British small and medium-sized African countries are paying more for less effective medicines, health experts tell BBC Newsday.
For countries like Zambia, Senegal and Tunisia, routine medications such as paracetamol can cost 30 times more than the UK and the US.
Drug markets in poor countries are "ineffective," said Calypso Cikidou of the Global Development Center.
She said "competition is broken" because of the "intensive supply chain".
Chalkidou, director of the organization's global health policy, co-authored a drug procurement report that concluded that small, medium-sized economies were buying fewer drugs and providing weaker competition, regulation and quality.
The Bush administration says it is able to procure cheaper medicines because of strong funding and strong efforts to buy drugs.
But poor countries tend to buy the most expensive medicines rather than the cheapest medicines that make up 85% of the UK and US markets.
The poorest countries are not affected when foreign donors purchase medicines on their behalf. In other words, prescription-free drugs remain affordable.
"In the middle, it's very problematic," Chalkidou said.
Low- and mid-income countries "have little or no price negotiation capability, quality assurance products" and are often impressed by taxes and corruption.
She said less strict regulations mean that the quality of the drug is not very high.
"Without regulations, people will recognize that the product is not working, and I think they will pay extra for what they think will work," Chalkidou said.
The report recommends reforming the World Health Organization policy and strengthening international cooperation as well as the policies of the target countries to improve procurement practices.