Health Exchange Spring 2010 launch - Improving access to medicine: Is it a matter of political will?
To launch the new issue of Heath Exchange, over 50 participants took part in a discussion in London on 17 April 2010, about improving access to medicines. The debate revolved around whether improving access to medicines is a matter of political will. Andrew Chetley, Executive Director of Healthlink Worldwide, started the event with a presentation and encouraged comments from the participants.
He asked, ‘What are essential medicines?’ They are medicines that satisfy the needs of the majority of the population and therefore should be available all the time. Unfortunately this is not the case. Two billion people in the world cannot access the medicines they need and they are the two billion poorest people.
There are a number of reasons for this lack of access. Transparency International’s Global Corruption report in 2006 states that up to 30per cent of medicines on the market in developing countries could be counterfeit or substandard. Prices are often too high to make medicines affordable, and often public sector pharmacies do not have the right stock. In some cases, there are ‘stock-outs’.
Participants suggested that stock-outs can happen for a number of reasons including: poor planning, inefficient data systems to tell you which drugs are needed, not knowing what the essential medicines list is, poor distribution, lack of foreign exchange and corruption.
In 2009 the United Nations reported the Millennium Development Goal (MDG) target to improve access to medicines is not being met. Why not? The UN says that part of the difficulty in assessing progress towards this commitment in the MDGs is the lack of a defined quantitative target. Andrew Chetley pointed out that no measurement equals no action!
So what are some of the possible solutions to the problem? A key concept is accepting the right to health: “The status of innovator companies would be immeasurably enhanced if they did not see, and treat, patents as their “crown jewels”. Companies must grasp, and publicly recognize, their critically important social function and right-to-health responsibilities. They must demonstrably do everything possible, within a viable business model, to fulfil their social function and human rights responsibilities. Presently, this is not happening. If it were to happen, it would not only greatly enhance companies’ status but also pressurize States, generic manufacturers and others to provide the environment that companies need if they are to enter into arrangements, such as commercial voluntary licences, that enhance access to medicines for all.” - Paul Hunt, UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, 2008
Another possible way forward is to improve governance, transparency and accountability. Examples of this are WHO’s Good Governance for Medicines programme; civil society monitoring of prices, availability, quality; industry support for quality improvements; the Medicines Transparency Alliance, and governments publishing what they pay/receive.
A recent approach that is being tested in many countries is working in partnership. This led to the central question of the event: Is increasing access a matter of political will? What are the roles for government, the private sector, the international agencies, and civil society to work together to improve access?
Three groups of participants held discussions to explore the topic further. In plenary at the end of the event, some key points emerged from the conversations held:
- The problem is very complex. There are lots of different stakeholders and systems to take into account. There is no one solution.
- Managing essential medicines is in the context of managing the whole health system. What is the point in having a vertical programme which puts AIDS medicines into hospitals that don’t have paracetamol or antibiotics? If you can’t meet basic health needs, the system is discredited and patients will not trust it.
- Pharmaceutical companies should do everything within a viable business model to fulfil their social function.
- Educating people in the community is very important. If people don’t know what the problem is, they can’t demand solutions.
- The public sector is a leader, the government is responsible to deliver medicines, but it also has a vested interest.
- Making medicines accessible is a very complex task and there are not enough people to do all the procurement, stock management, distribution etc. You can talk about transparency and accountability, but if there is no-one there to do it, it is problematic. More health workers are needed.
Andrew Chetley concluded the session by saying, “The two fundamental expenses in the health sector are the people (health workers) and the medicines. The health workers and the medicines are core to a functioning health system. If we are serious about public health, we need to pay attention to the number of people and the number of medicines available. If they are not our priorities, then we need to ask some serious questions”
The presentation from the event is available here: http://www.slideshare.net/HealthlinkWorldwide/health-exchange-access-to-medicines-april-2010
Health Exchange is jointly produced by Merlin, RedR and Healthlink Worldwide. (In addition to the issue on access to medicines, recent issues have looked at strengthening human resources for health, tackling the social determinants of health and dealing with people’s right to health.)
More information:
http://healthexchangenews.com
www.who.int/medicines/en/
www.haiweb.org
www.ghwatch.org/
www.MedicinesTransparency.org
www.unitaid.eu/en/Patent-pool-resources.html http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2009/MDG_Report_2009_En.pdf
Health Exchange contains articles about responses to increasing access to medicines. Features include campaigning to ensure pharmacies are well stocked, new ways of providing TB treatment at community level, how to respond to drug resistance and ensuring children’s medicines are in the right formula.
The issue is only available online. https://healthexchangenews.com