Download Ensuring access to essential drugs

Ensuring access to essential drugs
- framework for action
World Health Organization
April 2001
Access to essential drugs has increased
over 20 years - but a huge gap remains
Number of people (billions)
6
5
No regular
access
4
3
Regular
access to
essential
drugs
2
1
0
2
1977
1987
1997
World Health Organization
1. Rational selection
Essential drugs concept widely accepted - a floor not a ceiling
156 countries with EDLS
• 1/3 within 2 years
• 3/4 within 5 years
National Essential Drugs List
< 5 years
> 5 years
No NEDL
Unknown
3
(127)
(29)
(19)
(16)
Countries with an official selective list for training, supply, reimbursement or related
health objectives. Some countries have selective state/provincial lists instead of or in
addition to national lists.
World Health Organization
1. Rational selection
Essential drugs concept widely accepted - a floor not a ceiling
Key action - define what is needed
•
•
156 countries with EDLS
• 1/3 within 2 years
develop evidence-based treatment guidelines
• 3/4 within 5 years
base essential drug list on treatment guidelines
regularly update using best evidence
• use for supply, reimbursement, training, education
National Essential Drugs
List
• ensure
development of needed new drugs
•
< 5 years
> 5 years
No NEDL
Unknown
4
(127)
(29)
(19)
(16)
Countries with an official selective list for training, supply, reimbursement or related
health objectives. Some countries have selective state/provincial lists instead of or in
addition to national lists.
World Health Organization
2. Affordable prices
Annual cost per person for triple therapy in Africa
(US $)
$12,000
$10,000
$8,000
Drug Access Initiative
$6,000
Domestic production
$4,000
Accelerated access initiative
$2,000
February-April 2001 offers
$0
1991
5
1993
1995
1997
1999
2001
2003
World Health Organization
2. Affordable prices
Annual cost per person for triple therapy in Africa
(US $)
$12,000
$10,000
Key action
- reduce
Drug Access
Initiativecosts and promote competition
$8,000
• price information
$6,000
• generics policies
Domestic production
• reduce duties, taxes, distribution and dispensing costs
$4,000
equity / differential
pricing
- especially for newer drugs
Accelerated
access initiative
• apply WTO/TRIPS safeguards as appropriate
February-April 2001 offers
•
$2,000
$0
1991
6
1993
1995
1997
1999
2001
2003
World Health Organization
3. Sustainable financing
Fairness in financial contribution varies greatly
- rank order of 191 WHO Member States

Top 5 countries, Africa





Mozambique
Tanzania
Chad
Rwanda
Ghana
39
48
59
59
74/75

Bottom 5 countries, Africa





Burkina Faso
Zimbabwe
Nigeria
Cameroon
Sierra Leone
173/174
175
180
182
191
In 38 countries public drug expenditure is < US$ 2.00 / capita
7
Source for fair financing data: : World Health Report 2000
World Health Organization
3. Sustainable financing

Fairness in financial contribution varies greatly
- rank order of 191 WHO Member States
Key action - develop all viable funding sources
Top 5 countries, Africa

Bottom 5 countries, Africa
appropriate public funding
 Mozambique
39
 Burkina Faso
•
expand
health insurance
coverage& Zimbabwe
drug benefits
Tanzania
48
Chad employer role59in health financing
 Nigeria
•
extend
 Rwanda
59
 Cameroon
• better use of out-of-pocket spending
 Ghana
74/75
 Sierra Leone
 expand external funding - grants, donations
•
173/174
175
180
182
191
In 38 countries public drug expenditure is < US$ 2.00 / capita
8
Source for fair financing data: : World Health Report 2000
World Health Organization
4. Reliable health and supply systems
Direct delivery system
Primary distributor system
Autonomous medical stores
9
World Health Organization
4. Reliable health and supply systems
Key action - ensure availability and quality
integrate drug management in health systems development
• create efficient public-private-NGO mix
• assure drug quality through production & distribution chain
• promote rational prescribing, dispensing, use by patients
•
Direct delivery system
Primary distributor system
Autonomous medical stores
10
World Health Organization
UN framework for action Access to HIV-Related Drugs
1. Rational selection
 review of HIV-related drugs in treatment guidelines
2. Affordable prices
 UNICEF-UNAIDS-WHO list of prices for HIV-related drugs
3. Sustainable financing
 advocacy for substantial increases in external financing
4. Reliable health and drug systems
 operational research on optimal monitoring of ARV therapy
Developed by Interagency Task Team on Access to HIV Drugs, consisting of UNAIDS,
WHO UNICEF, the World Bank, UNFPA, UNDCP, UNDP, UNESCO, WIPO
11
World Health Organization
Ensuring access to essential drugs
- framework for collective action and
for defining roles and responsibilities
1. Rational
3. Sustainable
selection
financing
ACCESS
2. Affordable
prices
12
4. Reliable
health and
supply
systems
World Health Organization