Access to medicines for all

I’ve spent the last few days at this year’s World Health Assembly in Geneva. It’s been quite an event. Simon Wright’s been calling it a global health ‘jamboree’. Health ministers, civil society representatives and others have been scrambling between scores of official sessions and side events. The Director General of the World Health Organization, Margaret Chan, has been making her trademark special appearances all over. As much as a global health conference can (so not much), this year’s WHA has had the atmosphere of a summer music festival somewhere out in the English countryside. And hottest topics, as far as I can tell, have been how to address the growing problem of drug resistance, working towards universal health coverage (UHC), ensuring women and children’s health and access to new medicines.

Last night, at a side event organised by the Chilean government, and featuring the Colombian, South African and New Zealand governments, along with WHO, the Pan American Health Organization, Médecins Sans Frontières and the Union for International Cancer Control, Save the Children launched a new briefing paper that tries to connect all of these dots. The paper argues that the best way to ensure equitable and sustainable access to medicines for all is to include them in well-regulated public health systems under the principles of UHC.

Usually when people talk about UHC, what they really mean is access to health services. But obviously good healthcare involves much more than just getting the services you need. Medicines and health technologies in particular play a critical role in all health systems and ensuring good outcomes.

And medicine costs affect the poor more than most. In many low- and middle-income countries, most of the money that poor households spend out of their own pockets on health is for medicines.

The consequences of having to paying for medicines out of pocket are no different from paying for services the same way. When you’re poor, you often have to make difficult and unfair decisions about how you spend your money. Having to pay for medicines when you need them leaves you with a number of bad and potentially overlapping choices and outcomes:

• You can’t buy the medicines at all and get more sick.
• You try to scrape together the money to pay but are pushed deeper into poverty as a result.
• You buy what you can, which could lead to drug resistance like in the case of antibiotics.
• You buy the cheapest alternative, which in many cases might be a substandard or poor quality product.

There are also other problems that result when medicines aren’t included in government-led systems of UHC. People and governments end up spending more money on health and spending it more inefficiently. And often, it leads to greater inappropriate and unsafe use of medicines, which increases problems such as anti-microbial resistance.

But as countries shift the burden of medicines costs from individuals to the government by reducing out of pocket costs, they’ll need to do so in smart ways that don’t overburden the poor and bankrupt the government health system. This means using progressive (paying more when you have more) mandatory prepayments such as tax, pooling the collected resources and allocating them based on public health needs and human rights obligations, while focusing on the most vulnerable and marginalised populations.

And in order to do all of this, governments will need use of all of the tools they have to ensure they purchase the lowest cost good-quality medicines they can. This could mean making sure that generic medicines are always used when available and that there is competition in medicines markets, and buying medicines in bulk with other countries and using legal tools like intellectual property flexibilities. Other countries and key stakeholders all need to make sure that they don’t undermine countries’ ability to use these tools.

Of course, none of this means that countries should or will be able to make everything available for free all at once. Not even the richest countries in the world can do that. And while most countries need to spend more on health, all of them will need to take into consideration the resources that they currently have available and make intelligent decisions in order to progressively increase the scope of medicines coverage within and as a part of health coverage as a whole. Save the Children believes that as a starting point all medicines on the WHO Model Essential Medicines List and those necessary for the continuum of care for reproductive maternal, newborn and child health should urgently be made available.

A great deal of energy has been expended in Geneva this week on trying to solve the world’s biggest health problems. And surely some strides have been made. But in some ways all of the activity boils down to just one immensely important question. Are countries prepared to demonstrate a real political commitment to ensure access to medicines for all and achieve UHC?