Read by Dr Godfrey Walker representing WR, Thailand.

Distinguished participants, Dear Colleagues, Ladies and Gentlemen,

I have the honour to present greetings from Dr Uton Muchtar Rafei, Regional Director of the South-East Asia Regional Office of the World Health Organization, to the Ministry of Public Health, Thailand and the distinguished participants. The Regional Director would have liked to be in our midst today, as the subject of our deliberations is of importance to WHO. However, this could not be possible due to his unavoidable commitments. Under the circumstances, I have the honour to read his message on this occasion.

I quote: "I take this opportunity to welcome the initiative taken by the Drug Action Programme of WHO Headquarters, Geneva which enables us to convene this meeting of the WHO Working Group on Financing of Essential Drugs. I also welcome and extend my greetings to all of you. I am happy that such an important activity is taking place in our Region.

I wish to thank the Ministry of Public Health, the Royal Thai Government, for hosting this important meeting and the Technical Division of the Food and Drug Administration for making excellent arrangements.

The changing scenarios in development of national health systems necessitate a critical look at the respective roles of the public and private sectors in providing health care services. Based on the overall status of national health care needs and the capabilities of the public and private sectors in filling those needs, an appropriate public-private mix for the provision of essential drugs should now be put in place. This is a dynamic process which will depend on the overall socioeconomic development status of a country and will require continuous monitoring and evaluation of services rendered and the impact they have on the health of the people.

Privatization of health care is becoming a topical subject of discussion. Recent health plans put into operation in some countries of the South-East Asia Region have given importance to the role of the private sector in the delivery of health care. This is in the light of the observation that a centralized economic system does not necessarily result in providing equitable health services, thus further demonstrating the fact that public sector financing alone is not an ideal solution for the attainment of Health for All goal.

It is contended by the advocates of the private sector that the solution for establishing equity in health care lies in its privatization, including its related components such as drug supply and laboratory services. The idea that private health care and drug financing would lead to effective and efficient health care delivery for those who are able to pay for it is strongly highlighted. These, it is hoped, would pave the way for appropriate reallocation of Government resources for the underprivileged and underserved groups of people.

On the other hand, it is argued by the public sector advocates that privatization would lead to commercialization of services which would result in cost escalation due to undesirable prescriptions, unethical practices in dispensing of drugs, superfluous investigations and even unnecessary surgical procedures. Charging of commission for referral services without actually improving the quality of health care has also been cited. Collectively, these could be seen to have a negative impact on equity in health. A meeting point of these views needs to be identified, bringing together their useful aspects to ensure quality of health care.

In any drug financing scheme, it is important to ensure equity in availability of essential drugs. This can be promoted by redistribution of adequate resources from the public sector, or introduction of, or increase in user-fees within the context of revolving drug funds, community drug schemes and other similar mechanisms. Community cost-sharing of drugs can have provision for subsidizing quality drugs for the poor and needy. Donor financing and development loans can improve accessibility of essential drugs and vaccines to the target groups in both rural and urban communities.

In the South-East Asia Region, quality essential drugs and vaccines are indispensable tools in the prevention, control and treatment of diseases. It is important to ensure that they are readily available in sufficient quantities at the primary health care level as well as at other levels of health care at all times. In order to achieve this goal, it would be important to consider a drug financing strategy which is suitable and appropriate for each country. But, before instituting such a measure, optimum utilization of available financial resources must be ensured through judicious selection and quantification, proper procurement, efficient distribution and rational use of drugs.

In countries where the supply of essential drugs is adequate, the drug management cycle, which may consist of selection, procurement, distribution and use, must be maintained with parameters which lend support to its adequacy and sustainability. Similarly, priority should be given to improve the drug management cycle through regular monitoring, evaluation and remedial measures in countries where the supply of essential drugs is not adequate.

In undertaking any of the above measures, governments have a critical role to play in areas such as: policy making and regulation, advocacy, provision and dissemination of information, price control, distribution of sufficient amounts of quality drugs and related services.

The primary role of the Ministries of Health, depending upon the national set-up, will continue to be the architect of the national drug policy within the context of the overall health policy. It would be important to critically look at the state of development in the availability and accessibility of quality essential drugs against the needs of the consumers. The requirement of the public will have to be given priority over that of the interest groups. Furthermore, the complementary roles of the public and private sectors need to be strengthened and harmonized through realistic policy instruments such as incentives, regulation and other measures for a successful symbiotic relationship of the two sectors.

It is important that financing schemes now operating in some of the Member Countries should be evaluated so as to identify successful approaches to financing of essential drugs in the health care system and to facilitate their adaptation and application.

I am confident that this expert Working Group will measure up to the task at hand. I wish you every success in your deliberations and a fruitful meeting. I also wish you a pleasant stay in Nakhorn Ratchasima." Unquote.

I shall, of course, apprize the Regional Director of your deliberations and the outcome of the meeting. Before concluding, I would like to thank the Ministry of Public Health for giving me this opportunity to bring the Regional Director's message to this august gathering.

Thank you.