Year : 2018 | Volume
: 7 | Issue : 2 | Page : 59--61
Accelerating access to essential medicines in the WHO South-East Asia Region: opportunities for greater engagement and better evidence
Poonam Khetrapal Singh1, Phyllida Travis2,
1 World Health Organization, Regional Director for South-East Asia, New Delhi, India
2 Director, Department of Health System Development, World Health Organization, Regional Office for South-East Asia, New Delhi, India
Director, Department of Health System Development, World Health Organization, Regional Office for South-East Asia, New Delhi
|How to cite this article:|
Khetrapal Singh P, Travis P. Accelerating access to essential medicines in the WHO South-East Asia Region: opportunities for greater engagement and better evidence.WHO South-East Asia J Public Health 2018;7:59-61
|How to cite this URL:|
Khetrapal Singh P, Travis P. Accelerating access to essential medicines in the WHO South-East Asia Region: opportunities for greater engagement and better evidence. WHO South-East Asia J Public Health [serial online] 2018 [cited 2019 Jan 19 ];7:59-61
Available from: http://www.who-seajph.org/text.asp?2018/7/2/59/239414
This issue of the WHO South-East Asia Journal of Public Health focuses on access to medicines. Progress on universal health coverage and the Sustainable Development Goal (SDG) for health, “Ensure healthy lives and promote well-being for all at all ages”, will be achieved only if there is significant improvement in access to quality essential medicines. This is explicitly recognized in the declaration of the 2030 Agenda for Sustainable Development, and for the first time there is an indicator for tracking progress: the “Proportion of the population with access to affordable medicines and vaccines on a sustainable basis” (SDG indicator 3.B.1).
There is an urgent need to improve access to medicines. The situation in the World Health Organization (WHO) South-East Asia Region was summarized in 2017. Despite limited data, which is a worldwide problem, a reasonably consistent picture emerged for the region, that, while the overall availability of medicines has improved, availability still tends to be lower in the public sector compared with the private sector; lower in health centres than in hospitals; and more of a problem for medicines for noncommunicable diseases than for those for communicable diseases. There are sometimes concerns about how to decide on additions to national lists of essential medicines; the quality of medicines being procured; and the prices paid. Looked at through a lens of universal health coverage, paying out of pocket for medicines is the main driver of impoverishment due to health-care spending in this region, affecting at least 65 million people, and affecting people most when they are sick. Access to medicines has rightly become increasingly prominent on both global and regional public health agendas.
There is much that can be done to increase access to quality essential medicines. Production can be expanded; improved drug formulations can be developed to more easily reach “those being left behind”; procurement and pricing policies and practices can be improved; creative ways to improve distribution to hard-to reach areas, along with more appropriate use, can be developed; and effective strategies to increase protection from financial hardship can be introduced. Multiple parties need to be involved – national and subnational government bodies – including national regulatory authorities; pharmaceutical manufacturers; health professional bodies; civil society organizations; development partners; and academia. The medicines market in the WHO South-East Asia Region is unique in many ways. Several countries are major manufacturers of generic medicines, and are global not just regional suppliers. There are also some very small countries in the region that will always lack sufficient purchasing power for “economies of scale” when procuring medicines – in terms of both negotiating price and assuring quality.
Five priority areas for greater engagement and better evidence
There are five clear areas in which action, especially inter-country cooperation, will help to accelerate progress, and these have become priorities for this region. They are also areas in which more knowledge and evidence is needed.
Procurement, pricing and greater use of TRIPs flexibilities
Broadly, there are two categories of essential medicines. The first is common, off-patent essential medicines such as first-line antibiotics and medicines for blood pressure and diabetes, where the main issue is negotiating a fair price, especially for smaller countries with limited prospects for economies of scale. Two forms of cooperation are now under way in the region that should help: greater transparency of information on procurement price, and the first steps towards pooled procurement, starting with antidotes., There may also be relevant experience for medicines procurement from the experience with pooled procurement of vaccines by countries of the Association of South-East Asian Nations (ASEAN). Second, some innovative medicines that are still under patent and often high cost, have been accepted onto the WHO model list of essential medicines and address important health issues in the region – for example, drugs for hepatitis C and certain cancer drugs. Here, greater capacity to work within intellectual property and competition rules, and use the full provision and flexibilities of the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) is needed. A recent review found that TRIPS flexibilities were mainly used for HIV/AIDS or related conditions, but used far less frequently for cancer. In 2015, 16 cancer drugs, including three high-cost medicines, were added to the WHO model list of essential medicines. However, an analysis reported in this issue of the journal shows that, in many countries, this expansion has not yet been translated into inclusion in their national lists of essential medicines. In an accompanying perspective paper, the authors explore potential approaches to improving the affordability and availability of essential cancer medicines in the region.
Effective regulation ensures the quality and safety of both generic and patented medicines. There are significant differences in regulatory capacity between countries, and existing expertise could be used more efficiently. The South-East Asia Regulatory Network (SEARN) was created in 2016, to improve access to safe, high-quality medical products in the region, by facilitating greater information-sharing, collaboration and convergence of regulatory practices across the region. Regulatory authorities from all 11 Member States of the region are members. Working groups have been created in five priority areas, as shown in [Box 1].
Rational use of medicines, with a focus on antimicrobials
Improvement in rational use of medicines is part of efforts to improve health service quality and is essential to achieving better health outcomes. The need for optimization of the use of medicines is as great as ever, and is increasingly urgent in the case of antimicrobials. A reappraisal of approaches may be merited in situations where little progress on appropriate use has been made. Innovative approaches that tackle the problem on the supply side, for example reducing incentives for inappropriate prescribing, are needed. Equally important, but often forgotten, is the need to reduce inappropriate demand for medicines. A perspective paper in this issue describes how Thailand successfully incorporated a module into the country’s 2017 national health and welfare survey, to assess public awareness of antibiotics. The findings will be used to design targeted public communications strategies.
Data on access to medicines
There is an urgent need to improve data on access to medicines. A simple hand-held application to monitor the availability and price of medicines has been piloted in 19 countries in Europe, the Americas and Africa. A number of countries in the WHO South-East Asia Region also plan to pilot it in the next year.
Protection from financial hardship
The fifth area in which more knowledge is needed is how to reduce financial hardship caused by out-of-pocket payment for medicines. Countries in the region are using a range of policies. There is an urgent need to analyse their effectiveness, especially in terms of expanding financial protection for the most vulnerable groups.
There are some clear priorities for action and generating evidence on the agenda for access to medicines in the WHO South-East Asia Region. There are also areas where existing knowledge needs to be translated into action. For example, access to opioids, needed for severe pain, remains very low in the region. As described in this issue, though some progress has been made in recent years, well-formulated policies to increase access to opioid medications are urgently needed. National medicines policies and lists of essential medicines may need revision, to reflect today’s health needs. The WHO model list of essential medicines remains the benchmark for many countries, and judicious use of health technology assessment can also help national decisions., Better data are needed to monitor progress. More operational research is required to identify which types of policies and strategies help improve equitable access to quality medicines at scale, and can be sustained. Fundamental research and development work is also needed. There is much to do for the range of parties involved in improving access to essential medicines. The research community will play a pivotal role in evaluating and documenting what works in the WHO South-East Asia Region.
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