In this review article, the issues related to provision of psychotropic drugs in services in sub-Saharan Africa are explored. Problems encountered in procurement of drugs, their safe prescription and practical supply systems are discussed, with possible solutions suggested. The evidence-base for the preferential use of first-generation drugs is presented, with the practical implications for cost-effective service delivery shown. Options for sourcing of quality drugs are outlined with practical examples. An argument is made for a wider range of medical personnel to be allowed to prescribe than is often currently the case. This is so as to allow for the scale up of community based psychiatric services which will otherwise fail to meet the needs of the majority of persons with mental illnesses, particularly in rural communities. Drug Revolving Funds are proposed as a means of managing supplies by local projects in a context of a lack of an alternative supply. Some suggestions are made for practical solutions to the problem of those cannot afford even cheaper medications.