This study examined and analysed how, through the General Agreement on Trade in Services (GATS) and the Trade Related Intellectual Property Rights Agreement (TRIPS), national policy options that support equity in health are threatened. More specifically the study examines how we can we protect rights of access to essential medicines under trade and market policies. The report was produced under a programme of the Regional network for Equity in Health in East and Southern Africa (EQUINET) with Centre for Health Policy South Africa, SEATINI Zimbabwe and TARSC. The audit was implemented following an EQUINET training workshop on trade and health held in Tanzania in 2005. A qualitative methodology was used with desk review of relevant literature. Additional information was collected through key informant interviews in the health sector including the Ministry for Health, Tanzania Food and Drug Authority, the Business Registrations and Licensing Agency (BRELA), Medical Stores Department (MSD), pharmaceutical companies, pharmacists and other medical practitioners.

The report outlines that the noble objectives of equitable accesses to health care services generally and specifically to essential medicines, which were implicit in the Tanzania’s Ujamaa policy, were jeopardised by the economic crisis that befell the country in the late 1970s and early 1980s. The prescribed strategies by Breton Woods Institutions to address the economic crisis included a wide range of economic and social reforms. They included introduction of cost sharing in the public health care facilities and liberalisation of health care provision to allow the private sector, which hitherto was restricted. Besides increasing the degree of inequality in access to essential medicines, the adoption of the health sector reforms, which were not participatory in their formulation process, increased the difficulty of access among poor people and other marginalised groups of people, i.e. expectant mothers, children, the elderly and people living with HIV/AIDS. The report explores the flexibilities in the World Trade Organisation’s (WTO’s) General Agreements on Trade in Services (GATS) and Trade Related Intellectual Property Rights (TRIPS), so that Tanzania’s equity objectives in access to essential medicines could be safeguarded, even within the increased integration in the global economy. We conclude that equitable development, which goes hand-in-hand with equitable access to essential medicines, is a choice. If countries like Tanzania choose to develop and share the benefits of development equitably, then equitable access to essential medicines can be achieved. Tanzania’s long upheld equity objectives need to be safeguarded even as the world becomes increasingly integrated. This is important to achieve the health related millennium development goals (MDGs). Inequity in access to essential medicines that has progressively been apparent in the country following the reforms in the health sector could be reversed by introduction of equity safeguarding regulation in the sector. The fact that under GATS countries have the possibilities of choosing to make commitments only in some sectors, and to set the limits as required to deal with various policy concerns, makes it possible for countries like Tanzania to maintain its long upheld equity objectives in all spheres of life including equitable access to essential medicines.