South African’s rallying cry of “Getting medicines to the people” is echoed by governments and development agencies throughout the world, although strategies and circumstances vary. This Monitor looks at some current issues and debates around access to medicines. It describes programmes in Africa, Asia and Latin America. And it also reports on a thought-provoking World Health Assembly, WHO’s “roundtable process” with civil society, and progress with drug donations.

A report from India describes how a state-level approach to rational drug use - through a unique partnership of committed local government, an NGO and WHO - has so improved access to essential medicines through better drug selection, management and use that it is being replicated in other parts of the country. The article highlights how transparency and concrete results overcame initial opposition to the process.

South Africa describes the meticulous development of its essential drugs list and treatment guidelines using evidence-based data and sound public health principles to steer the process.

In Latin America, participants at Argentina’s congress on rational use of medicines commit to a multifaceted approach that includes professional and consumer training, tougher regulation and strengthened drug management. Meanwhile in Brazil a national drug policy based on essential drugs, rational drug use and generics is launched.

At the international level WHO Director-General Gro Harlem Brundtland reported to the 52nd World Health Assembly on health gains and new threats to public health. She stressed the need for WHO to establish more effective partnerships with other key players. Nobel prize-winner Amartya Sen’s riveting keynote address reminded delegates that economic growth does not lead to better health unless income is also used to expand public services and reduce the burden of poverty. Using country examples he showed how major health achievements can be made, even in poor countries, by using resources in a socially productive way. Nothing is as important as informed public discussion and public participation in pressing for changes that can protect lives, he concluded.

Such discussion and participation are very apparent in the debate centring around the impact of international trade agreements on public health and access to drugs reported on pages 15-18. Governments, UN agencies and international coalitions of NGOs are placing these issues high on their agenda, with a particular focus on the needs of developing countries.

South Africa’s Department of Health has issued posters promoting the use of essential drugs and standard treatment guidelines