Andrew ChetleyExecutive Director,
Healthlink Worldwide 15 April 2010
Improving access
to essential medicines:
is it a matter of political will?
What are essential medicines?
medicines that satisfy the needs of the majority of the population and therefore should be available all the time. -World Health Organization
What’s supposed to happen?
Essential medicines are intended to be available within the context of functioning healthcare systems at all times, in adequate amounts, in appropriate dosage forms, with assured quality, and at a price the individual and community can afford.
… and they are meant to be used appropriately.
What is the problem?
Two billion people lack access to essential medicines.
>100,000 medicines on the market …
… and only 300 on the WHO essential list
What’s the problem?
What’s the problem?
Illustration: TI Global corruption report 2006
Up to 30% of medicines on the market in developing countries could be counterfeit or substandard.
What’s the problem?
Data were collected from 93 countries, where the price for a 7 day treatment course of ciprofloxacin ranged between US$0.42 and US$131.
What’s the problem?
Stock-outs: when health facilities have a shortage of one or more essential medicines
Photo credit: Nora Marshall
What’s the problem?
Contra-ceptives and
RHequipment
STIDrugs
EssentialDrugs
Vaccinesand
Vitamin ATB/Leprosy
BloodSafety
Reagents(inc. HIV
tests)
DFID
KfW
UNICEF
JICA
GOK, WB/IDA
Source offunds for
commodities
CommodityType
(colour coded) MOHEquip-ment
Point of firstwarehousing KEMSA Central Warehouse
KEMSARegionalDepots
Organizationresponsible
for delivery todistrict levels
KEMSA and KEMSA Regional Depots (essential drugs, malaria drugs,
consumable supplies)
ProcurementAgent/Body
CrownAgents
Governmentof Kenya
GOK
GTZ(procurement
implementationunit)
JSI/DELIVER/KEMSA LogisticsManagement Unit (contraceptives,
condoms, STI kits, HIV test kits, TBdrugs, RH equipment etc)
EU
KfW
UNICEF
KEPI ColdStore
KEPI(vaccines
andvitamin A)
Malaria
USAID
USAID
UNFPA
EUROPA
Condomsfor STI/
HIV/AIDSprevention
CIDA
UNFPA
USGov
CDC
NPHLS store
MEDS(to Mission
facilities)
PrivateDrug
Source
GDF
Government
NGO/Private
Bilateral Donor
Multilateral Donor
World Bank Loan
Organization Key
JapanesePrivate
Company
WHO
GAVI
SIDA
NLTP(TB/
Leprosydrugs
Commodity Logistics System in Kenya (as of July 2006) Constructed and produced by Steve Kinzett, JSI/Kenya - please communicateany inaccuracies to [email protected] or telephone 2727210
Anti-RetroVirals
(ARVs)
Labor-atorysupp-lies
GlobalFund forAIDS, TB
and Malaria
PSCMC(CrownAgents,GTZ, JSI
and KEMSA)
BTC
MEDS
DANIDA
Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,Dispensaries come up and collect from the District level
MEDS
Provincial andDistrictHospital
LaboratoryStaff
Organizationresponsible fordelivery to sub-district levels
KNCV
MSF
MSF
JSI/DELIVER
KEMSA
JSI
WHO
Source: SSDS Inc for the World Bank
Gaps in meeting the target
2009: UN report notes that the 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.
No measurement = no action!
WHO: 9 indicators
1. Is access to essential medicines recognised as part of the fulfillment of the right to health?
135 constitutions recognise the right to health; 5 recognise access to medicines as part of that right
WHO: 9 indicators
2. Is there a published and regularly updated national medicines policy?
71% of countries have a policy; only 48% of developing countries have updated in the past 5 years
WHO: 9 indicators
3. Is there a published and regularly updated national list of essential medicines?
95% of countries have a policy and 86% of these have been updated in the past 5 years
WHO: 9 indicators
4. Are there legal provisions to allow/encourage generic substitution in the private sector?
72% of developing countries have legal provisions
WHO: 9 indicators
5. What is the level of public and private per capita expenditure on medicines?
Ranges from US$0.04 to $187 among developing countries
WHO: 9 indicators
6. What percentage of population is covered by health insurance?
2.8% of population in low income countries covered
WHO: 9 indicators
7. What is the average availability of 30 selected essential medicines in public and private health facilities?
In 27 developing countries, average public sector availability is 35%; private sector was 63%
WHO: 9 indicators
8. What is the median consumer price ratio of 30 selected essential medicines in public and private health facilities?
In 33 developing countries, lowest price generics cost more than 6 times international reference prices IIRPs) in the private sector; public sector procurement prices average 40% above the IPRs for generics.
WHO: 9 indicators
9. What is the margin or mark-up (in per cent) between producer and consumer price?
Limited data available, but mark ups can more than double prices in the private sector in some countries
Moving to solutions
More use of generics? – UN report says adopt generic substitution, enhance production of generics, and encourage companies to use differential pricing to reduce prices where there are no generics
Moving to solutions - 2
Changing the way innovation is rewarded: UNITAID’s patent pool concept; Public interest companies; advance purchase commitments
Moving to solutions -3 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
Moving to solutions - 4
Improving governance, transparency and accountability: WHO’s Good Governance for Medicines programme; civil society monitoring of prices, availability, quality; industry support for quality improvements; governments publishing what they pay/recieve
Moving to solutions - 5
Working in partnership: What are the roles for government, the private sector, the international agencies, and civil society to work together to improve access?
More information http://healthexchangenews.com http://www.who.int/medicines/en/ www.haiweb.org http://www.ghwatch.org/ www.MedicinesTransparency.org http://www.unitaid.eu/en/Patent-pool-
resources.html http://mdgs.un.org/unsd/mdg/
Resources/Static/Products/Progress2009/MDG_Report_2009_En.pdf