Opinion: Strong Pharmaceutical Systems are Crucial to Attaining UHC
The World Health Organization recently issued a statement calling on all countries to make three specific commitments to universal health coverage and be prepared to announce them at the World Health Assembly, which begins May 21.
UHC — the assertion that every person must have access to the health services they need, when and where they need them, without facing financial hardship — improves health. But that’s not all: It reduces poverty, creates jobs, drives economic growth, promotes gender equality, and prevents epidemics. It’s a momentous occasion and a great opportunity to start making real progress toward UHC.
But unless country commitments include efforts to strengthen pharmaceutical systems, communities will continue to struggle with inadequate health services and rising health costs that put their health and economic well-being in peril.
Here’s why: Poorly managed pharmaceuticals may be simply unaffordable or unavailable, meaning many people are unable to access the medicines they need. In some countries, medicine spending accounts for up to 67 percent of total health expenditures. They are a big expense for households, too, accounting for 45 to 75 percent of out of pocket payments.
And then there is availability: A Lancet analysis of 36 low- and middle-income countries showed that public availability of generic medicines ranged from about 29 percent to 54 percent. Gaps that drive system inefficiency include faulty selection and quantification, poor procurement and distribution practices, underuse of generic medicines, use of substandard and counterfeit medicines, and inappropriate medicine use.
But we know what to do about it.
Leadership and governance
UHC isn’t possible without country-wide policies that take it into consideration. Laws, policies, and financing arrangements should promote access to health services and quality-assured medicines at a cost that does not put people at risk of financial catastrophe.
It’s important for countries to allocate essential medicines within expanded health services coverage. For example, in early 2017, Management Sciences for Health supported Ukraine in approving a national essential medicines list to streamline the selection of medicines — a landmark achievement in a country with a weak health system inherited from the former Soviet Union.
Public procurement was troubled by unethical practices and inefficiency, and patients were reduced to paying outrageous prices for unprescribed, unregulated medicines. Ukraine also launched a pharmacy reimbursement program covering 21 essential medicines for cardiovascular disease, type 2 diabetes, and asthma. Of the 157 products available in the program, 35 are free and the others have a small co-pay. More than 6,600 pharmacies are accredited to participate in the program.
There’s been a particularly big void in the UHC conversation on good pharmaceutical management, which helps strengthen supply chains, set optimal prices, track spending and reduce waste, and can get safe, cost-effective pharmaceuticals to market faster.
Good pharmaceutical management improves cost-efficiencies, too.
According to Systems for Improved Access to Pharmaceuticals and Services 2018 report, four countries — Cameroon, the Dominican Republic, South Sudan, and Swaziland — saved $120 million through improved pharmaceutical management practices, namely, improved national quantification and procurement; revised national essential medicines list; as well as revised hospital formularies and stock redistribution at service delivery points.
Savings accrued from improved efficiencies can be utilized for additional procurement of life-saving medicines or for improving health services
Countries need sound data for better decision-making. Solutions range from higher-tech web-based logistics systems to basic tools such as standardized checklists for storage facilities. With MSH’s support, seven countries have improved electronic information systems for product registration to make their processes more efficient and transparent.
Four countries — Bangladesh, Ethiopia, Mozambique, and Namibia — are implementing a web-based regulatory information system called Pharmadex. In Mozambique, the average time to approve a registration application and product time to market decreased by 36 percent, from 429 days to 275 days.
And then there are the people who deliver services.
Trained health workers limit inappropriate drug prescribing and use, fighting the spread of antimicrobial resistance, which threatens to make standard treatments ineffective. With our support, South Africa, Lesotho, and Sierra Leone have adopted pharmaceutical leadership development programs that address real workplace challenges and improve service delivery. Schools of pharmacy in Namibia and Afghanistan have updated their curricula to reflect best practices.
Involving the private sector
No approach can work without including those who are critical to the day-to-day operations of a pharmaceutical system. This means those who might be the first health worker a patient encounters.
Unregulated neighborhood drug shops — their owners and workers untrained and their stock of unreliable quality — are the first point of care for millions of people.
In 2003, MSH and Tanzania pioneered a model to accredit and regulate these private businesses, dramatically improving access to affordable, quality medicines and services, including malaria prevention and treatment, family planning, and HIV/AIDS information.
Tanzania’s early success led to a nationwide program with more than 11,500 accredited shops. Uganda, Liberia, Nigeria, Zambia, and Bangladesh are now adapting the program — and global health stakeholders are recognizing the profound potential drug shops have to advance public health.
Our company has also launched a new private venture in Kenya called MedSource. It’s a group purchasing organization that offers a platform for governments, health facilities, and vendors to procure quality-assured pharmaceuticals negotiated at favorable rates.
For achievements like these, all countries must explicitly recognize that strengthening pharmaceutical systems and management practices to improve access to and affordability of medicines is imperative for achieving UHC. We’ve seen that it works, and we know how to do it.
When the health leaders of every country gather in Geneva this May and announce their commitments to making UHC a reality, I hope they will make pharmaceuticals a priority.