Summary: Joint Session between the Working Groups on Health Promotion and Private Sector

Private sector and Health: Access to Medicines

Introduction
It is difficult to work with the private sector, but it is almost impossible to live without it. The relations between the private sector and NGOs on health issues and access to cheaper medicine have been all but easy. There are many issues to be resolved: access to essential drugs, unaffordable life-saving drugs, equitable drug prices, lack of R&D for neglected diseases, etc. The Commitment of NGOs, the pharmaceutical industry, public support, political will and public funding can play a role in defining solutions.

General Summary
Developing countries represent 75% of the world population and account for 8% of the pharmaceutical sales. Half of the population living in impoverished areas of Africa and Asia does not have access to essential drugs. Since 1999 Médecins sans frontiers (Doctors without borders) have led the Access to Essential Medicines Coordination campaign. This campaign is based on 3 main pillars of research:

1. Overcoming the barriers to access drugs;
2. Underlining the need for research and development of drugs for neglected diseases;
3. Studying the effect of globalisation on prices.

Solutions can only be political, as the world leaders need to bring money on the table. There is a new tendency to concentrate efforts on major killer diseases such as AIDS, malaria and tuberculosis, whilst the access problem is spread through the whole spectrum of preventive and curative drugs. Access to existing drugs, however, does not mean the efficient use of effective medicines. The rational use of essential drugs persists as an enormous barrier. For example, old antibiotics and other drugs are widely available and used in poorer countries for treatment regimens that are difficult to adhere to. Prices make drugs inaccessible.

The WHO's role has been mainly concentrated in assuring that available medicines are safe and of high quality when they reach the market. There is much to be done to ensure that international patent and drug production agreements do not impinge on the current insufficient access to drugs. The WHO has been urged to create more links with civil societies to ensure leadership and to build capacity in key countries for producing their own essential, safe and quality medicines. The WHO also ought to support and work with these countries to ensure the monitoring of the quality of drugs available for sale in the informal sector. The WHO should also provide visible leadership and close relations with new enterprises, such as the Global Fund, to ensure that people who suffer from major diseases benefit from it.

Whilst pharmaceutical companies have, in some cases, donated drugs to African countries for specific diseases such as leprosy and epilepsy since 1995, their main thrust has been research and development for profit. The greater challenge is to ensure early diagnosis and a rational prescription of effective drugs and treatment close to the people. The high price of drugs—in addiction to other health costs—cannot be covered by the patients.

Surprising issues
A number of examples were cited to show what could be done in terms of price reductions, especially for drugs used to combat HIV. Similar efforts should be extended to other life-saving drugs. It was pointed out that availability and accessibility of medicines go hand in hand and that strengthening health infrastructure has to be a priority.

Conclusions and recommendations
Creating partnerships between the public and private sector organizations has become a popular mechanism in the endeavour to surmount the health and disease problems of the poor. However, the results cannot easily be demonstrated. There is no evidence that such partnerships have had any positive effect on the people's health status, especially in connection with their access to at least essential drugs. At the same time, the private sector and the international economical and financial policies on public services have deprived many countries of their already fragile infrastructure, their material and human resources and their national health care delivery systems.

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