Prescription for Healthy Development: Increasing Access to Medicines

This document describes the need to increase the availability, affordability, and appropriate use of medicines in developing countries. The working group proposes steps to increase incentives for research for priority diseases of developing countries, improve procurement and distribution, strengthen primary health systems, develop more human resources, and increase health funding to improve access to essential medicine in developing countries. It underscores its recommendations with a case study of Uganda.


The document puts forth two main areas of challenge:
• How to increase access to affordable existing medicines in resource-poor settings - it states that countries can do this by improving the selection and use of essential medicines, taking steps to ensure affordable prices, increasing sustainable financing, and strengthening reliable supply systems.
• How to find new ways to promote the development of new medicines and vaccines to treat diseases of poverty.


The following are general, national, and international communication-related recommendations:

• Make equity of access a cornerstone in thinking and policymaking.
• Use a bottom-up approach for developing pro-economically poor healthcare.
• Use market competition as an essential driver for innovation, supply, and affordable prices.
• Create an appropriate and supportive policy environment for medicines research attuned to the needs of the economically poor.

Recommendations on a national level include:

• Developing countries need to be more confident about negotiating for technology transfer and more national capacity building to participate directly in research and design (R&D).
• Even in countries with very limited resources, some steps can and must be taken to formulate a national research policy and provide the funding and infrastructure needed to implement it, either independently or in collaboration with foreign, regional, or global institutions.
• Countries can combat the sale and use of poor-quality medicines by raising public knowledge and empowering consumers to demand quality assurances. Registry and information dissemination systems are needed for such public monitoring.
• The regulatory environment should reward sound research into priority diseases.
• Work should be undertaken to institute no-fault systems for redressing injury caused by medicines.
• Prices for medicines should be transparent to protect against higher prices. Medicines price lists, such as those published by the World Health Ogranization (WHO) and Management Sciences for Health (MSH), can be a valuable tool for countries.
• It is vital to provide reliable information on medicines and their use, both during the education of professionals and on an ongoing basis during their professional careers (such as through the publication of formularies, standard treatment guidelines, and regular prescribing bulletins).
• Patients should always be given basic information about the medications that are prescribed for them (including name, dosage, clear use instructions, and possible side effects). This approach will require sensitivity to patient population characteristics, such as accommodating different dialects and meeting the needs of largely illiterate populations.
• Governments should educate the public on priority health issues, including the proper use of medicines. This general information should be supplemented by medicine-specific information, disseminated to households or patients in a culturally appropriate manner. This should not be a unilateral task for the authorities: community mobilisation around issues of health and education is common. Forming alliances with community groups will be a valuable way of disseminating important information.
• The community’s own resource persons should be mobilised to participate in healthcare planning and delivery of large-scale treatment programmes (such as vaccines programmes).
• In health systems, policies and plans should mainstream gender considerations. This can be done only if women’s participation increases and is valued in policymaking.
• Monitor the following: governance and adequate focus on essential medicines for the economically poor.

Recommendations on the international level include:

• New ways of approaching innovation should be considered and pursued with some urgency, for example: technology transfer, patent regimes, intellectual property management, and local production as ways of meeting the demand for increased access to medicines. Further development and use of traditional medicines deserve consideration.
• Monitor for adequate participation of experts from affected countries.
• International standards for ethical research such as those elaborated by the Declaration of Helsinki should be applied in all countries.
• A reorientation of medicines research, better attuned to the needs of the world as a whole needs to include creative research, development, and finance mechanisms.
• Public-private initiatives appear to be offering useful models for new medicines and vaccines development.
• The exchange of information and advice on successes and failures of national or pooled procurement systems, routinely updated price lists, and systems of distribution and supply will aid in further systems development.
• International organisations should work to strengthen national regulatory capacity through training, capacity building, information sharing, evaluation of best practices, and sustained funding.
• Much benefit will be gained by sharing information among countries and agencies on producer prices, markups and profits, tariffs and taxes, and other charges, so that successful approaches to reducing consumer prices in one country can be emulated in others
• Donors and global agencies engaged in the health field need to work together to promote the appropriate use of medicines. The WHO Ethical Criteria for Medicinal Drug Promotion (WHO 1988) should be updated and extended to deal with newer issues, including the trend toward direct-to-consumer advertising and the increasing use of the internet to promote medicines.
• The WHO should also ensure the worldwide sharing and dissemination of authoritative texts on the best way to treat major and epidemic conditions, so that these can form the basis for national guidelines.
• International health organisations and non-governmental organisations (NGOs) should continue to develop and disseminate health literacy information related to appropriate use of medicines for use in developing countries.
• International financing agencies, such as the World Bank and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), and major bilateral donors should focus on training and building capacity in a substantial number of supply chain managers and other essential health workers in developing countries.
• United Nations (UN) agencies and the GFATM should adopt policies and approaches that ensure that gender considerations are adequately integrated into all aspects of their planning, activities, and budgets.