INCREASING ACCESS TO MEDICINES EDITH ANDREWS ANNAN MeTA CSO Meeting 16 th  April 2009
Background  <ul><li>Globally one third of the world’s population lack access to essential medicines (WHO) </li></ul><ul><l...
Background <ul><li>60% of population have access to primary healthcare  and therefore essential medicines </li></ul><ul><l...
Essential Medicines: The Criteria <ul><ul><li>Satisfy priority health needs of a population </li></ul></ul><ul><ul><li>Rea...
Access to essential medicines is fundamental to human rights <ul><li>The enjoyment of the highest attainable standard of h...
Access <ul><li>Essential medicines are intended to be  available  within the contest of functioning healthcare systems at ...
THE FOUR ‘A’S FOR ACCESS <ul><li>Availability  </li></ul><ul><li>Accessibility </li></ul><ul><li>Acceptability  </li></ul>...
Access in Poor Countries: The Hurdles  <ul><ul><li>Lack of health infrastructure </li></ul></ul><ul><ul><li>Lack of educat...
Increasing access to essential medicines:  WHO framework for collective action 1.  Rational selection 4.  Reliable health ...
WHO’s Access Framework <ul><li>Access to essential medicines depends on:  </li></ul><ul><li>1) Rational selection and use ...
Ghana Governments attempts at improving access <ul><li>Free and comprehensive medical care including medicines till 1971 <...
Key Barriers in country to access to medicines <ul><li>Limited financial access as a result of a weak exemption policy and...
Key Barriers in country to access to medicines  <ul><li>Lack of cooperation for pooled procurement (economics of scale) </...
Critical Analysis of Barriers to Access   <ul><li>Rational Selection </li></ul><ul><li>Reduced number of medicines will </...
Critical Analysis of Barriers to Access   <ul><li>Affordability of Medicines </li></ul><ul><ul><li>Lack of systematic appr...
Critical Analysis of Barriers to Access   <ul><li>Reliable Supply systems: Import or Manufacture locally </li></ul><ul><ul...
Critical Analysis of Barriers to Access   <ul><li>Reliable supply systems </li></ul><ul><ul><li>Partnerships/collaboration...
Public/Private Partnerships <ul><li>Establishment of public/private collaboration </li></ul><ul><ul><li>Networks </li></ul...
Medicines Transparency Alliance/Good Governance for Medicines <ul><li>To build  transparency  and  accountability  </li></...
Conclusion <ul><li>MeTA Strategy </li></ul><ul><ul><li>Advocacy </li></ul></ul><ul><ul><li>Partnerships </li></ul></ul><ul...
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Increasing access to medicines

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Increasing access to medicines, presentation by Edith Andrews Annan of World Health Organization (WHO) during the MeTA Ghana, CSO & media orientation workshop, 16 April 2009.

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  • World Health Organization June 9, 2009
  • Increasing access to medicines

    1. 1. INCREASING ACCESS TO MEDICINES EDITH ANDREWS ANNAN MeTA CSO Meeting 16 th April 2009
    2. 2. Background <ul><li>Globally one third of the world’s population lack access to essential medicines (WHO) </li></ul><ul><li>50% of the people who lack regular access live in Africa and Asia (WHO) </li></ul><ul><li>In Ghana it is estimated that 0-49% of population have access to Essential Medicines (HDR) » 0-31% lack access to EM </li></ul><ul><li>It is estimated that 70-80% of health costs are from medicines in developing countries </li></ul>
    3. 3. Background <ul><li>60% of population have access to primary healthcare and therefore essential medicines </li></ul><ul><li>Tracer drug availability at HF estimated at 85% </li></ul><ul><li>92% of all outpatients received all drugs prescribed for them at the HF (Current WHO sponsored survey of the pharmaceutical sector) </li></ul><ul><li>In Ghana it costs on average 1.18 days’ wages to treat pneumonia in adults and 1.45 for children (WHO sponsored survey ) </li></ul><ul><li>Over 70% of the population rely on TRM </li></ul>
    4. 4. Essential Medicines: The Criteria <ul><ul><li>Satisfy priority health needs of a population </li></ul></ul><ul><ul><li>Readily available within the health system </li></ul></ul><ul><ul><ul><li>Delivery infrastructure including providers </li></ul></ul></ul><ul><ul><li>Price-Performance Ratio </li></ul></ul><ul><ul><ul><li>Affordable, Cost-Effective (for poor nations) </li></ul></ul></ul>
    5. 5. Access to essential medicines is fundamental to human rights <ul><li>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 </li></ul><ul><li>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 </li></ul><ul><li>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 </li></ul><ul><li>Access to goods and services include the provision of essential medicines necessary for the prevention and treatment of diseases </li></ul>
    6. 6. Access <ul><li>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. </li></ul><ul><li>Access to essential Medicines of assured quality is one of the key indicators of equity and social justice (Dr. Brundtland 2000) </li></ul>
    7. 7. THE FOUR ‘A’S FOR ACCESS <ul><li>Availability </li></ul><ul><li>Accessibility </li></ul><ul><li>Acceptability </li></ul><ul><li>Affordability </li></ul>Let’s focus on the affordability of drugs because the principal barrier to access is the price of medicines!
    8. 8. Access in Poor Countries: The Hurdles <ul><ul><li>Lack of health infrastructure </li></ul></ul><ul><ul><li>Lack of education </li></ul></ul><ul><ul><ul><li>Provider and patient </li></ul></ul></ul><ul><ul><li>High import tariffs </li></ul></ul><ul><ul><li>High cost of drugs </li></ul></ul><ul><ul><li>… </li></ul></ul>
    9. 9. 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
    10. 10. WHO’s Access Framework <ul><li>Access to essential medicines depends on: </li></ul><ul><li>1) Rational selection and use of medicines based on National EML and STGs </li></ul><ul><li>2) Sustainable adequate financing through equitable funding mechanisms such as government revenues or social health insurance </li></ul><ul><li>3) Affordable prices for governments, healthcare providers and consumers </li></ul><ul><li>4) Reliable health and supply systems incorporating a mix of public and private supply systems. </li></ul>
    11. 11. Ghana Governments attempts at improving access <ul><li>Free and comprehensive medical care including medicines till 1971 </li></ul><ul><li>Introduction of user fees – Bamako Initiative 1985 </li></ul><ul><ul><ul><li>Revolving Drug Funds </li></ul></ul></ul><ul><ul><ul><li>Out of pocket payment for services including medicines (Cash and Carry) </li></ul></ul></ul><ul><li>Exemptions </li></ul><ul><ul><ul><li>Paupers </li></ul></ul></ul><ul><ul><ul><li>Elderly </li></ul></ul></ul><ul><ul><ul><li>U5 </li></ul></ul></ul><ul><ul><ul><li>Pregnant women </li></ul></ul></ul><ul><li>National Health Insurance Scheme </li></ul><ul><li>Expansion of CHPS zones </li></ul>
    12. 12. Key Barriers in country to access to medicines <ul><li>Limited financial access as a result of a weak exemption policy and absence of drug pricing policy </li></ul><ul><li>Absence of differential pricing policies on drugs other than for ARVs </li></ul><ul><li>System of taxes, tariffs and mark-ups </li></ul><ul><li>Limited capacity for local production (human and technology) to benefit from compulsory licensing </li></ul>
    13. 13. Key Barriers in country to access to medicines <ul><li>Lack of cooperation for pooled procurement (economics of scale) </li></ul><ul><li>Limited use of TRIPS flexibilities and public health safeguards </li></ul><ul><li>Limited parallel importation due to contradictory policies and laws governing its permissibility as well as administrative obstacles </li></ul>
    14. 14. Critical Analysis of Barriers to Access <ul><li>Rational Selection </li></ul><ul><li>Reduced number of medicines will </li></ul><ul><ul><li>Bring down purchase cost </li></ul></ul><ul><ul><li>Reduce cost of transactions </li></ul></ul><ul><ul><li>Reduce storage cost </li></ul></ul><ul><ul><li>Improve logistics </li></ul></ul><ul><ul><li>Improve information about rational use </li></ul></ul>
    15. 15. Critical Analysis of Barriers to Access <ul><li>Affordability of Medicines </li></ul><ul><ul><li>Lack of systematic approach to drug pricing in both public and private sectors </li></ul></ul><ul><ul><li>Taxes and high mark ups in public and private sectors </li></ul></ul><ul><ul><li>Lack of consistency in drug policy and financing mechanisms </li></ul></ul><ul><ul><li>Weak controls leading to implementation/compliance to policy and guidelines </li></ul></ul>
    16. 16. Critical Analysis of Barriers to Access <ul><li>Reliable Supply systems: Import or Manufacture locally </li></ul><ul><ul><li>Explore potential/opportunities/barriers to local manufacture, technology transfer or international importation </li></ul></ul><ul><ul><li>Develop system to harmonize procurement at sub-regional level </li></ul></ul><ul><ul><li>Analysis of barriers/opportunities for bulk procurement in the sub-region as practiced in the Francophone west African countries </li></ul></ul><ul><ul><li>Effective use of TRIPS flexibilities </li></ul></ul><ul><ul><li>Identify opportunities for differential pricing </li></ul></ul><ul><ul><li>Advocacy for removal/reduction of taxes and tariffs </li></ul></ul>
    17. 17. Critical Analysis of Barriers to Access <ul><li>Reliable supply systems </li></ul><ul><ul><li>Partnerships/collaboration with private for profit and private not for profit </li></ul></ul><ul><ul><li>Strengthen drug supply management capacity (LMIS in all regions and districts) </li></ul></ul><ul><ul><li>Strengthen CHPS to improve geographical access </li></ul></ul><ul><ul><li>Supervise and monitor supply chain </li></ul></ul><ul><li>Sustainable financing mechanism & affordable Prices </li></ul><ul><ul><li>Review of application of taxes and tariffs </li></ul></ul><ul><ul><li>Develop National pricing policy </li></ul></ul><ul><ul><li>Develop Procurement code, providing guidelines and standards for good practice both in public and private </li></ul></ul><ul><ul><li>National Health Insurance </li></ul></ul>
    18. 18. Public/Private Partnerships <ul><li>Establishment of public/private collaboration </li></ul><ul><ul><li>Networks </li></ul></ul><ul><ul><li>Partnerships </li></ul></ul><ul><ul><li>Private sector: for profit and not-for profit </li></ul></ul><ul><li>Public sector </li></ul><ul><ul><li>International organizations </li></ul></ul><ul><ul><li>Development partners </li></ul></ul><ul><ul><li>Government </li></ul></ul><ul><ul><li>academia </li></ul></ul>
    19. 19. Medicines Transparency Alliance/Good Governance for Medicines <ul><li>To build transparency and accountability </li></ul><ul><li>To increase access to quality medicines </li></ul><ul><li>To tackle … corruption and mismanagement </li></ul><ul><li>To work with all stakeholders – public, private and non-governmental </li></ul><ul><li>To proactively engage civil society and the private sector . </li></ul>
    20. 20. Conclusion <ul><li>MeTA Strategy </li></ul><ul><ul><li>Advocacy </li></ul></ul><ul><ul><li>Partnerships </li></ul></ul><ul><ul><li>Training and </li></ul></ul><ul><ul><li>Research </li></ul></ul>

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