Developing countries essential medicines

Despite the obvious medical and economic importance of essential medicines, there are still problems with lack of access, poor quality, and irrational use. In many health facilities in developing and in developed countries, essential medicines are not used to their full potential. While the EDL is regarded as a key aspect of global health and economics, the WHO EDL is, for the past few years, at the center of debates with respect to access issues (such as new essential medicines for HIV/AIDS, tuberculosis, and bacterial infections) and availability issues (such as the lack of pharmaceutical research and development for tropical diseases, most of the current tropical pharmacopoeia having been driven by colonization requirements during the first part of the 20th century). In 2001, still one-third of the world s population (over 50% in the poorest part of Africa and Asia) does not have regular access to the most vital essential medicines. 

Major causes of morbidity and mortality in many developing countries such as malaria, tuberculosis, pneumonia, acute diarrheas, maternal diseases can be treated with simple essential medicines (Box 1). But, essential medicines will save lives and improve health, only if they are available, affordable and of good quality, and properly utilized. 

In developed countries, the discovery of new medicines and their introduction in the existing health care system during the second part of the last century has dramatically improved health, reducing mortality and morbidity from many common diseases. The society in general have benefited from these advances through the regular access to the needed medicines in their health care system. However, in many developing countries the needed essential medicines are not always available, accessible and affordable to those in need. 

The discovery of new medicines and their introduction into the market will not optimally have positive impacts on health if the needed essential medicines are not available and affordable, if they are not of good quality and if they are not properly utilized by the health care providers and consumers. This chapter will highlight the issues related to commonly occurring problems in the area of medicines in developing countries, and relevant policies and programme to deal with them. In particular, the chapter will highlight the problems of access to... 

Reduction or elimination of duties and taxes for both generic and patented essential medicines contribute to price reduction. In developing countries, the final price of a medicines may be two five times the producer or importer price. This reflects the effects of multiple middlemen, taxes of over 20% in some countries, pharmaceutical import duties up to 65%, high distribution costs, and pharmacy and drug seller charges. 

Donor assistance and development loans such as bilateral aid and development loan/grants from development banks continue to provide for many countries sources of health sector financing, which can include funding for essential medicines, such... 

In line with reasons developed by Baker and Carapinha, Kinsley Wilson and colleagues also accept the premise that the state is primarily responsible for ensuring access to essential medicines. They suggest that countries should develop a National Drug Policy (NDP) and accompanying implementation plans. Countries need to establish adequate processes as far as the registration, selection, procurement, and distribution of drugs are concerned. 

We are now in a cycle characterized by incremental innovation, not therapeutic breakthroughs, and it is reasonable for industry critics to question the industry on the value of its innovations. A wave of patent expiries, high failure rates of developmental products, pressure to reduce or contain healthcare inflation (prices and expenditures), and access to essential medicines in developing countries have resulted in a global environment of increasing hostility. At this point it is difficult to predict the direction in which the environment will move over the next three to five years. 

Attaran, A. 2004. How Do Patents and Economic Policies Affect Access to Essential Medicines in Developing Countries Health Affairs 23 155-166. 

Ganslandt, M., K. E. Maskus, and E. V. Wong. 2001. Developing and Distributing Essential Medicines to Poor Countries The DEFEND Proposal. The World Economy 24 779-795. 

The impact of TRIPS-plus IP standards on medicines access will be particularly harmful In sub-Saharan African countries where approximately 25 million people are infected with HIV (UNAIDS 2004), more than 1.5 million TB cases occur each year (WHO 2002), and 90 per cent of malaria deaths occur, with approximately 3,000 deaths each day (WHO 1998a). Yet, as in other developing regions, in sub-Saharan Africa, one in three people lack access to essential medicines, a figure that rises to one in two in the most impoverished parts of Africa (WHO 1998b). 

Ratanawijitrasin, S., S. Soumerai and K. Weerasuriya. 2002. Do National Medicinal Policies and Essential Dmg Programs Improve Dmg Use A Review of Experiences in Developing Countries. Social Science Medicine 53 831-844. 

Crucial, then, to the provision of essential medicines to the developing world (where government regulation and industry in many countries are disrupted by armed conflict), is the WHO EML. Originally produced in 1977, the WHO EML now contains over 300 products. By 1998, 140 countries had developed their own national lists of essential drugs. 

Quick JD. Ensuring access to essential medicines in the developing countries a framework for action. Clin Pharmacol Ther 2003 73 279-283. 

The selection of pharmaceutical products based on a national formulary or on the essential medicines list is recommended. WHO s Model Formulary (15 and Model Essential Medicines List 4) identify the most cost-effective and affordable pharmaceutical products to treat prevailing health problems. They are updated regularly and are made freely available for adaptation by countries. The health systems of many industrialized and developing countries have used the essential medicines concept for decades to use existing resources effectively. Because the use of a national formulary reduces the number of products used, supply management activities and inventorycarrying costs are minimized. 

Plant-based systems continne to play an essential role in healthcare, and their use by different cultures has been extensively documented. It has been estimated by the World Health Organization that approximately 80% of the world s inhabitants rely mainly on traditional medicines for their primary healthcare, while plant products also play an important role in the healthcare systems of the remaining 20% of the population, mainly residing in developed countries. ... 

The position of the pharmaceutical industry should he taken into account when the authorities plan to introduce new measures. It is clear that even fully justihed policies may he criticized vigorously hy industry if they impede its purely commercial interests, and that they will frequently have to be implemented in the face of such protest. On the other hand there are some situations in which caution is needed if one public interest is not to be sacrihced to another. While large multinational corporations are sufficiendy resilient and flexible to adapt to restrictive measures, local firms in developing and transitional countries may much more susceptible. Industrial employment, income, exports and economic activity at large may be at stake, or even the continuity of supplies for essential medicines. 

Some bodies, mainly in the public sector, use tender systems. This is often the case when vaccines are purchased for immunization campaigns or when drugs are bought for the armed forces or to provide a strategic reserve. In developing countries, tendering is commonly used to cover the needs of hospitals and primary clinics for essential medicines. 

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