UHC and Access to Medicines: From Dialogue to Defining Action

UHC and Access to Medicines: From Dialogue to Defining Action

 {Photo credit: MSH/Paula Champagne}Participants of "Medicines as Part of UHC: Starting a Dialogue".Photo credit: MSH/Paula Champagne

What do medicines, financing, governance, and management have in common?

They are all essential pieces of the puzzle that must come together in order to make universal health coverage (UHC) a realizable goal.

From June 2-4, 2013, Management Sciences for Health (MSH), in collaboration with the Rockefeller Foundation and Harvard Medical School’s Department of Population Medicine, and additional support from the Pan American Health Organization (PAHO) and the US Agency for International Development (USAID), brought representatives of countries working towards UHC, private insurance schemes, and medicines and financing experts from across the globe to start a dialogue around medicines coverage under UHC.

Dr. Jonathan Quick, MSH’s President and CEO opened the event: “UHC is about filling the tragic gaps that exist in health systems around the world: gaps in access, in affordability, and health needs that go unanswered.”

What constitutes UHC?

This question continues to evolve. Yet, during this event, it became clear that access to medicines, a critical component of UHC, is missing or under-represented in many conversations.

Dr. Carissa Etienne, the Director of PAHO, explained that now is the right time to address the role of medicines in UHC and that medicines need to become a priority topic that is rigorously discussed. According to Dr. Etienne, mainstream thinking about UHC has centered on financing health care, but this is only one part of the puzzle. UHC needs to ensure access to preventative, curative, and promotive health care. UHC should also be accompanied by strengthening health systems. UHC is a goal and at the same time a process. Hence, measurability and monitoring progress with sound indicators is critical, she said.

“Countries must understand that medicines are a major cost factor and that runaway medicine benefit costs will limit UHC progress,” noted Douglas Keene, vice president of MSH's Center for Pharmaceutical Management.

So, why are medicines, financing, governance, and management grouped together?

To put it simply, without proper financing, governance, and management mechanisms in place, inclusion of medicines and other health technologies in a coverage plan can bankrupt a country’s or private insurance scheme’s efforts in pursuit of UHC. In turn, this would leave families and individuals without essential life-saving medicines.

Out of these discussions, six domains of action emerged:

  1. Medicine benefits design for cost and quality: To enable countries to roll out sound pharmacy benefits packages using a step-wise approach, they need to conduct medicine utilization and cost reviews. Tools also need to be developed to support decision-making, such as clear criteria to select and evaluate medicines and services.
  2. Public-private design for cost and quality: The first step that participants identified was to define what public-private partnership means for each country. In some cases, it may mean contracting out services. In others, it may involve private sector management of government facilities. The government needs to assure that incentives are aligned with clear, measurable health goals and that supportive regulation exists to ensure healthy partnerships.
  3. Information for decision making across multiple systems: Participants unanimously agreed that information for decision-making is a key component for smart policy making around pharmaceutical benefits. Two seemingly contradictory challenges were identified: lack of data and too much data. Resulting recommendations included defining indicators and feedback mechanisms that can help decision makers find out how the system is operating and defining methodologies to ensure data standardization and interoperability across various data systems.
  4. Good governance: Accountability and transparency were identified as crucial for the success of any benefits management scheme. One step to ensure accountability and transparency is developing outcome metrics and then linking incentives to these metrics. Another step is to include a broad range of stakeholders in program decision making.
  5. Advocacy and civil society: Civil society actors were identified as important groups to engage in advocacy for UHC. Additionally, the evaluation of pilot programs and communication of success stories through the media is a powerful way to build popular support and assure the integration of the program into the national health agenda.
  6. The politics of medicine and UHC: Health systems are complex and comprise stakeholders with many different agendas. However, the success of UHC relies on strong political will. Bringing stakeholders together to create a common understanding of UHC and the role of medicines within it can help address fragmentation and inequity at the country level and move the UHC agenda forward.

[Participants identified six "domains of action" at the UHC and medicines meeting.] {Graphic facilitation by dpict}Participants identified six "domains of action" at the UHC and medicines meeting.Graphic facilitation by dpict

With these six domains of action defined, Medicines as Part of UHC: Starting the Dialogue ended with the goal of ensuring that all people have access to “promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access” (World Health Organization). This dialogue can now continue by focusing on action-oriented next steps to assure that medicines are adequately covered in sustainable UHC initiatives.

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Megan Rauscher is a project officer in the Center for Pharmaceutical Management at MSH.