Rapid assessment of health care and supply systems is essential for identifying the major weaknesses and initiating corrective actions. Among the many elements of an effective health care system, those most important in supporting access to essential medicines are as follows.
Health sector development is a vital government obligation. In a national health system, proper use of well-known and newer essential medicines for priority health problems depends on a certain minimal level of medical and pharmaceutical services. This includes inexpensive diagnostic tests to confirm diagnosis, and well-informed trained clinicians, pharmacists, nurses and other health staff to help patients, especially those with chronic illnesses, to adhere to their treatments. An overall capacity strengthening of the health and supply systems is a prerequisite to respond adequately to the increased medical and pharmaceutical needs of populations.
Public-private-NGO mix approaches are being pursued to ensure timely availability of medicine supplies of assured quality in the health care system. These vary considerably with respect to the role of the government, the role of the private sector (nonprofit and for-profit), and the incentives for efficiency. Many countries struggle with the unfortunate combination of an inefficient public medicines supply system meant for the entire country and various private supply systems serving mostly urban areas. Increasingly, an effective medicines supply system is seen to depend on an appropriate mix of public, private, and NGO procurement, storage and distribution services.
Box 6. Four types of medicines supply strategies in addition to central medical stores
• Central medical stores
Centralized, fully public management, warehousing and delivery system.
• (Semi-) autonomous supply agency
Centralized, (semi-) private management and warehousing system.
• Direct delivery system
Centralized decision-making but decentralized, private direct-delivery system.
• Prime distributor
Centralized decision-making but decentralized, private warehousing and delivery system.
• Fully private supply
Decentralized decision-making, fully private wholesalers and pharmacies system.
Regulatory control is a shared responsibility of the national regulatory authorities, pharmaceutical producers, distributors, and other actors active in medicines management. Effective medicines regulation is a public service necessary to ensure the quality of pharmaceutical products, that producers fully implement good manufacturing practices to combat counterfeit and substandard medicines, and to contain drug resistance resulting from uncontrolled supply and use of antibiotics and other essential medicines in both public and private sectors.
Procurement co-operatives increase efficiency. Regional and sub-regional procurement schemes can become a credible option for ensuring reliable medicine supplies. The Gulf Cooperation Council (GCC) and the Organization of Eastern Caribbean States Pharmaceutical Procurement Service (OECS/PPS) sucessfully organize pooled procurement for six and eight countries respectively.
Traditional and complementary medicines are increasingly used in many parts of the world and play a major role in the health care system. In many low- and middle-income countries, greater accessibility to and confidence in traditional medicine practitioners, especially in rural and remote areas, may explain why most patients consult them. Traditional practitioners can therefore play a considerable role in the health care system for some aspects of health care.