Ghana, Tanzania and El Salvador Selected for Programs to Improve Access to Medicines

The SEAM Program will work in each country to establish effective systems for providing quality medicines and health services at affordable prices

WASHINGTON, DC (APRIL 4, 2002) — Jim Rankin, Director of the Center for Pharmaceutical Management at Management Sciences for Health, announced today that Ghana, Tanzania and El Salvador have been selected for country programs to improve access to quality essential medicines and services. Using innovative public-private initiatives, the Center's Strategies for Enhancing Access to Medicines (SEAM) Program will work in each country over the next three years to establish effective systems for providing quality medicines and health services at affordable prices.

Ghana and Tanzania have been selected for in-depth country programs. In both countries, people lack regular access to the medicines required for treatment of the most common killer illnesses and diseases, such as diarrhea, respiratory infections, tuberculosis, and malaria, particularly in underserved rural areas. In Ghana, availability of drugs has improved since the mid-1990's, but one out of every three patients is still unable to access drugs in the public sector. Further, the cost of drugs in the rural areas is substantially higher, the distance to the nearest clinic much greater and incomes much lower than in urban areas. Consequently, people in these areas are unable to afford the full cost of treatment, particularly when they must also bear the cost of travel and lost work time.

The same situation exists in Tanzania. Patients often are forced to turn to the private sector for medicines, where prices are commonly twice the cost of those provided in public facilities. As a result, patients purchasing medicines in the private sector can often only afford a portion of the prescribed dosage. This results in ineffective therapy and in the case of antibiotics it increases the risk of antimicrobial resistance. Compounding the problem further are ongoing issues of questionable quality of drug products and pharmaceutical services in both the public and private sectors.

"Limited access to good quality pharmaceuticals continues to be a major problem in developing countries, despite significant gains in the pharmaceutical industry during the last 50 years," said David Lee, Deputy Director of the Center for Pharmaceutical Management. "The SEAM program is breaking new ground in addressing this problem by bringing the public and private sectors together at the country level to achieve public health goals."

In Ghana, SEAM will provide technical support to establish a network of essential medicines franchises, with a focus on reaching underserved rural areas. The franchises will be monitored by the government to ensure that the products and services are of high quality. However, they will operate in the private sector and owners will have incentives and benefits to encourage provision and delivery of high quality medicines and services at affordable prices. A second component of the Ghana program will focus on improving procurement services to assure availability of high quality drugs and pharmaceutical services in private, faith-based hospitals.

Similarly, SEAM support in Tanzania will be to establish a network of private accredited drug dispensing outlets, which can provide a range of quality essential medicines and services at reasonable prices. SEAM will also assist the Ministry of Health of Tanzania in their selection of one or more commercial wholesalers to serve as pharmaceutical suppliers. By selecting a limited number of suppliers, the Ministry will be able to better monitor the quality and price of products sold to public and private health facilities as well as the accredited drug dispensing outlets. SEAM will also provide technical assistance to the Ministry in developing and implementing a program for ensuring the quality of pharmaceutical products in the Tanzanian marketplace.

The SEAM initiative in El Salvador will focus specifically on improving access to medicines in hospital settings and outpatient clinics. These facilities provide care for nearly 50 percent of El Salvador's six million people, yet they are often unable to maintain a sufficient stock of essential medicines to effectively treat patients. In an effort to improve the availability of medicines in these facilities, SEAM will work with the government of El Salvador to engage a commercial wholesaler to provide inventory management and distribution services to a network of 30 hospitals and 130 outpatient clinics. By purchasing medicines from a single wholesaler, the government can better ensure an adequate supply of drugs, monitor their quality, and will be empowered to negotiate and control prices with the wholesaler.

"Critical to the success of these programs is the commitment and involvement of the respective national government, as well as the other public sector and private sector participants," said Lee. "SEAM has engaged these partners from the beginning to ensure that the initiatives are consistent with their own goals."

Funded by the Bill & Melinda Gates Foundation, the SEAM Program seeks to develop and implement innovative systems that increase consumer access to health commodities by using private sector infrastructure and services, while at the same time improve the quality of these private sector services in support of public health objectives. For more information on the SEAM initiatives in Ghana, Tanzania, or El Salvador, please visit the SEAM Web site.