ACCESS TO MEDICINES: A CRITICAL AND GROWING PROBLEM

A little over two billion people lack access to essential medicines. As this gap continues to widen, it contributes to ongoing illness and avoidable disability and deaths¹, highlighting another critical dimension of health inequity. In this regard, it is reported that the average availability of generic medicines is only 38 percent in the public sector in low-and-middle-income countries (LMICs) and medicines in the private sector are unaffordable². This poses a considerable challenge as expenditure on medicines constitutes 25% to 65% of total public and private spending on health and 60% to 90% of household expenditure on health in developing countries². In this regard, access to medicines is especially problematic for rare diseases³ and neglected tropical diseases (NTDs)⁴ for which there is a paucity in the research and development of drugs.

In improving access to medicines, essential medicines play an important role. Essential medicines are those that satisfy the priority health care needs of the population. They have public health relevance and have evidence on being effective, providing clear clinical benefits, and being affordable¹.  The World Health Organization states that ‘essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford⁵.

Factors contributing to poor access to medicines include inefficient procurement processes and practices, tax and tariff policies, and mark-ups along the supply chain which increase drug prices and make them unaffordable¹. Additionally, access to medicines also depends on the strength and efficiency of national drug regulatory authorities¹. Further, international trade agreements and intellectual property rights regimes have also been cited as a threat to equitable access to medicines⁶. Finally, corporate practices of big pharma, including irregular marketing practices, excessive expenditure on marketing vis-à-vis research and development, have also been cited as factors contributing to asymmetries in the sector and access to medicines.

In recent years, there has been concern about the exposure of medical students to pharmaceutical companies. The concern is for the consequences it has for the development of their medical identity and medical mores as a result of pharmaceutical gift-giving and reciprocal obligations^7,8.