Improving Access of the Poor to Essential Drugs and Key Drugs for Major Disease in Developing Countries

Human and Social Development Issues

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improve health and health protection of the poor.
In the poorest parts of Africa and Asia. over 50
per cent of the population do not have regular
access to the most vital essential drugs. In
developing countries, up to 90 per cent of
medicines are paid for < out of pocket >. and this
expenditure represents a large proportion of
household spending among the poorest.
Therefore ensuring that cost-effective key
public health interventions reach the poorest
populations remains a challenge. Existing
public service systems do not, at present. serve
these populations well. New and innovative
approaches are needed to complement ongoing
efforts to develop effective and more equitabie
health systems.
A promising trend is the increase in social and
private health insurance coverage leading to
expanded access to drugs in many diverse
countries. Some programmes include special
arrangements to ensure that rural and loweincome populations are not excluded from
coverage. Drugs represent 25% to -0 00 of total
costs of such schemes.
Complementary to existing efforts international
agencies should therefore explore innovative
financing mechanisms. for example the
establishment of endowment funds. for the
control of specific communicable diseases in the
least developed countnes and targeted at the
poorest populations.
A simultaneous maior effort is also needed to
address the systematic obstacles and incoherences
that prevent most effective utilization of available
resources. Improvements are needed in the
capacity of governments and non-governmental
organizations to disburse and account for funds
and to monitor and report outcomes. This will
require sustained support to health systems
development, a further scaling up of efforts to
date and increase coordination of donors. Many
countries in Africa struggle to define essential and
basic packages of health services that can be
provided for less than US $ 5 per head. Much
more support will be needed and should be

directed at those countries which demonstrate
commitment to delivering equitable services,
which have accountable systems in place and
which can demonstrate positive out comes for the
poorest.

Improving access to key drugs
through a comprehensive approach
(medium term)
The lack of access to essential key drugs for
major infectious diseases in developing countries
is due to multi-factorial causes but is in part also
caused by unaffordable pricing mechanisms.
Countries supported by NGO advocates have
called for review of international pricing
policies. Alternative solutions to enable lower
prices for the poorest developing countries even
on newly patented products are to be actively
exolored.
Experience in the vaccine sector demonstrates that
simificant price differentials can be maintained
bevtween costs in developed and developing
countries. Some pharmaceutical companies have
indicated that they might be willing to se: similar
price differentials for other pharmaceuticals.
including newer essential drugs and for the
expensive patented drugs for HIV AIDS. Tiered
pricing allows manufacturers to offer the lowest
possible prices to the poorest countries without
threatening their profits in developed countries.
The willingness of the R&D pharmaceutical
industry' to lower prices for developing countries
will therefore be the crucial factor regardless of
whether intellectual property protection exists or
not. An agreement on differential pricing
policies would make key drugs available to
developing countries at significantly reduced
prices - irrespective of patent - and would be a
major step forward in overcoming the
affordability obstacle.
The potential beneficiaries of such vaccines are
the very poor who live in countries that typically
can spend just a few dollars per year per person
on all health expenditures. but also the global
community in general. Therefore. the vast bulk of
the development efforts and the subsequent
delivery of these new vaccines will ultimately
have to rely heavily on private finances and
support, not necessarily from official aid.

The agreement reached in May 2000 between five
pharmaceutical companies and five UN Agencies
in order to significantly improve access to and
availability of, a range of medicines by