GHF2010 – PS26 – Accountability and Access to Essential Medicines: Global Perspectives

Session Outline

Parallel session PS26, Monday, April 19 2010, 16:00-17:30, Room 14
Chair(s):  Guy Willis, Director of Communications, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), Switzerland
Richard Laing
, Team Leader, Medicine Information and Evidence for Policy, Department of Essential Medicines and Pharmaceutical Policies, World Health Organization, Switzerland
Impact of the Economic Recession on the Consumption of Medicines
Richard Laing, Essential Medicines and Pharmaceutical Policies, WHO, Geneva, Switzerland
Strategies for Universal Access to Medicines: A Case Study of Participatory Healthy Public Policy in Thailand 
Tipicha Posayanonda, Global Collaboration Development Program, National Health Commission Office
The Access to Medicine Index: A Key Information Source for Societies in Need
Femke Markus, Managing Director, Access to Medicine Index Foundation, The Netherlands

Session Documents

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Session Report

Submitted by: Yunjin Moon (ICVolunteers); Contributors: Kashka Huyton (ICVolunteers), Christoph Wirth (ICVolunteers)

Photo by John Brownlee,

The Millennium Development Goals call for universal access to health, including essential medicines. Some 4.8 billion people are currently estimated to benefit from access to essential medicines, leaving some 2 billion still unable to access them. The Accountability and Access to Essential Medicines: Global Perspectives session examined some factors impacting access to medicines and their availability. The impact of the recent global recession was put under the microscope, as was the pharmaceutical industry's performance, based on a new indexing and ranking tool. The differences in availability of medicines for chronic versus acute diseases were also examined. Finally, Thailand provided a case study of how policy development can increase access. The session emphasised the need for a participatory approach, involving all stakeholders, in increasing access to essential medicines.

The impact of the 2009 global recession on the consumption of medicines had been examined by WHO, through an Expert Review. In the session on Accountability and Access to Essential Medicines, Richard Laing, of the Department of Essential Medicines and Pharmaceutical Policies of the World Health Organization (WHO), presented the review, which collected data in 83 countries worldwide and examined trends in consumption, availability and pricing of medicines for both chronic and acute diseases. The preliminary findings of the review showed no significant evidence of decline in levels of medicine consumption, with most governments able to absorb the shocks of the recession. The most notable exceptions were some Baltic states in Europe and Malaysia in the South East Asia region. However, as shown by the 1997-1999 Asian Financial Crisis, trends may take up to five years to emerge fully. The analysis of data, particularly the effects on mortality, is ongoing. The final report of the Expert Review will be presented to the World Health Assembly 2010.

Femke Markus, Managing Director of the Access to Medicine Index Foundation, discussed the necessity for adequate information sources on medicines for societies in need. A novel approach to measuring the accountability of the pharmaceutical industry is being developed by the Foundation. Aimed at stimulating the pharmaceutical companies to ‘lead by example’, the Foundation examines and ranks the top twenty companies’ performance in least and mid-developed countries. This is based on a set of agreed criteria such as pricing and management, among others. A ‘scoring card’ system is then developed and publicised, with the aim of motivating the top companies to increase global access to medicines through ethical policies. The index will allow continual monitoring and assessment of their performance. At the root of the 2008 exercise undertaken by the Foundation is the critical question of “who decides what the pharmaceutical companies should do” and a stakeholder mapping exercise has been undertaken to respond to this point. The Foundation is endorsed by nineteen organisations, including governments and civil society. As the next step, the Foundation aims to assess the practical implications of the ‘score cards’ on the ground in least-developed countries. Companies are under increasing pressure from their investors to apply ethical standards to their business practices. The ‘scorecard’ will be scrutinised by investors in judging industry’s ethical policies.

Richard Laing gave a presentation on the subject of Differences in Availability of Medicines for Chronic and Acute Conditions in Public and Private Sectors in Developing Countries. Whereas the focus of the study was the prices of medicines, their availability is equally important. He presented the results of the survey, conducted in forty developing countries, covering thirty medicines; in particular, fifteen most-commonly surveyed medicines for each of the acute and chronic diseases were researched. The availability of each medicine was analysed for both the originator brand and generic medicine, in public and private sectors. The results of the survey show a sharp difference between the public and private sectors regarding average availability of medicines for chronic diseases in contrast to acute ones. Whereas the availability of medicines for acute conditions amounts to 53% in the public sector and 66.2% in the private sector, only 36% of medicines for chronic conditions are available in the public sector, as opposed to 54.7% in the private sector. This contrast is particularly severe in Africa. Mr Laing emphasised that, whereas we talk about access to medicines, we should consider how to measure the access; we need to disaggregate the components of access. He concluded, “If we want to reach the MDG goal concerning access to essential medicines, we should focus more on the medicines for chronic diseases.”

Dr. Tipicha Posayanonda, from the National Health Commission of Thailand, presented the case study of participatory health public policy in Thailand, with regard to strategies for universal access to medicines. Thailand is faced with increasing expenditure on medicines which is creating a financial burden for the government. Dr. Posayanonda referred to a number of causes, such as irrational use of medicines, overuse of medicines, no appropriate control of prices and expensive patented medicines, resulting in limited access for large segments of the population. The National Health Act 2007 has developed a triangular participation strategy to engage different stakeholders. The three axes of the triangle are the creation of relevant knowledge; social movement that engages civil society, private sector and the media; and political involvement. These three have to be coordinated by the National Health Commission. At the first National Health Assembly in 2008, which adopted “National Strategies for Universal Access to Medicines,” over 1,000 people from the three axes of the triangle actively participated in developing national strategies for access to medicines. The strategies aim to have essential medicines available for general use in a timely and self-reliant manner and for the public good. These strategies will be completed by July 2010.

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