Opinion: Strong Pharmaceutical Systems are Crucial to Attaining UHC

Opinion: Strong Pharmaceutical Systems are Crucial to Attaining UHC

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

This story was originally published on Devex

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.


Pharmaceutical management

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.