NIGERIA: Seizure of drug shipment threatens ARV access

IRIN – 13/03/09 19:19

HEALTH-KENYA: Drug Shortages Threaten Public Health

Australia.To – 13/03/09 09:34

STOCK-OUTS OF ESSENTIAL MEDICINES

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Chronic drug shortage crippling EA health centres

The East African – 13/03/09 22:32

The Essential Medicines Concept

“Essential medicines are those that satisfy the priority health care needs for
the population. They are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.” (WHO, 2002)

Essential medicines were originally defined by the World Health Organization (WHO) as those which: “satisfy the needs of the majority of the population and therefore should be available at all times, in adequate amounts, in appropriate dosage forms and at a price the individual and community can afford.”

The idea of defining essential medicines – and establishing a list of them – was developed from a report made to the 1975 World Health Assembly. These efforts were aimed to increase the range and availability of medicines for populations with poor access.
An Expert Committee on the Use of Essential Medicines was established to assist member states to select and procure essential medicines. In 1977, the first report of the Expert Committee included (a) criteria for determining if a medicine fit the definition of an essential medicines and (b) the first model Essential Medicines List (EML) as two examples of how the concept of essential medicines could be implemented. Since then WHO has updated the model EML every two years. In 2007, 30 years after introduction of the essential medicines concept, a model EML for children was also introduced.

Adapting the concept at national level
The model EML is expected to be adapted at national level based on the local public health context of the country. Most countries have published a national EML. Most national lists have been updated in the past five years; this exercise is crucial to reflect new therapeutic options and changing therapeutic needs.
There should be clear links between the national EML, standard treatment guidelines, national expenditure on essential medicines, and procurement practices within the country.
Uganda has a national EML, which was last updated in 2007. However, two thirds of government health centres do not have the EML, according to the 2008 Pharmaceutical Situation Assessment survey (MoH).

The Stop Stock-outs campaign is supported by funds from Open Society Institute

Selection of medicines for the national EML
Within a country, the selection of essential medicines is usually a two-step process. The first involves regulatory approval, which is based on a review of efficacy, safety, and quality of medicines (without comparison between medicines). From these registered products, essential medicines within a therapeutic class are then selected on the basis of comparative efficacy, safety, and cost. To best ensure the widest acceptance of the list, the selection process for essential medicines needs the involvement of a number of stakeholders, including prescribers, dispensers, academia, health facilities, civil society, professional organizations, and others.
Before 2002, relatively expensive medicines were basically not found on the WHO model EML. This was successfully challenged by public health advocates and treatment activists. With the issue abolished, traditionally more expensive medicines (such as antiretrovirals) were quickly included on the WHO model EML and the official definition of essential medicines was updated to: “Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.”

It is also important to stress that essential medicines represent the most cost effective treatments for a given condition in a country.

Challenges
The Uganda EML has established priorities for selection of, and expenditure on medicines to meet the needs of the population. However, it does not adequately provide for key medicines which might not be needed for the majority of the population, but are crucial for the treatment of certain diseases (such as cancer) and specific age groups (such as the elderly and children).
A renewed commitment to availability of essential medicines in the Uganda Minimum Health Care Package is urgently needed in order to realize the spirit and intention of the second national Health Sector Strategic Plan (HSSP II).
References
World Health Organization. 1 The selection and use of essential medicines. Report of the WHO Expert Committee, 2002 (including the 12th Model List of Essential Medicines). Technical Report Series No 914. Geneva: WHO,
Hans V Hogerzeil 2 The concept of essential medicines: lessons for rich countries
Laing R, Waning B, Gray A, Ford N, van t ‘Hoen E.3 25 years of the WHO essential medicines lists: progress and challenges. Lancet 2003 May 17;361(9370):1723-9
Stolk P,Willemen MJC, Leufkens HGM. 4 “Rare essentials” : drugs for rare diseases. Essential Medicines. Lancet 2003; 361:1723-9. 4.
J Robertson1 and SR Hills. 5 The Essential Medicines List for a Global Patient population
World Health Organization. Backgrounder and Facts for launch of the United Nations report Delivering on the Global Partnerships for Achieving 6 the Millennium Development Goals: WHO
World Health Organization. 7 World medicines situation. 2004. Geneva: WHO

The importance of an EML
An EML serves the following important functions:
to guide the procurement and supply of • medicines in the public sector
to inform reimbursement schemes •
to inform medicine donations •
to define training of health workers •

Campaign statement – Thursday, 19th March 2009

Access to essential medicines is a human right and a cornerstone of an effective primary health care system. Access to free essential medicines determines whether people live or die, suffer pain and discomfort or have their ailments cured, recover from illness or endure life-long disease.

The World Health Organization (WHO) defines essential medicines as “those that satisfy the priority health care needs of the population… Essential medicines are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford.” At the World Health Assembly in 1977, our governments made a commitment to ensure these essential medicines are available in public health facilities.

Yet today, over 30 years later, surveys conducted over the past four years show that essential medicines are not available in 32-50% of government health facilities in Uganda. These are medicines used to treat common diseases such as malaria, pneumonia, diarrhoea, HIV/AIDS, TB, diabetes and hypertension – all of which are among the highest causes of death in the country.

Stock-outs disproportionately affect the 9 million Ugandans who live on less than a dollar a day. To compound these problems, stock-outs force people in already dire circumstances to buy medicines at much higher prices from the private facilities. Due to these excessively high prices, patients are frequently forced to go without medicines needed to treat serious conditions that are otherwise treatable or preventable. Too often, stock-outs unnecessarily leave patients facing serious illness or death.

The “Stop the Stock-outs” campaign is calling on Uganda government, MoH and local government to end stock-outs now by:
Ensuring that there is sufficient funding for the medicines within minimum healthcare package•
Giving representation of civil society on the board of the National Medical Stores and at local government • level
Enhancing transparency in medicine procurement by districts•
Ending corruption in the medicine supply chain to stop theft and diversion of essential medicines•
Living up to commitments to spend 15% of the national budget on health•
Providing free essential medicines at all government health facilities•

The failure to properly stock government health facilities with essential medicines stems in part from budget constraints and bureaucracy. But above all, it is a failure of political will. If the Uganda government commits to having medicines in its health facilities, it can do it.

We also call upon international partners and civil society actors to support the availability of essential medicines in Uganda.

It is time to Stop Medicines Stock-outs; it is time to Ensure Access to Essential Medicines for All!

Kenyan team organizes two public forums

The Kenya ‘Stop- stock out’ campaign team is organizing two public forums to spread out the campaign message to the people on the ground as well as to create better awareness of stock outs and unavailability of essential medicines around the country.

The public forums will be held on 23 June in the coastal city of Mombasa and in the first week of July in Kisumu in Western Kenya. The forums are expected to bring together policy makers, health professionals, and civil society organizations working on health issues.

The forums will offer a good opportunity for consumers and patients to discuss problems around access to essential medicines including the causes and possible solutions. The forums are also expected to empower the public to put pressure on government to provide essential medicines in public health institutions and demand that the recommendations of the task force put up to look into the Kenya medical Supply Agency (KEMSA) be implemented.

The taskforce had recommended among others that KEMSA be given financial and operational autonomy and procurement functions be solely left to it so that it can comply with Public Procurement Regulations as outlined in the Public Procurement Act.

The two forums are being organized by the Kenyan campaign team members who include Consumer Information Network (CIN Kenya), Kenya Access Treatment Movement (KETAM) and Kenya Hospice and Palliative Care Association (KEPHCA).

Which essential medicines for common diseases are experiencing stock outs in your country?

Margaret Fondo

When we spoke to Margaret Fondo, a primary school teacher in Takaungu sub-location in Coast Province, she was deeply concerned about the availability of medicines in the area.

As a teacher, the 44 year-old mother had a medical allowance which paid for most of the treatment that Margaret and her family of four needed. However, despite having the assurance of a medical allowance, unavailability of medicines within the village and the inconvenience of having to travel far to get medicines was a major worry.

“I am thankful that we don’t fall sick often. I say ‘thankful’ because I know that when someone falls sick they have to spend a lot of money on medical expenses. As a teacher I have a monthly medical allowance, so I hardly spend money from my pocket on treatment. But even so, there is still a problem in getting medicines. In September 2007, for example, I had a skin rash that needed attention. The local dispensary was out of stock of the medicine I needed, so I had to travel to the next town to buy it. Medicines are not regularly available at the local dispensary. There may be medicines at the dispensary today and none tomorrow. That is unfortunate because many people rely on the dispensary which, as a government health facility, is supposed to offer medicines free of charge. The dispensary is also the only health facility in Takaungu. Some medicines, such as malaria drugs and painkillers, are usually available. However, medicines for chronic illnesses, such as HIV and AIDS, are hardly ever available.

Worse still, there is no chemist shop in Takaungu where people can buy prescribed medicines. If the local dispensary was well stocked, Takaungu residents would not have to travel all the way to Kilifi town to buy medicines. To get to Kilifi using public transport involves one taking a boda boda (scooter) ride from the village to the main road, that costs KSh50. After that, one has to spend an additional KSh50 on a matatu (minibus) to Kilifi town, which means spending KSh200 for the round trip. Many people have resorted to consulting traditional medicine-men when they are sick.”

Onyango Wambia

Onyango Wambia is a small-scale farmer from Lela village in Kisumu district, in the western part of Kenya. Although Onyango is diabetic, he rarely uses medicine because he cannot afford to buy the prescribed regimen. How does he then manage his condition? “This is what I use for diabetes,” he says peeling off a clove of garlic and throwing it into his mouth. “I eat an average of eight of these a day. I have done this since 1998, when I was diagnosed with diabetes. Someone tipped me about the garlic, and I have found it to be useful.” The cloves of garlic and a sizeable piece of ginger that he also adds to his self-treatment cost him about KSh10 per day. He is convinced that this routine controls his blood sugar.

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