Putting Access to Medicines at the Center of Universal Health Coverage: A Conversation with Dr. Douglas Keene

Dr. Douglas Keene. {Photo credit: MSH.}Photo credit: MSH.

Modern medicines, vaccines, and other pharmaceutical products have revolutionized health care, yet budget constraints and poor infrastructure prevent many people in developing countries from accessing even the most basic treatments. Millions die each year from diseases that could have been prevented or treated with modern pharmaceuticals. MSH’s Center for Pharmaceutical Management (CPM) develops the capacity of both the public and private sectors in low- and middle-income countries to procure and distribute quality medicines and health supplies and ensure their proper dispensing and use—all in a cost-effective way.

MSH spoke with Douglas Keene, PharmD, MHS, Vice President for CPM, about how pharmaceutical services should fit into the UHC framework and MSH’s role in developing that framework.

Why is access to medicines a critical component of universal health coverage?

Much of health care in resource-limited countries is financed out-of-pocket—an average of 50%—which places the largest burden on the people who can least afford it. In addition, up to 68% of those out-of-pocket health costs are for medicines. However, without access to medicines to treat the most common illnesses, countries cannot begin to make a dent in the number of avoidable deaths from conditions ranging from malaria to high blood pressure. We feel that as more and more countries contemplate how to initiate UHC plans, pharmaceuticals are often under-rated or overlooked all together.

In what context will access to medicines be discussed at the Second Global Symposium on Health Systems Research in Beijing?

MSH is collaborating with Harvard Medical School’s Department of Population Medicine to present a 90-minute satellite session, “Medicines and Universal Health Coverage: Why must we care and what can the global health community do?” Moderated by MSH President Jonathan D. Quick, MD, MPH, expert commentators will address the issues of how health systems are addressing key medicine challenges to achieving universal coverage and how the global health community can support medicines management and sound benefit policies as part of a universal coverage scheme. Panelists include Mr. Osei Acheampong of the National Health Insurance Authority of Ghana; Dr. Benito Reverente of Prudentiallife Healthcare, Inc., Philippines; Dr. Jing Sun, National Institute of Hospital Administration, Ministry of Health, China; Dr. Abdulkadir Keskinaslan, Novartis Pharma AG, Switzerland; and Dr. Anita Katharina Wagner, Harvard Medical School and Harvard Pilgrim Health Care Institute, USA.

In addition, as part of the MSH Center for Pharmaceutical Management’s advocacy efforts around this issue, we are making plans to convene next year a high-level technical meeting to discuss the role of medicines in UHC. This meeting will help the global health community better understand the issues, problems, and potential solutions to incorporating pharmaceutical services into UHC.

How can policymakers maximize the benefits from medicines while keeping the costs from crippling the health system or households?

To make health financing systems more equitable and increase coverage to everyone, many low- and middle-income countries are exploring ways to strengthen such systems. Five of the ten leading causes of waste in health systems involve medicines. UHC leaders need to advocate for the alignment of pharmaceutical policies with UHC goals from the very beginning and to target how medicines are chosen, managed, and used if UHC is to positively affect health outcomes in an affordable way.

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