Enhancing Equitable Access to Essential Medicines and Health Technologies

doi:10.1017/9781009211086.022

Chapter 21 - Enhancing Equitable Access to Essential Medicines and Health Technologies

from Section 2 - Transforming Health Systems: Confronting Challenges, Seizing Opportunities

Published online by Cambridge University Press: 08 December 2022

Veronika J. Wirtz and

Raffaella Ravinetto

Edited by

Sameen Siddiqi ,

Awad Mataria ,

Katherine D. Rouleau and

Meesha Iqbal

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Sameen Siddiqi: Affiliation:
Aga Khan University
Awad Mataria: Affiliation:
World Health Organization, Egypt
Katherine D. Rouleau: Affiliation:
University of Toronto
Meesha Iqbal: Affiliation:
UTHealth School of Public Health, Houston

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Summary

Pharmaceutical systems are a core part of health systems, and their failure to work adequately severely undermines the performance of the entire health system. The view that medicines are mere commodities managed for technical aspects by the national regulatory authority, disregards the role and need for a comprehensive and multidisciplinary system to ensure access to essential medicines. This has serious consequences, as it leaves key functions underfunded and under-represented in national and international platforms where decisions related to health care systems and for achievement of UHC are made. Key strategies to strengthen pharmaceutical systems have been extensively described, but their effective implementation requires political commitment, institutional oversight and adequate financial allocation to each function, including quality assurance, financing, supply and transparency among others. Assessing pharmaceutical systems is often neglected but essential for promoting an effective health system as well as population health. The Chapter presents some key performance measures that countries should routinely apply to measure and report on the performance of pharmaceutical systems and on their good governance.

Keywords

Medicines Pharmaceutical systems System performance Equity Governance Universal health coverage L&MIC

Information

Type: Chapter
Information: Making Health Systems Work in Low and Middle Income Countries
Textbook for Public Health Practitioners
, pp. 320 - 335

DOI: https://doi.org/10.1017/9781009211086.022 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2022

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References

Perehudoff, S. K., Alexandrov, N. V., Hogerzeil, H. V.. The right to health as the basis for universal health coverage: a cross-national analysis of national medicines policies of 71 countries. PLoS One 2019; 14(6): e0215577.Google Scholar

Hafner, T., Walkowiak, H., Lee, D., et al. Defining pharmaceutical systems strengthening: concepts to enable measurement. Health Policy Plan 2017; 32(4): 572–584.Google Scholar

Bigdeli, M., Peters, D. H., Wagner, A. K.. Medicines in health systems: advancing access, affordability and appropriate use. 2014. www.who.int/alliance-hpsr/resources/publications/9789241507622/en/ (accessed December 15, 2020).Google Scholar

Pisani, E., Nistor, A. L., Hasnida, A., et al. Identifying market risk for substandard and falsified medicines: an analytic framework based on qualitative research in China, Indonesia, Turkey and Romania. Wellcome Open Res 2019; 4: 70.Google Scholar

World Health Organization. Monitoring the components and predictors of access to medicines. 2019. www.who.int/medicines/areas/policy/monitoring/monitoring-the-components-of-access-to-medicines.pdf (accessed December 19, 2020).Google Scholar

Wirtz, V. J., Hogerzeil, H. V., Gray, A. L., et al. Essential medicines for universal health coverage. Lancet 2017; 389(10067): 403–476.Google Scholar

Torreele, E.. Business-as-usual will not deliver the COVID-19 vaccines we need. Development (Rome) 2020; 63: 191–199.Google Scholar

World Health Organization. The World Health Report: Health Systems Financing – the Path to Universal Coverage. Geneva, World Health Organization, 2010. https://apps.who.int/iris/handle/10665/44371 (accessed December 19, 2020).Google Scholar

Lu, Y., Hernandez, P., Abegunde, D., et al. The world medicines situation 2011: medicine expenditures. 2011. http://digicollection.org/hss/documents/s18767en/s18767en.pdf (accessed December 19, 2020).Google Scholar

World Health Organization, International Bank for Reconstruction and Development, World Bank. Global Monitoring Report on Financial Protection in Health 2019. Washington, DC, World Bank, 2019. www.who.int/healthinfo/universal_health_coverage/report/fp_gmr_2019.pdf?ua=1 (accessed December 19, 2020).Google Scholar

World Health Organization. Public spending on health: a closer look at global trends. 2018. www.who.int/publications/i/item/WHO-HIS-HGF-HFWorkingPaper-18.3 (accessed December 18, 2020).Google Scholar

Wagstaff, A., Flores, G., Hsu, J., et al. Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Glob Health 2018; 6(2): e169–e179.Google Scholar

Watkins, D. A., Jamison, D. T., Mills, A., et al. Universal health coverage and essential packages of care. 2018. www.ncbi.nlm.nih.gov/books/NBK525285/ (accessed December 19, 2020).Google Scholar

Sum, G., Hone, T., Atun, R., et al. Multimorbidity and out-of-pocket expenditure on medicines: a systematic review. BMJ Glob Health 2018; 3(1): e000505.Google Scholar

Thomson, S., Cylus, J., Evetovits, T.. Can people afford to pay for health care? New evidence on financial protection in Europe. Eurohealth 2019; 25(3): 41–46.Google Scholar

Luthra, S.. “Pharma bro” Shkreli is in prison, but Daraprim’s price is still high. 2018. https://khn.org/news/for-shame-pharma-bro-shkreli-is-in-prison-but-daraprims-price-is-still-high/ (accessed December 13, 2020).Google Scholar

World Health Organization. Multisource (Generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability, revision. 2014. www.who.int/medicines/areas/quality_safety/quality_assurance/guideline-be-revision_qas14-583rev1_15072014.pdf (accessed December 18, 2020).Google Scholar

Vawda, Y. A., Shozi, B.. Eighteen years after Doha: an analysis of the use of public health TRIPS flexibilities in Africa. 2020. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3559478 (accessed December 17, 2020).Google Scholar

Morgan, S. G., Vogler, S., Wagner, A. K.. Payers’ experiences with confidential pharmaceutical price discounts: a survey of public and statutory health systems in North America, Europe, and Australasia. Health Policy 2017; 121(4): 354–362.Google Scholar

Vogler, S., Paris, V., Panteli, D.. Ensuring access to medicines: how to redesign pricing, reimbursement and procurement? 2018. www.euro.who.int/__data/assets/pdf_file/0009/379710/PolicyBrief_AUSTRIA_PB30_web_13082018.pdf (accessed December 11, 2020).Google Scholar

Juneja, S., Gupta, A., Moon, S., et al. Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP). PLoS One 2017; 12(5): e0177770.CrossRef Google Scholar PubMed

United Nations. Sustainable Development Goals 3.b.3. 2020. https://unstats.un.org/sdgs/metadata/?Text=&Goal=3&Target=3.b (accessed December 11, 2020).Google Scholar

Tatay, M., Torreele, E.. Ensuring access to life-saving medicines as countries shift from Global Fund support. Bull World Health Organ 2019; 97(5): 311–311A.Google Scholar

World Health Organization. How pharmaceutical systems are organized in Asia and the Pacific. 2018. www.oecd-ilibrary.org/docserver/9789264291706-en.pdf?expires=1627889008&id=id&accname=guest&checksum=681DA63B02A99996497E034891549E24 (accessed December 18, 2020).Google Scholar

World Health Organization. Forty-eighth report of the WHO Expert Committee on specifications for pharmaceutical preparations. 2014. https://apps.who.int/iris/handle/10665/112733 (accessed December 19, 2020).Google Scholar

World Health Organization. WHO Guideline on Country Pharmaceutical Pricing Policies. Geneva, World Health Organization, 2020. www.who.int/publications/i/item/9789240011878 (accessed September 15, 2021).Google Scholar

World Health Organization. Interagency reproductive health kits for crisis situations. 2011. www.who.int/publications/i/item/inter-agency-reproductive-health-kits-for-crisis-situations (accessed December 12, 2020).Google Scholar

Fletcher, E. R., Health Policy Watch. World Health Assembly approves milestone resolution on price transparency. 2019. https://healthpolicy-watch.news/world-health-assembly-approves-milestone-resolution-on-price-transparency (accessed December 16, 2020).Google Scholar

Vogler, S., ed. Medicine Price Surveys, Analyses and Comparisons: Evidence and Methodology Guidance. New York, Academic Press, 2018.Google Scholar

Nurse-Findlay, S., Taylor, M., Savage, M., et al. Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: an evaluation from multi-country surveys and stakeholder interviews. PLoS Med 2017; 14(12): e1002473.Google Scholar

Ewen, M., Joosse, H.-J., Beran, D., et al. Insulin prices, availability and affordability in 13 low-income and middle-income countries. BMJ Glob Health 2019; 4: e001410.Google Scholar

Berterame, S., Erthal, J., Thomas, J., et al. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet 2016; 387: 1644–1656.Google Scholar

International Narcotics Control Board. The yellow list of narcotic drugs under international control. 2019. www.incb.org/incb/en/narcotic-drugs/Yellowlist_Forms/yellow-list.html (accessed September 20, 2020).Google Scholar

International Narcotics Control Board. The green list of psychotropic substances under international control. 2020. www.incb.org/incb/en/psychotropics/green-list.html (accessed December 18, 2020).Google Scholar

Ozawa, S., Higgins, C. R., Yemeke, T. T., et al. Importance of medicine quality in achieving universal health coverage. PLoS One 2020; 15(7): e0232966.Google Scholar

World Health Organization. Good regulatory practices: guidelines for national regulatory authorities for medical products. 2016. www.who.int/medicines/areas/quality_safety/quality_assurance/GoodRegulatory_PracticesPublicConsult.pdf (accessed December 17, 2020).Google Scholar

Newton, P. N., Amin, A. A., Bird, C., et al. The primacy of public health considerations in defining poor quality medicines. PLoS Med 2011; 8(12): e1001139.Google Scholar

Johnston, A., Holt, D. W.. Substandard drugs: a potential crisis for public health. Br J Clin Pharmacol 2014; 78(2): 218–243.Google Scholar

Newton, P. N., Bond, K. C.; Oxford Statement signatories. Global access to quality-assured medical products: the Oxford Statement and call to action. Lancet Glob Health 2019; 7(12): e1609–e1611.Google Scholar

World Health Organization. Substandard and falsified medical products. 2022. www.who.int/news-room/fact-sheets/detail/substandard-and-falsified-medical-products (accessed February 15, 2022).Google Scholar

Newton, P. N., Caillet, C., Guerin, P. J.. A link between poor quality antimalarials and malaria drug resistance? Expert Rev Anti Infect Ther 2016; 14(6): 531–533.Google Scholar

WHO. WHO expert committee on specifications for pharmaceutical preparations. 2016. www.who.int/medicines/publications/pharmprep/WHO_TRS_996_web.pdf (accessed December 19, 2020).Google Scholar

Uppsala Monitoring Centre. Making medicines safer for patients. 2020. www.who-umc.org (accessed December 10, 2020).Google Scholar

World Health Organization. WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Products. 2017. www.who.int/medicines/regulation/ssffc/publications/GSMSreport_EN.pdf?ua=1 (accessed December 18, 2020).Google Scholar

Ndomondo-Sigonda, M., Mahlangu, G., Agama-Anyetei, M., et al. A new approach to an old problem: overview of the East African Community’s Medicines Regulatory Harmonization initiative. PLoS Med 2020; 17(8): e1003099.Google Scholar

World Health Organization. World Health Organization prequalification. 2021. https://extranet.who.int/prequal/content/collaborative-registration-faster-registration (accessed January 20, 2021).Google Scholar

Laing, R., Hogerzeil, H., Ross-Degnan, D.. Ten recommendations to improve use of medicines in developing countries. Health Policy Plan 2001; 16(1): 13–20.Google Scholar

Gabarron, E., Oyeyemi, S. O., Wynn, R.. COVID-19-related misinformation on social media: a systematic review. Bull World Health Organ 2021; 99(6): 455–463A.Google Scholar

World Health Organization. Good governance for medicines: model framework, updated version 2014. 2014. https://apps.who.int/iris/handle/10665/129495 (accessed December 19, 2020).Google Scholar

Dimancesco., D. Pharmaceutical system transparency and accountability assessment tool. 2018. https://apps.who.int/iris/bitstream/handle/10665/275370/WHO-EMP-2018.04-eng.pdf?ua=1 (accessed December 19, 2020).Google Scholar

Wirtz, V. J., Mol, P. G., Verdijk, J., et al. Use of antibacterial fixed-dose combinations in the private sector in eight Latin American countries between 1999 and 2009. Trop Med Int Health 2013; 18(4): 416–425.CrossRef Google Scholar PubMed

World Health Organization. Good governance for medicines (GGM) overview. 2021. www.who.int/medicines/areas/policy/goodgovernance/en/ (accessed January 20, 2021).Google Scholar

Herlitz, A., Lederman, Z., Miller, J., et al. Just allocation of COVID-19 vaccines. BMJ Glob Health 2021; 6(2): e004812.Google Scholar

Perehudoff, K., ‘t Hoen, E., Boulet, P.. Overriding drug and medical technology patents for pandemic recovery: a legitimate move for high-income countries, too. BMJ Glob Health 2021; 6(4): e005518.Google Scholar

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