Access to medicines is critical to promote well-being of all people of all ages. Medicines exist, but are often inaccessible for reasons beyond control.
Access to medicines is critical to promote well-being of all people of all ages. Medicines exist, but are often inaccessible for reasons beyond control. They may be too costly—burdening household finances, risking poverty or debt. They may be in short supply due to problems in distribution channels, making continuity of treatment difficult. They may be substandard—falsified medicines are not only ineffective, but also dangerous.
The sentinel role of countries for access to medicines has become challenging, given the nature of the pathogens and reduction in time and space on travel. The rising concern of non-communicable diseases requiring life-course management makes access to medicines key to good health. Ensuring all people can access essential medicines is one of WHO South-East Asia’s priority areas, and key to achieving the Sustainable Development Goals agenda 2030 of health and well-being for all.
Many countries have made progress, and priority medicines are getting affordable and their supply steadier. Flexibilities in global trade agreements have been leveraged to reduce prices in several countries; there are regional examples of improved public sector purchasing. Some countries have updated their essential medicines lists, their supply chain management systems have improved, and action to improve quality has accelerated. Some have included health as top priority. We could do better.
Certain inadequacies are yet to be addressed: Out-of-pocket spending on essential medicines remains high, supply chains in some areas are weak, and countries lacking manufacturing capacity cannot leverage competitive prices from suppliers.
The region’s economic status is changing for the better, a positive sign that, however, will lead to reduced access to external financing for medicines and vaccines. This calls for self-reliance and collaboration by countries in the region. The South-East Asia Region members, supported by WHO, launched South-East Asia Regulatory Network (SEARN) for information sharing, collaboration and convergence of regulatory practices.
There are three key areas of action.
First, countries keep their Essential Medicines List (EML) and medicine policy current. By developing clear accountability systems for medicine selection and procurement, health authorities can harness opportunities for access to affordable medicines. Despite rising antimicrobial resistance, purchasing and supply of antibiotics is seldom rationalised. In a major revision of antibiotics section in EML’s 40-year history, WHO experts have grouped them into Access, Watch and Reserve—three categories, with recommendations on when each category should be used. This is a good yardstick and a starting point for antibiotic use. Also, across the region, countries are yet to capitalise on the massive drop in prices of a range of game-changing medicines—most notably for hepatitis C. This must change.
Second, guarantee quality and affordability of medicines. The role of the national regulator needs to be redefined to that of a facilitator for quality production. This entails providing adequate technical assistance and hand-holding for achieving quality standards at the level of manufacturing as well. Countries should continue with targeted quality control and testing of medicines that are substandard or falsified. From manufacture to sale, locally-produced medicines should always meet international standards. For affordability, the main stress points are promoting competition, implementing price-control measures, encouraging doctors to prescribe generics to regulating wholesale and retail mark-ups. Developing pricing strategies linked to health insurance, especially where national schemes are in place, is also important. Countries can exploit flexibilities in global trade agreements when negotiating with manufacturers. They can bargain collectively to increase market buying power. SEARN can help make regulation more efficient by developing the region’s diverse capacities and strengths.
Third, generating quality information on access to essential medicines within the countries. Knowing where and why people are facing shortage, where unsafe or ineffective medicines are being sold, is essential to develop lasting solutions. From smartphone apps to household surveys, the array of tools at health authorities’ disposal is considerable. By using them effectively, authorities can garner the information needed to make smart, high-impact interventions that drive life-changing gains.
Essential medicines should be accessible for all, to achieve universal health coverage. Supported by a clear vision, the dream of health equity and the Sustainable Development Goals of health and well-being for all are within reach. A healthier, more equitable and sustainable South-East Asia can be ours.
Poonam Khetrapal Singh
Regional Director, WHO South-East Asia Region