1. THE CHALLENGES & OPORTUNITIES OF ACCESS TO MEDICINES IN AFRICA Dr Pascoal MOCUMBI, orig Mozambique,High Representative EDCTP ABRASCO/WFPHA

2. Access to essential drugs is increasing - yet too many people still lack access

3. INEQUITABLE ACCESS About 30% of worlds population lacks regular access to essential medicines Over 50% are in poorest parts of Africa & Asia In low and middle income 50% -90% of medicines are paid for by patients themselves, whereas in many high- income countries 70% are publicly funded

4. Africas Problems Poverty Heavy disease burden Poor and inadequate infrastructure Lack of capacity to R&D medicines

5. OPPORTUNITIES AU/NEPAD Strategy to accelerate Africas self-sustained growth and promote long-term sustainable human development + health systems development Innovative knowledge based partnerships to accelerate development of new medicines/technologies for poverty related diseases, such as, AMANET, EDCTP, The Global HIV Vaccine Enterprise, DNDI,etc Positive Results in some countries – adoption and implementation of strategies for securing access to medicines and technologies

6. Strategy For Securing Access To Essential Drugs Assessment & development – therapeutic access Affordability – financial access Availability – supply access

7. Drug financing alternatives Public financing Out-of-pocket spending Health insurance Donor financing Development loans

8. Meeting drug financing challenges Improving health services public financing Reducing out-of-pocket purchases Improving health insurance Making ODA and loans sustainable, through investment in sustainable drug services

9. Managing drug prices Generic drugs: competition + quality; professional & public acceptance Patented new drugs: containing prices while promoting innovation; exploring price reduction for countries most in need All drugs: increasing financial resources; reducing mark ups

10. Supply to public health facilities Central medical stores (CMS) Autonomous medical stores = privatised CMS Primary distributor system: centralised, privatised Direct delivery system: decentralised, private Fully private

11. Private Sector Supply Systems Driven by profit Mainly urban based for profit wholesalers and retail pharmacies A number of not-for-profit generic wholesale agencies: e.g. UNICEF, IDA,… Funding: mainly out-of-pocket expenses Affordability is a major challenge

12. Future Challenges: optimising public/private mix Public sector: financing supply system; appropriate supply systems; health sector reforms:\improving efficiency and reducing waste e.g. decentralization Private sector: geographic coverage in low income countries; affordability/costs and local production

13. CONCLUSIONS Governments role is crucial Strategies with proved success must be used effectively Creativity is needed, especially for managing prices and improving supply systems An optimal public-private mix is needed for drug development, financing, and supply THANKS!