Access to Essential Medicines selection, affordability, financing, supply systems Marthe M Everard Policy, Access, and Rational Use (PAR) Essential Drugs.

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Access to Essential Medicines selection, affordability, financing, supply systems Marthe M Everard Policy, Access, and Rational Use (PAR) Essential Drugs and Medicines Policy (EDM) World Health Organization

2 WHO Access.ppt (2-Oct-14) Opportunities InequitiesInequities Access to essential medicines: staggering inequities - unparalleled opportunities

3 WHO Access.ppt (2-Oct-14) Economic inequity Economic inequity - percent of population below the poverty line has changed little in 2 decades Inequities Source: WHO/HFA (1997)

4 WHO Access.ppt (2-Oct-14) Health status inequity Health status inequity - infant mortality still varies 10-fold among regions of the world Source: WHO/HFA (1997) Inequities

5 WHO Access.ppt (2-Oct-14) Based on average worldwide price and national per capita income. Source: WHO/EDM Affordability inequity Affordability inequity - number of working hours to pay full treatment course Inequities

6 WHO Access.ppt (2-Oct-14) Source: Azerbaijan - UNICEF-Bamako Technical Report No. 35 ; Bangladesh National Accounts 1996/97 Mali (1986) - Diarra K and Coulibaly S. Financing of recurrent health costs in Mali. Health Policy and planning; 1990, 5(2); Medicines are the largest health expenditure for poor households Financing inequity Financing inequity - the burden falls heaviest on those least able to pay Inequity in health and pharmaceutical financing: ä äHigh income countries: % publicly funded ä äLow/middle income countries: % out-of-pocket Inequities

7 WHO Access.ppt (2-Oct-14) R&D inequity R&D inequity - expenditures grow, new medicines are launched, few specific for tropical diseases New chemical entities launched (number) R&D expenditure (US$ billions - top companies) Between 1975 and ä ä 1,223 new compounds launched ä ä only 11 for tropical diseases Sources: D. Gannaway and PriceWaterhouseCoopers (1999) R&D, NCE data; P. Trouiller et al (1999) tropical research data Inequities

8 WHO Access.ppt (2-Oct-14) Inequities Pharmacists per one million population Europe, N. America (150 to 940 per million) Asia (10 to 70 per million) Africa (1 to 30 per million) Pharmaceutical care inequity Pharmaceutical care inequity - a 100-fold variation in pharmacists per million population Source: WHO/HST/GSP/94.1 (1994)

9 WHO Access.ppt (2-Oct-14) Access inequity Access inequity - financing, delivery, and other constraints still limit access to essential medicines 1/3 of world’s population lacks regular access 320 million in Africa have <50% Problem worsens with economic pressures Source: WHO/DAP (1998) Percentage of population with regular access to essential medicines (1997) 1 = <50% (36) 2 = 50-80% (68) 3 = 80-95% (33) 4 = >95% (41) 5 = No data available (1) Inequities

10 WHO Access.ppt (2-Oct-14) OpportunitiesOpportunities Inequities Access to essential medicines: staggering inequities - unparalleled opportunities

11 WHO Access.ppt (2-Oct-14) Ensuring access to essential medicines - framework for collective action 1. Rational selection 4. Reliable health and supply systems 2. Affordable prices 3. Sustainable financing ACCESS 1. Rational selection and use 4. Reliable health and supply systems 2. Affordable prices 3. Sustainable financing ACCESS

12 WHO Access.ppt (2-Oct-14) Rational selection - define what is most needed The essential medicines concept is nearly universal: 146 countries have national list of essential medicines Key actions: ä develop evidence-based treatment guidelines ä define essential medicines list based on treatment guidelines ä regularly update guidelines based on best evidence ä use list for supply, reimbursement, training, etc.

13 WHO Access.ppt (2-Oct-14) The WHO Model List of Essential Medicines is a model process, model product and public health tool The WHO Essential Medicines Library WHO Model List Summary of clinical guidelines Reasons for inclusion Systematic reviews Key references WHO Model Formulary Cost: - per unit - per treatment - per month - per case prevented Quality information: - Basic quality tests - Intern. Pharmacopoeia - Reference standards Clinical guidelines BNF WHO clusters MSH UNICEF MSF WHO/QSM WHO/PAR WHO/EC, Cochrane Statistics: - ATC - DDD WCCs Oslo/Uppsala

14 WHO Access.ppt (2-Oct-14) Affordable prices - competition lowers prices Key actions: ä price information ä generics policies ä reduce duties, taxes, mark-ups ä differential pricing of newer essential medicines ä apply WTO/TRIPS safeguards as appropriate

15 WHO Access.ppt (2-Oct-14) UN Drug Access Initiative Domestic production Accelerated access initiative Generic offers Advocacy, corporate responsiveness, & competition have reduced prices 95% in 3 years ?? Selection Affordability Financing Health systems

16 WHO Access.ppt (2-Oct-14) Sustainable financing - contain financial costs of ill-health & increase sustainable funding In over 38 countries public drug expenditures are < US$2 per capita - inadequate by most estimates Key actions: n increase public funding for cost-effective medicines n expand drug benefits in health insurance n better use of out-of-pocket spending n seek external funding for the poorest populations

17 WHO Access.ppt (2-Oct-14) Drug benefits in public health insurance - access and risk-sharing Medicines covered by public health insurance Selection Affordability Financing Health systems

18 WHO Access.ppt (2-Oct-14) Reliable health and supply systems - ensure quality and availability Key actions: ä integrate supply management into health system development ä develop efficient mix of public - private - NGO systems ä assure drug quality throughout distribution channels ä promote rational use of medicines

19 WHO Access.ppt (2-Oct-14) Reliable health and supply systems - successful examples exist in all regions Direct delivery system - privatized, decentralized Primary distributor system - privatized, centralized Autonomous medical stores - partly private, centralized Selection Affordability Financing Health systems

20 WHO Access.ppt (2-Oct-14) Unparalleled opportunities exist - to build on local successes to expand access for those in need Unparalleled opportunities exist - to build on local successes to expand access for those in need Staggering inequities exist - in income, health status, R&D, pharmaceutical care, and access Staggering inequities exist - in income, health status, R&D, pharmaceutical care, and access Conclusion 1. Rational selection & use 4. Reliable health systems 2. Affordable prices 3. Sustainable financing ACCESS

Department of Essential Drugs and Medicines Policy Thank you