WHO says governments must do more to improve access to essential medicines

An alarming lack of availability of essential medicines in the public sector drives patients to pay higher prices in the private sector or go without, according to a WHO study reported in the online edition of The Lancet. The results confirm that governments must do more to improve access to essential medicines as part of their efforts to make national health systems more efficient and equitable.

The study analysed data from surveys in 36 countries from all WHO geographical regions and World Bank income groups. Results show an average public-sector availability of only 38% across surveys. This forces patients to buy medicines from the private sector where treatments are more expensive and frequently unaffordable. In Africa, for example, the lowest-paid government worker needs to spend two days' salary each month to purchase diabetes treatment using the lowest-priced generic medicine. When the originator brand is used, costs escalate to over eight days' wages.

"You should not have to choose between buying medication for an ailing parent or buying food for your children," said Carissa Etienne, WHO Assistant Director-General of Health Systems and Services. "It is not fair or necessary. That is why we are calling again for comprehensive primary health care, so that health systems in every country put the real health needs of people and communities first, and families are not impoverished or bankrupted because of health care payments."

On the pricing side, the study revealed that "cuts" taken by wholesalers, distributors and retailers plus government taxes and duties are driving prices beyond affordability in many countries. In some countries, add-on costs can double the public-sector price of medicine, while in the private sector, wholesale mark-ups ranged from 2% to 380%, and retail mark-ups ranged from 10% to 552%.

"Essentially, multi-layered supply chain costs add up to one thing for patients, no access to essential medicines," said Dr Richard Laing of the Essential Medicines and Pharmaceutical Policies department at WHO. "When you pull apart the layers of additional charges, the potential solutions for governments to make life-saving medicines more available and accessible are clear - improve financing and distribution efficiency, promote the use of generic products and control supply chain costs by limiting mark-ups and removing duties and taxes."

The study further asserts that these actions should all be part of national medicine policies that are measured and evaluated against predetermined benchmarks at least every two years, with routine monitoring and reporting more frequently.

The results cover 15 medicines included in at least 80% of surveys, as well as four specific medicines used to treat asthma, diabetes, hypertension and acute infections. The figures are adjusted to account for differences in buying power of local currencies and then compared to international reference prices, allowing for cross-country comparison.

The work is part of an ongoing joint effort between WHO and Health Action International (HAI) to highlight and improve availability and affordability of essential medicines, especially in low- and middle-income countries.