In its Eighth Report on the State of World Health, the WHO dedicated a brief chapter to the «availability of essential drugs and vaccines» (OMS, 1993b, Vol. I, pp. 87-88). The Report points out that «the idea of a rational use of drugs is widely accepted»; that many developing countries have problems in purchasing drugs due to lack of foreign currency, and that these countries continue to adopt national pharmaceutical policies to rationalize the situation and coordinate foreign cooperation in this field. Meanwhile, Health Authorities in developed countries are concerned by the health and financial repercussions of overprescription, and try to change physician's prescribing habits and population habits regarding the use of drugs. The chapter concludes with a warning on the need to monitor the quality of vaccines used in developing countries. The section is not supported by any figures. In short, it is too limited and too vague.
However, the Report of the General Director of WHO to the 47th World Health Assembly, May 1994 (HELLING-BORDA, 1994), pointed out the need to examine five issues: a) availability of resources, since due to the economic crisis and adjustment programmes, public sector financing and households purchasing power have diminished; b) exaggerated privatization tendencies, prevalent in many developing and former socialist countries, which oblige to insist on the preservation of equity in terms of access to drugs; c) sustenability, at mid-term, of co-payment formula; d) need to train doctors, to educate consumers and to regulate drug promotion; e) need to coordinate more efficiently, and according to the needs of the recipient, the international aid by the various players in this field.
As it is usual, the Assembly adopted a number of resolutions to a) improve equitable access to essential drugs with good quality and at an affordable cost, and encourage their rational use; b) dedicate personnel and resources to strengthen national capacity for regulation, and boost manufacturers and governments cooperation in the achievement of goals in public health; c) approve the revision of Good Manufacturing Practices; d) strengthen the pharmacist role as responsible for quality, objective information and rational use; e) regulate publicity and ensure that promotional claims have scientific validity.
When discussing this issue, in June 1994, the Executive Committee of the Governing Council of the WHO examined a Report of the General Director (OPS, 1994f, pp. 7-10) which, after pointing out some initiatives of the Programme on Drugs and Technology for Health Care, specifically in the spreading of ethical criteria approved by the World Health Assembly in 1988, insisted on «the insufficient personnel and resources in the governmental sector to adequately monitor the industry marketing methods». It pointed out that «except for the fact that all the interested parties are now more conscious of the need to take steps to that effect, in the Americas we have observed very little progress in this area» (the emphasis is mine). It concluded by observing that «in the climate currently prevailing of controls elimination, the national authorities recognize that appropriate surveillance of the industry cannot be carried out by the government alone. On the contrary, governments should promote active participation of consumer organizations and a better industry self-regulation».
In spite of the rather pessimistic tone of the aforementioned paragraphs, some progress seems to have been made recently. For example, at the end of May 1994, the Drugs Consultative Commission under the Hipólito Unanue Convention (Bolivia, Colombia, Chile, Ecuador, Peru and Venezuela) approved its internal operating mechanism (creating three workshops) and the harmonization of the Andean Health Registry of Drugs, initially limited to common active ingredients included in the essential drug lists of the participating countries. Moreover, a four-year Plan was approved (1994-1997) with four main chapters: Pharmaceutical Policy; Supply; Regulation and Quality Assurance and Rational Use. One of the action lines recommended was, precisely, the «encouragement of production and marketing of essential drugs under their generic name».
In June 1994, the Central American presidents decided to set up a free market for 40 products selected by an ad hoc technical committee established in 1993. In November 1994, with the support of WHO and PAHO, there was a meeting of coordinators for projects on essential drugs in Central America, Panama, Belice and the Dominican Republic. There, they revised the situation of several sub-regional projects (studies of utilization and indicators; harmonization of pharmaceutical regulations, etc.). Three experiences came to light: the Program for Essential Drugs initiated in 1986 in Sololá, later extended to five other provinces in Guatemala; the Nicaraguan experience on essential drugs in local health care integral systems (SILAIS), and the development of hospital pharmacies in Honduras. They reached an agreement, to be developed in detail before August 1995, for an action plan in four main areas: policy and legislation; registration and quality assurance; supply and logistics; and information and training.
To sum up, on the issue of drugs Latin America exhibits the same simultaneous processes, although not always well articulated, as it does for other products (FEFER, 1994): one, at national level, directed to deregulation of markets; and another, at sub-regional level, aimed at creating larger markets according to free trade schemes. The positive aspect is that this is compelling governments to revise outdated and often contradictory laws, and to begin to accept the criteria of Good Manufacturing Practices and Certification of Quality recommended by the WHO; and more important, that the governmental departments dealing with these topics should be strengthened.
As a consequence, if I were to select a few areas where external cooperation with the countries in the region may be relevant in the immediate future, I would venture to point out the following: a) the curriculum reforms in Pharmacy and Medical Schools in the above mentioned direction; b) legislative harmonization in general, and registration conditions in particular; c) clinical pharmacy and, in particular, hospital pharmacy; d) research on the use of drugs. In some of these areas, the Spanish cooperation has offered and continues to offer relevant support.