Understanding the dilemma of access to medicines requires more than shifting the blame of affordability

March 2, 2015


Citizen Journalist: Sanskriti Sasikumar


A patient being treated for MDR-TB by MSF in India holds his daily medications (Sami Silva; MSF 2014)

Pharmaceutical companies are cold-hearted, profiteering misanthropes that care not for the people they provide but for the pockets they fill.

Although there might be some truth to that statement, much of the speculation behind pharmaceutical companies arises because they have been used as a scapegoat; bearing the blame in a rather complicated issue. Unfortunately, the failure of equal access to medicines cannot be accounted for that easily.

As with all endeavors in global health, we need to accurately define a problem before we can begin to discuss ways of solving it. The World Health Organization (WHO) assesses access to medicines by four factors.  Those being that medicines are:

  1. Selected and used rationally
  2. Affordable
  3. Financed sustainably
  4. Distributed through reliable health systems

Yet somehow, the only factor that seems to inspire initiative is the affordability of the medicines. There has been an immense amount of time and energy dedicated to tackling this issue.  Strategies include: reducing taxes, promoting competition through generic medicines, tiered pricing, etc.  I suppose, it is somehow expected that once medicines are made affordable, the rest of the factors will just fit into place! When in reality, it is this one directional thinking that might be to blame for the little progress we have made.

It is important to establish that ‘access to medicines’ is not a phrase that we can interchangeably use on high- and low-income nations alike. As the World Medicines Situation Report points out, the failure of access in high-income nations is due to affordability (or lack thereof), whereas in low- and middle-income nations (LMICs) the affordability is compounded by an additional inability to access medicines that address the burden of neglected tropical diseases (NTDs).

Improving access to combat disease remains one of the Millennium Development Goals (MDGs).  However, if those goals were followed through with the same passion with which they were instigated, the end of 2015 would mark the start of a new era. Unfortunately, that hardly seems to be the case. World leaders promise great changes, but offer no sustainable plan to fulfill those promises. The WHO-determined pillars of access to medicines might not be welcomed as fact, but at least it provides a framework that we can use to stimulate solutions.

When access to medicines is not addressed using an established framework, it results in failure. The WHO reports that the least access to healthcare occurs in parts of India and Africa. If you are not already familiar with the reputation, India is touted as being the ‘pharmacy of the developing world’. Hence, being called out for a lack of access highlights a much bigger problem. Medicines in India are affordable, but that does not ensure that they get to the people who need it. The solution lies in strengthening existing healthcare systems, where there is a unified approach to access to care.  If we continue to approach the pricing of medicines independently of a country’s existing healthcare provisions, donor organizations will continue to lose a lot of money to economies that provide no returns.  Access to medicines relies on four factors; if we intend to implement change, we need to incorporate these factors into our framework for a solution.

The aid model is faulty. The sooner we realize that, the faster we will see an improvement in the equity of healthcare access around the world. Currently, we see the debt in many African countries rising (especially in those that receive the most aid). So, while global health actors struggle to find a solution that will involve public financing (affordability, yet again), many African countries are eagerly taking out credit from private companies. This system of borrowing worsens the vicious cycle of debt. Nevertheless, this money is going towards infrastructure and subsidies, so with a good plan in place, countries can be successful in generating income. However, global health actors do not enable these countries to implement sustainable systems based on frameworks that address access as a whole. Instead, organizations like GAVI Alliance, UNITAID, and the Bill and Melinda Gates Foundation, continue to implement independent projects that address maternal health in some countries and vaccinations in others? Healthcare actors seem to be intentionally sustaining a system of aid.

World leaders need to stop making fractured plans in the name of development goals. Identifying aspects of care that we believe are part of the human right to health, such as access to maternal and reproductive health, or the eradication of malaria, won’t have any long-term impact if there isn’t a sustainable system in place to ensure its continuity.

As the MDGs reach their end in 2015, these world leaders will adopt a new set of goals called the Sustainable Developmental Goals (catchy in name, but will they be the solution we need?).  It may be a good while yet, before there is a shift in our method of improving access to medicines. We need to establish a systems-based approach to improve access to care; perhaps a framework, consisting of rationality, affordability, sustainability and progress. The future of global health needs to see a celebration of the diversity of global health actors, whereby persecution is replaced with the understanding that a collaborative approach is needed in policy making. Until then, however, there is a good chance that we will be stuck in this stalemate for a little longer.


Sanskriti Sasikumar is a third year medical student at the University of Limerick.  She is interested not only in appropriately defining complex issues, but also in working to sustainably solve the dilemmas of today’s global health and development.  She joins us as a regular contributor and citizen journalist with our new Global Health Writes initiative.

Email: [email protected]

Twitter: @sanskritiskumar



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