With a severe respiratory infection and a prescription for medicines that would cost 35,000 CFA francs (US$83) at official prices, Drissa Kone has a problem – he has no hope of raising enough money to buy the medicines.

His solution? The stalls of counterfeit medicines at Abidjan’s Adjame market that will sell him an illegal reproduction of the original drug at a fraction of the price.

“I can buy the same medicines at the market by the individual tablet not the packet, and pay just 150 CFA francs (US$0.35) per pill,” he said. “For 500 CFA francs (US$1.19) I can get enough medicine to last me three days!”

The downside of Kone’s thrift is that the medicines might at best be considerably less effective than the originals – a serious problem when treating potentially deadly illnesses like malaria. At worst, fake medicines sometimes contain a mix of chemicals which further harms health.

Dr Ambroise Kouadio, a doctor in Abidjan, says that even though the risks of using counterfeit medicines are fairly well understood, the number of people like Kone who are turning to them is increasing.

“The rate of use of health centres remains relatively low, while the consumption of street medicines is increasing,” he said.

The last time a formal survey of the problem was conducted was in 1998 when the World Bank concluded that 20 percent of Ivorians used counterfeit medicines.

Health experts say that proportion might have risen to between 30 and 50 percent or even higher today, for a mix of reasons including worsening poverty, and the spread of cheaper and cheaper counterfeit drugs around the country.

Also, Cote d’Ivoire as other developing countries in Africa, Asia and Latin America has experienced high inflation this year, due to an upward spiral in world food and fuel prices.

The price of medical consultations and of buying drugs in the formal sector has remained relatively stable.

“The state has built many more health centres and hospitals, but the people are still poor. They have to choose between healthcare and eating and they usually choose to eat,” said Dr Kouadio.

The government has made several efforts at sensitising people about the dangers of counterfeit medicines with information campaigns, leaflets and radio commercials.

At the end of May, the health ministry announced it was going to take a new approach – cutting the price of the legitimate medicines.

“Considerable price reductions will be made in all pharmacies… to permit people to get what they need at a lower cost,” the ministry said in a statement.

Observers said that the move is in the right direction. “The fight against street medicines is not going to be won with repression or a crack down,” said Ernest Bouady, an Ivorian economist.

“They need to think instead about how to improve people’s living conditions.”

Bouady said the ultimate solution would be a functioning system of social insurance which he says the government first promised it would put in place six years ago. “The government promised universal health insurance… but the programme was never put in place,” he said.

“While there is no overall policy in place to help people get access to medicines, they will always turn to counterfeit drugs.”