(2004; 16 pages)
Millions of people worldwide still do not have access to essential medicines that are affordable and of good quality. Access to medicines means access to treatment. Improving access to quality treatment is currently the most important strategy to reduce disability and death from many diseases. More generally, ensuring access to effective treatment is a high priority issue for international public health. Access to essential medicines is part of the human right to health.
The poor lack access to medicines for many reasons, all of which must be addressed in a comprehensive manner. The most important is poverty, which means that neither the poor nor their governments can afford to purchase essential medicines or ensure their rational use in well-run health systems. Affordability is one core issue at the centre of debates about medicine use in international health. The reasons for the lack of access to essential medicines are manifold, but in many cases the high prices of medicines are a barrier to needed treatments. Prohibitive medicine prices are often the result of strong intellectual property protection. The World Trade Organization Trade- Related Aspects of Intellectual Property Rights (TRIPS) Agreement, which provides 20 years’ patent protection for pharmaceuticals, also includes safeguards such as compulsory licensing, to ensure that countries can override patents whenever they are a barrier to access to medicines. The past years have clearly shown that the Doha Declaration must be actively implemented and defended if it is to have any force.
There are however other major factors which deny access by the populations of low-income countries to effective medicines for the treatment of the diseases to which they are subject. Poor infrastructure and unreliable medicine supply systems, waste and inefficiencies in managing logistics add to low availability of medicines. Most medicine research is carried out by global pharmaceutical companies, which exist to make profits for their shareholders. This means that they focus mainly on the diseases of developed countries, with the result that diseases prevalent in developing countries are largely neglected. Many of the issues surrounding the accessibility of medicines in low income countries can only be addressed with concerted national and international action. In this paper we consider the issues of accessibility and availability of pharmaceuticals in international health, and describe the initiatives that have been taken by SDC to address them in Tanzania and Mozambique. The situation in Tanzania is described from personal experience over 10 years, the situation in Mozambique is illustrated using information and documentation from SDC, consultants and other sources...