improving access to medicines

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Dear Madam Kunda,

Hope you are keeping well, nice conclusion, from my end, essential medicines should be accessible at any cost and circumstances to patients, since it is basic human rights to which nations are agreed.

I would like to emphasize more on Public Awareness Programme, where you covered it under factor #02 (Rational Use). The Public Health authorities should allocate budget, human resources to it specifically, since it is imperative to have strong public awareness campaign.

From my understanding and know-how, most of the people even the physicians, nurses and health workers don’t know the definition of the Essential Medicine, ultimately it is beyond of the understanding of local people who are living in remote areas. This why, it is crucial the Government and Civil Societies should advocate it.

Affordable Prices: I do agree with your points that the prices should be affordable to everyone since if all diverse types of health dissimilarities that have been documented, such as male, female, urban, rural, employed, unemployed, or the variations in health across ethnic groups, the largest health breach is among the rich and the poor.

Therefore; it is imperative to have pro-poor pricing strategy for Essential Medicine and these prices should be regularly controlled by the regulatory authorities and Monitoring Teams. And from other angle the high cost of medicine is putting increasing pressure on health care budgets too, which is directly affecting the patients by indirect way.

Adding to the point # 5 (Reliable supply system). The Government should shun from the very complex bureaucratic and antiquated procedures, which always causing headache to the suppliers. As a result of these complex procedures the essential medicines may not be available when patients need them in the right time.

Erroneous medical diagnosis and prescriptions is also the most central factor keeping the patients to have access to essential medicines. Determining rational use involves ensuring that prescription is according to the diagnosis or appropriate for patient’s clinical needs and requirements or not.

Drug Procurement Process and Inventory Management: an uncomplicated, transparent and coordinated drug procurement process can make considerable benefits for a country both in dropping costs and improving access to medicines. For the public health bodies, the focus should be on centralizing purchases, abridge process and increasing transparency and accountability in the procurement. Inventory management could also advances the overall service levels and trim down costs of medicines.

Impose controls on demand for drugs: It includes setting treatment protocols, monitoring and evaluation and establishment of therapy guidelines and procedures. This system will also help control demand for prescriptions by determining real need for medicine.

For the kind information of NETRUM colleagues I have copied a report from WHO website:

December 2008 | GENEVA -- An alarming lack of availability of essential medicines in the public sector drives patients to pay higher prices in the private sector or go without, according to a WHO study reported in today’s online edition of The Lancet. The results confirm that governments must do more to improve access to essential medicines as part of their efforts to make national health systems more efficient and equitable.

The study analyzed data from surveys in 36 countries from all WHO geographical regions and World Bank income groups. Results show an average public-sector availability of only 38% across surveys. This forces patients to buy medicines from the private sector where treatments are more expensive and frequently unaffordable. In Africa, for example, the lowest-paid government worker needs to spend two days' salary each month to purchase diabetes treatment using the lowest-priced generic medicine. When the originator brand is used, costs escalate to over eight days' wages.

“You should not have to choose between buying medication for an ailing parent or buying food for your children,” said Carissa Etienne, WHO Assistant Director-General of Health Systems and Services. “It is not fair or necessary. That is why we are calling again for comprehensive primary health care, so that health systems in every country put the real health needs of people and communities first, and families are not impoverished or bankrupted because of health care payments.”

On the pricing side, the study revealed that “cuts” taken by wholesalers, distributors and retailers plus government taxes and duties are driving prices beyond affordability in many countries. In some countries, add-on costs can double the public-sector price of medicine, while in the private sector, wholesale mark-ups ranged from 2% to 380%, and retail mark-ups ranged from 10% to 552%.

“Essentially, multi-layered supply chain costs add up to one thing for patients, no access to essential medicines,” said Dr Laing of the Essential Medicines and Pharmaceutical Policies department at WHO. “When you pull apart the layers of additional charges, the potential solutions for governments to make life-saving medicines more available and accessible are clear – improve financing and distribution efficiency, promote the use of generic products and control supply chain costs by limiting mark-ups and removing duties and taxes.”

The study further asserts that these actions should all be part of national medicine policies that are measured and evaluated against predetermined benchmarks at least every two years, with routine monitoring and reporting more frequently.

The results cover 15 medicines included in at least 80% of surveys, as well as four specific medicines used to treat asthma, diabetes, hypertension and acute infections. The figures are adjusted to account for differences in buying power of local currencies and then compared to international reference prices, allowing for cross-country comparison.

The work is part of an ongoing joint effort between WHO and Health Action International (HAI) to highlight and improve availability and affordability of essential medicines, especially in low- and middle-income countries.

Best Regards

Dr. Mohammad Bashaar

Kabul, Afghanistan

From: kunda gharpure <gharpurekunda@...>Subject: improving access to medicinesnetrum Date: Tuesday, December 16, 2008, 7:10 AM

Hello,

On the last day I would like to suggest few solutions to problems of accessibility as seen in actual practice.

When we take into consideration the factors responsible for accessibility, one by one, we can also come to apt solutions to each of them. These are some of the solutions from my point of view. 1. Rational selection – this takes into consideration the selection of EML at the national level and should percolate down to the primary level where the local needs should be the selection criteria.Once the EML is prepared it should be the responsibility of all players to see that they are available to everyone irrespective of the economic status, or state boundaries. 2. Rational use –this involves the user who should be informed by the manufacturer, the prescriber and the dispenser. Rational use will entail expenditure on medicines only where it is essential. Unnecessary expenditure on nutritional supplements tonics life style drugs can be checked. Patient education is the key factor here. 3. Affordable price – Role of NPPA and the implementing authority cannot be overlooked. They play a very significant role in making medicines accessible when medicine price has to be paid out of pocket..All medicines in EML should be under price control along with monitoring of same therapeutic class medicines .Remember Disprin Plus ? 4. Responsive health system- The manufacturers, the physicians the pharmacists, the nursing staff, and the policy makers are all equally responsible for medicine accessibility. Uniform policies, proper implementation, ethical practicing will all together lead to better accessibility. The health system will not only be responsible but responsive to the patient sufferings.Health system is for improving health of the individual, so feel the sufferings and dont alienate yourself from the pain. 5. Reliable supply system- Reliable supply takes into consideration the non stop supply as well as good quality. The supply system also pre-supposes good manufacturing practice by the pharma. Industry.Factors of proper storage conditions and , transport are a part of the supply system. 6. Sustainable financing-.At the national level, the provision of medicines in the public sector is utterly important, backed by continuous flow of funds to maintain adequate medicine supply. any more additons are welcome. kunda

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