Access to affordable essential medicines:

Increasing access to affordable essential medicines is important to achieving the health-related MDGs. Yet, there has been little improvement in recent years in improving availability and affordability of essential medicines in developing countries. Only 51.8 per cent of public and 68.5 per cent of private health facilities in those countries are able to provide patients with essential medicines. Prices of available essential medicines tend to be the multiple of international reference prices. As a result, obtaining essential medicines, especially for treatment of chronic diseases, remains prohibitive for low-income families in developing countries. The problem is compounded when several family members suffer from illness at the same time. In such cases, treatment of common diseases with even the lowest-priced generics becomes impossible for many low-income households. Availability of originator brand medicines tends to be greater in private health facilities, but they are also priced substantially higher and therefore out of reach for the poor. Despite the global economic downturn, resources available for the provisioning of essential medicines through some disease-specific global health funds increased in 2011. New funding was pledged to the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunisation. Global initiatives such as these have been effective in the prevention and control of specific diseases. The challenges for these initiatives are to generate new and additional resources, rather than merely intermediating already committed ODA and private charitable contributions, and to align the diseasespecific interventions with broader national health programmes and policies of recipient countries. Various initiatives to improve access to essential medicines are being explored. Some efforts aim to reduce production and distribution costs of generic medicines through manufacturing in developing countries. Several developing countries have managed to produce medicines locally with the support of pharmaceutical companies and initiatives from developed and developing countries. In recent years, an increasing number of developing countries have successfully used the flexibilities provided in the World Trade Organization (WTO) Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS) to lower costs and increase access to essential medicines by facilitating local production or the importation of generic medicines. However, many countries have yet to amend their national laws to incorporate TRIPS flexibilities fully. Furthermore, an increasing number of bilateral and regional free trade agreements include intellectual property protection that exceeds the minimum standards required by the TRIPS Agreement, which may hamper the use of flexibilities. Quality is another key issue in access to essential medicines. Counterfeit as well as substandard pharmaceutical products can pose a very serious threat to health. However, resource constraints limit the capacity of regulatory authorities in developing countries to properly oversee the quality, safety and efficacy of medicines circulating in their markets.