmacy of Antoine Bissa, a nursing student, on February 21, 2023 in Bangui, Central African Republic © Barbara DEBOUT / AFP

"If the government closes the mini-pharmacies, it is because it does not think of those who do not have the means to pay, many will die," worries Yaguina Nesly, her 9-month-old baby wrapped on her back.

© 2023 AFP