PHA-Exchange> Improving Access to Medicines in Latin America

[claudio at hcmc.netnam.vn]

from "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----

Improving Access to Medicines in Developing Countries

Application of New Institutional Economics to the Analysis of Manufacturing 
and Distribution Issues


C. James Attridge,  Research Fellow, Centre for Health Management, Tanaka 
Business School, Imperial College, London, UK
Alexander S. Preker, Chief Economist, HNP, The World Bank, Washington DC, USA

Paper prepared for the 4th iHEA World Congress, San Francisco, USA, 15th-18th 
June 2003

Discussion Paper Series is produced by the Health, Nutrition, and Population 
Family (HNP)
World Bank's Human Development Network.- March 2005

 
Available online as PDF file [54p.] at: 

http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/28162
7-1095698140167/AttridgeImprovingAccessFinal.pdf 
<http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/2816
27-1095698140167/AttridgeImprovingAccessFinal.pdf>  

 
"...The debate on improving access to medicines in developing countries has 
focused attention on the macroeconomic context and defining the demand side 
needs, based upon disease categories and purchasing power in a range of middle-
income and Least Developed Countries. Far less attention has been given to 
understanding the diversity of supply side processes and their likely future 
evolution. This paper examines alternative frameworks for empirical analysis 
of supply side activities, namely, the manufacture and distribution of 
medicine, through the application of New Institutional Economics (NIE)
concepts. Attention is focused particularly upon the potential utility of 
ideas from agency theory, transaction cost analysis and contemporary ideas 
from strategy theory. 

The major purpose of this paper is to use these theoretical frameworks to 
provide insight for policy makers, when faced with specific situations, 
whether in an international agency, or a private company, or in defining a 
national strategy. The analysis attempts to show the importance of 
distinctions between ideas of 'make' or 'buy', between 'national self 
sufficiency' and 'international purchasing' strategies, the limitations of 
contractual agreements under market governance and the crucial linkages 
between strategy formulation, strategy implementation and the necessary 
capabilities to achieve successful performance in practice. 

The current international situation on the investment, location and capacity 
of pharmaceutical manufacturing is reviewed and likely future scenarios 
suggested. Correspondingly current patterns of trade in medicines and their 
likely development within the context of the WTO and bilateral trade 
agreements are discussed.

Against this background the promise and the pitfalls for new forms of public-
private partnerships, which may offer attractive alternatives to conventional 
structures are evaluated. The implications of alternative future strategic 
options for national governments in setting the balance between health and 
industrial policies are examined and in particular the extent to which a 
national manufacturing capability should be developed or sustained. Similarly 
the scope for improving low cost distribution systems for medicines, based 
upon a mix of public and private sector channels, is assessed. The authors 
conclude with suggestions for further development of a transaction-based 
framework....'

 
GENERIC DRUG POLICIES IN LATIN AMERICA
Núria Homedes , Associate Professor, University of Texas, Houston Health 
Science Center, School of Public Health, El Paso, TX, USA
Roberto López Linares, Coordinator for Latin America, Health Action 
International
Antonio Ugalde,  Professor Emeritus, Department of Sociology, University of 
Texas, Austin, TX, USA

Discussion Paper Series is produced by the Health, Nutrition, and Population 
Family (HNP)

World Bank's Human Development Network.- March 2005

Available online as PDF file [52p.] at: 

http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/28162
7-1095698140167/HomedesGenericDrugFinal.pdf 
<http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/2816
27-1095698140167/HomedesGenericDrugFinal.pdf>  

".....The World Health Organization and pharmaceutical experts have 
recommended that Generic Drug Policies be implemented to improve the 
availability of affordable medicines. This document reports on the status of 
generic drug policies in Latin America. The data presented are based on 
several sources: a survey conducted in 2003, archival information, and 
official health and pharmaceutical policy documents. The survey revealed that 
countries use different definitions for the terms "generic and bioequivalence" 
severely curtailing the ability to make comparisons across countries. 

 

There is also ample variability in the periods allowed for drug registration 
and registration charges. Although most countries in the region are becoming 
increasingly dependent on pharmaceutical imports, many have sizeable local 
pharmaceutical manufacturing capacity. The need to adopt common definitions 
for technical terms, the urgency of improving quality controls and the 
importance of strengthening generic drug programs are highlighted....."

 


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