Health Exchange: Access to medicines April 2010

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?


Illustration: TI Global corruption report 2006

Up to 30% of medicines on the market in developing countries could be counterfeit or substandard.


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.


Stock-outs: when health facilities have a shortage of one or more essential medicines

Photo credit: Nora Marshall


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


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


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

Health Exchange: Access to medicines April 2010

Health & Medicine

Transcript of Health Exchange: Access to medicines April 2010