Stop the Stock-outs! Access to Essential Medicines for All Christa Cepuch BSc Phm Health Action International Africa RHS Coalition Meeting 27 May 2010, Kampala

What are Essential Medicines?  satisfy the priority health care needs of the population  selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost- effectiveness  intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford  implementation of the concept of essential medicines is intended to be flexible  exactly which medicines are regarded as essential remains a national responsibility

WHO: Availability of essential medicines Average availability was only 34.9% in the public sector and 63.2% in the private sector. Public sector availability of medicines is consistently lower than in the private sector.

Country-specific evidence: Kenya MMePA (monitoring of medicine prices and availability)

Barriers to Access  Health system capacity  Health budgets  Lack of research and development  Price  Patents  Quality of diagnosis  Accurate prescribing  Selection, distribution, dispensing of medicines  Medicine quality

WHO: Public expenditure on medicines There is wide variation in national per capita spending on medicines by the public sector, ranging from US $0.04 to $ among developing countries.

Availability of Artemether/lumefantrine 20/120 mg in Kenya Global Fund grant start date (02/2006) WHO / HAI Africa: Increased finances and differential pricing -- impact on availability

Using evidence for advocacy: Stop Stock-outs (SSO)!  Work with partners in different countries to engage the public on their Human Right to access essential medicines  KETAM, CIN, EPN, KEHPCA, AGHA, NAPHOFANU, HEPS, ZLP+, TLAC, MHEN, others

SSO campaign: context and structure  30 years after the introduction of the EM concept, there are simply not enough medicines on the pharmacy shelves.  Stock-outs are worst in rural areas, and harm poor people.  Stock-outs force people to purchase medicines from much higher suppliers in the private sector or -- more frequently -- simply to go without needed medicines.  The failure to properly stock public health pharmacies and clinics stems in part from economic constraints and bureaucratic obstacles. But above all, it is a failure of political will. If governments commit to get EMs on the shelves, they can do it.  CS teams in five countries (Malawi, Ke, Ug, Zam, Zim)  CS teams getting small grants to run their campaigns  Truly a networking effort

SSO campaign: demands The SSO campaign is calling on governments and health departments to end stock-outs now by: Giving financial and operational autonomy to the national medicines procurement and supply agency Allowing representation of civil society on the board of the national medicines procurement and supply agency Ending corruption in the medicine supply chain to stop theft and diversion of essential medicines (EMs) Providing a dedicated budget line for EMs Living up to commitments to spend 15% of national budgets on health care Providing EMs for free at all public health institutions

SSO continental campaign  Taking SSO issues to the regional and sub-regional levels (WHO AFRO, AU, EAC, SADC, etc)  Getting broad continental support for the UNITAID Patent Pool  Countering problematic counterfeit legislation  Highlighting specific medicines (CEPA, RH medicines …?)