Increasing access to medicines

INCREASING ACCESS TO MEDICINES EDITH ANDREWS ANNAN MeTA CSO Meeting 16 th April 2009

Background
Globally one third of the world’s population lack access to essential medicines (WHO)
50% of the people who lack regular access live in Africa and Asia (WHO)
In Ghana it is estimated that 0-49% of population have access to Essential Medicines (HDR) » 0-31% lack access to EM
It is estimated that 70-80% of health costs are from medicines in developing countries

Background
60% of population have access to primary healthcare and therefore essential medicines
Tracer drug availability at HF estimated at 85%
92% of all outpatients received all drugs prescribed for them at the HF (Current WHO sponsored survey of the pharmaceutical sector)
In Ghana it costs on average 1.18 days’ wages to treat pneumonia in adults and 1.45 for children (WHO sponsored survey )
Over 70% of the population rely on TRM

Essential Medicines: The Criteria
Satisfy priority health needs of a population
Readily available within the health system
Delivery infrastructure including providers
Price-Performance Ratio
Affordable, Cost-Effective (for poor nations)

Access to essential medicines is fundamental to human rights
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition
Everyone has a right to a standard of living adequate for the health of himself and of his family, including food, clothing, housing and medical care and necessary social services
Government and the international community have an obligation to see the right to health progressively realized, which includes the responsibility for prevention, treatment and control of disease, and the creation of conditions to ensure access to health, facilities, goods and services
Access to goods and services include the provision of essential medicines necessary for the prevention and treatment of diseases

Access
Essential medicines are intended to be available within the contest 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.
Access to essential Medicines of assured quality is one of the key indicators of equity and social justice (Dr. Brundtland 2000)

THE FOUR ‘A’S FOR ACCESS
Availability
Accessibility
Acceptability
Affordability
Let’s focus on the affordability of drugs because the principal barrier to access is the price of medicines!

Access in Poor Countries: The Hurdles
Lack of health infrastructure
Lack of education
Provider and patient
High import tariffs
High cost of drugs
…

Increasing access to essential medicines: WHO framework for collective action 1. Rational selection 4. Reliable health and supply systems 2. Affordable prices 3. Sustainable financing ACCESS

WHO’s Access Framework
Access to essential medicines depends on:
1) Rational selection and use of medicines based on National EML and STGs
2) Sustainable adequate financing through equitable funding mechanisms such as government revenues or social health insurance
3) Affordable prices for governments, healthcare providers and consumers
4) Reliable health and supply systems incorporating a mix of public and private supply systems.

Ghana Governments attempts at improving access
Free and comprehensive medical care including medicines till 1971
Introduction of user fees – Bamako Initiative 1985
Revolving Drug Funds
Out of pocket payment for services including medicines (Cash and Carry)
Exemptions
Paupers
Elderly
U5
Pregnant women
National Health Insurance Scheme
Expansion of CHPS zones

Key Barriers in country to access to medicines
Limited financial access as a result of a weak exemption policy and absence of drug pricing policy
Absence of differential pricing policies on drugs other than for ARVs
System of taxes, tariffs and mark-ups
Limited capacity for local production (human and technology) to benefit from compulsory licensing

Key Barriers in country to access to medicines
Lack of cooperation for pooled procurement (economics of scale)
Limited use of TRIPS flexibilities and public health safeguards
Limited parallel importation due to contradictory policies and laws governing its permissibility as well as administrative obstacles

Critical Analysis of Barriers to Access
Rational Selection
Reduced number of medicines will
Bring down purchase cost
Reduce cost of transactions
Reduce storage cost
Improve logistics
Improve information about rational use

Affordability of Medicines
Lack of systematic approach to drug pricing in both public and private sectors
Taxes and high mark ups in public and private sectors
Lack of consistency in drug policy and financing mechanisms
Weak controls leading to implementation/compliance to policy and guidelines

Reliable Supply systems: Import or Manufacture locally
Explore potential/opportunities/barriers to local manufacture, technology transfer or international importation
Develop system to harmonize procurement at sub-regional level
Analysis of barriers/opportunities for bulk procurement in the sub-region as practiced in the Francophone west African countries
Effective use of TRIPS flexibilities
Identify opportunities for differential pricing
Advocacy for removal/reduction of taxes and tariffs

Reliable supply systems
Partnerships/collaboration with private for profit and private not for profit
Strengthen drug supply management capacity (LMIS in all regions and districts)
Strengthen CHPS to improve geographical access
Supervise and monitor supply chain
Sustainable financing mechanism & affordable Prices
Review of application of taxes and tariffs
Develop National pricing policy
Develop Procurement code, providing guidelines and standards for good practice both in public and private
National Health Insurance

Public/Private Partnerships
Establishment of public/private collaboration
Networks
Partnerships
Private sector: for profit and not-for profit
Public sector
International organizations
Development partners
Government
academia

Medicines Transparency Alliance/Good Governance for Medicines
To build transparency and accountability
To increase access to quality medicines
To tackle … corruption and mismanagement
To work with all stakeholders – public, private and non-governmental
To proactively engage civil society and the private sector .

Conclusion
MeTA Strategy
Advocacy
Partnerships
Training and
Research

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Increasing access to medicines

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