Stop the Stock-outs! Access to Essential Medicines for All Christa Cepuch BSc Phm Health Action International Africa RHS Coalition Meeting 27 May 2010,

Stop the Stock-outs! Access to Essential

Medicines for All

Christa Cepuch BSc PhmHealth Action International Africa

RHS Coalition Meeting27 May 2010, Kampala

What are Essential Medicines?

satisfy the priority health care needs of the population selected with due regard to public health relevance,

evidence on efficacy and safety, and comparative cost-effectiveness

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 adequate information, and at a price the individual and the community can afford

implementation of the concept of essential medicines is intended to be flexible

exactly which medicines are regarded as essential remains a national responsibility

www.who.int/medicines

WHO: Availability of essential medicines

• Average availability was only 34.9% in the public sector and 63.2% in the private sector.

• Public sector availability of medicines is consistently lower than in the private sector.

Country-specific evidence: KenyaMMePA (monitoring of medicine prices and availability)

Fig 1. Trends in percentage availability of medicines in the hospitals and health centres in the public sector April 2006-July 2008

69%

57%

63%

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65%68%

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Hospitals Health centres

Barriers to Access

Health system capacity Health budgets Lack of research and development Price Patents Quality of diagnosis Accurate prescribing Selection, distribution, dispensing of medicines Medicine quality

WHO: Public expenditure on medicinesThere is wide variation in national per capita spending on

medicines by the public sector, ranging from US $0.04 to $187.30 among developing countries.

Availability of Artemether/lumefantrine 20/120 mg in Kenya

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public sector facilities

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mission sector facilities

Global Fund grant start date (02/2006)

WHO / HAI Africa: Increased finances and differential pricing -- impact on availability

Using evidence for advocacy: Stop Stock-outs (SSO)!

Work with partners in different countries to engage the public on their Human Right to access essential medicines KETAM, CIN, EPN, KEHPCA, AGHA, NAPHOFANU, HEPS,

ZLP+, TLAC, MHEN, others

SSO campaign: context and structure

30 years after the introduction of the EM concept, there are simply not enough medicines on the pharmacy shelves.

Stock-outs are worst in rural areas, and harm poor people. Stock-outs force people to purchase medicines from much

higher suppliers in the private sector or -- more frequently -- simply to go without needed medicines.

The failure to properly stock public health pharmacies and clinics stems in part from economic constraints and bureaucratic obstacles. But above all, it is a failure of political will. If governments commit to get EMs on the shelves, they can do it.

CS teams in five countries (Malawi, Ke, Ug, Zam, Zim) CS teams getting small grants to run their campaigns Truly a networking effort

SSO campaign: demands

The SSO campaign is calling on governments and health departments to end stock-outs now by:

• Giving financial and operational autonomy to the national medicines procurement and supply agency

• Allowing representation of civil society on the board of the national medicines procurement and supply agency

• Ending corruption in the medicine supply chain to stop theft and diversion of essential medicines (EMs)

• Providing a dedicated budget line for EMs

• Living up to commitments to spend 15% of national budgets on health care

• Providing EMs for free at all public health institutions

SSO continental campaign

Taking SSO issues to the regional and sub-regional levels (WHO AFRO, AU, EAC, SADC, etc)

Getting broad continental support for the UNITAID Patent Pool

Countering problematic counterfeit legislation

Highlighting specific medicines (CEPA, RH medicines …?)

Availability of oxytocin injection 5IU/mL

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Overall Public

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Overall Private

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Overall Mission

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Kenya: PUBLIC SECTOR AVAILABILITY of FERROUS 200mg / FOLATE 400mcg

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