Millennium Development Goal 8. The Global Partnership for Development: Time to Deliver. MDG Gap Task Force Report 2011. United Nations, New York
(2011; 100 pages) [Arabic] [Chinese] [French] [Russian] [Spanish]

Abstract

Access to affordable essential medicines:

Having access to medicines is important for achieving the health-related MDGs and attending to the health needs of developing countries. However, essential medicines are available in only 42 per cent of facilities in the public sector compared to 64 per cent in the private sector. On top of poor availability, the lack of national regulatory capacity to ensure quality remains a problem in many countries, and thus populations remain vulnerable to low quality medicines. The availability of medicines to treat non-communicable diseases is even lower than that of communicable diseases. This is also a growing concern in low-income countries, where the burden of these diseases is rapidly increasing.

Insufficient access to medicines for children is another major area of concern. There is a need not only to increase the supply of paediatric formulations but to better facilitate their use by health-care staff.

The limited availability of essential medicines in the public sector is forcing patients to buy from the private sector, where medicines are more expensive. As the majority of medicine purchases in low- and middle-income countries are made out of pocket, the affordability of medicines is a key determinant of access. Substantial shares of the populations in many low- and middle-income countries can be impoverished by the costs of medicine purchases, particularly where originator brand products are used. Switching private sector purchases from originator brands to the lowest-priced generic equivalents can reduce expenditure by 60 per cent.

A number of steps have been taken to reduce costs and to increase the availability of essential medicines. These include UNITAID activities in fostering the expansion and decreasing the costs of paediatric AIDS treatment, while assuring their quality through the WHO prequalification programme; and the use by many developing-country Governments of public health-related flexibilities of the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), such as compulsory licences for domestic production or importation of patent-protected medicines. Recent initiatives have also been helpful, including that of the pharmaceutical industry’s having granted other research organizations access to “early stage” drug compounds, thus increasing the chances of a successful development of new products for neglected diseases, the development of innovative approaches to facilitate generic competition and the building of local capabilities.

Local production can offer an additional way in which to enhance the availability of medicines and can facilitate access to innovation, in particular through technology transfer arrangements. Developing local production capacity has been prioritized in several regional and subregional programmes in Africa, and has also been recognized as a priority at the national level, as in Botswana, Ghana, Kenya and the United Republic of Tanzania.

Making affordable essential medicines more accessible will require stronger and more complex measures at the local, national, regional and international levels, as well as greater collaboration between the public and private sectors. The present report recommends taking the following actions to increase the accessibility and affordability of essential medicines:

  • Assist national Governments in low- and middle-income countries in promoting the use of quality-assured, low-cost generic medicines, and in providing essential medicines at little or no cost to the poor through the public health system
  • Introduce programmes focused on essential medicines for non-communicable diseases as part of national medicine policies
  • Provide more donor funding for the treatment and prevention of noncommunicable diseases
  • Increase the use of public health-related TRIPS flexibilities and improve the availability of patent information in developing countries
  • Facilitate and encourage regional cooperation by developing countries to promote innovation among pharmaceutical manufacturers through, for instance, the Medicines Patent Pool.
 
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