PHM-Exch> [Global Health Check] Ensuring the availability of medicines in Burkina Faso: a shared responsibility

[Claudio Schuftan]

From: Global Health Check <oxfamblogs at gmail.com>


Global Health Check has posted a new item, 'Ensuring the availability of
medicines in Burkina Faso: a shared responsibility'
Up to 90% of people in developing countries still buy medicines through
out-of-pocket payments. Spending on medicines can be catastrophic. Medicines
also constitute a major part of national health budgets (second only to
staff
costs). For these reasons, ensuring low and affordable medicine prices is
crucial for all countries seeking to move towards universal health care,
and to
reduce economic burdens on households.

Securing adequate supplies of medicines is a shared responsibility. It is
dependent upon national governments implementing the right
policies, pharmaceutical companies producing affordable and appropriate
medicines, and the international community promoting policies to ensure
developing countries can obtain quality medicines at affordable prices.
This is
where recent progress on driving down medicines costs in Burkina Faso offers
some interesting insights.

The ‘Burkinabe’ system is based on a rationalised supply structure combined
with a policy to promote generic medicines, with prices set each year by
ministerial decree. This ensures generic medicines are available throughout
the
country at a reasonable price. According to the World Health Organisation
(WHO),
countries could save up to 5% of their health expenditure by reducing
unnecessary expenditure on medicines and using medicines more appropriately.
Underuse of generic medicines is a key driver of inefficiency. Generics cost
between 20% and 90% less than branded medicines and promoting rational use
is an
effective method to reduce health spending.

In Burkina Faso all medicines supplied to the public health sector come
through
CAMEG (Office for the Purchase of Essential Generic Drugs), a private
not-for-profit organization that exclusively sells generics. An exception is
made for hospitals to allow the procurement of brand name medicines from
private
wholesalers when needed, e.g. when no generic version exists. As well as
supplying the public sector CAMEG also caters for private pharmacies, NGOs,
and
the Global Fund, which use it as an intermediary for the supply of
medicines for
HIV, tuberculosis and malaria. CAMEG is highly effective and efficient in
its
procurement strategies. While African governments typically pay 34% above
the
international reference price, a 2010 study on the prices, availability and
affordability of medicines in Burkina Faso shows that the prices offered by
CAMEG are similar to international reference prices.

In terms of availability, Burkina Faso scores quite well. The same 2010
study
shows that a basket of 50 medicines was available in 73% of the health
centres,
compared to an average availability of 40% in the African region and less
than
60% in all WHO regions. However, while in the lower level facilities
availability is very good, hospitals worryingly lack medicines (65% for
generics
and 1.2% for branded medicines). As a consequence patients who cannot be
treated
in lower level facilities are forced to buy their medicines from private
pharmacies where prices are considerably higher.

Access to medicines to treat chronic non-communicable diseases such as
cancer or
diabetes and newer HIV/AIDS medicine is also problematic. These medicines
are
often protected by patent rights in key producing countries such as India,
South
Africa and Brazil, and so generic equivalents are not available for
countries
like Burkina Faso. In order to address this challenge Burkina Faso should
urgently follow the advice of UNAIDS, WHO and UNDP by fully implementing
available TRIPS flexibilities.[1] This should include nullification of any
intellectual property rules for pharmaceuticals, since as a least developed
country, Burkina Faso is not required to implement TRIPS consistent
legislation
for medicines until at least 2016. At present, the country, by adhering to
the
Bangui agreement, is exceeding its obligations under TRIPS.[2] This policy
should be reviewed. In the future, when the Government must fully accede to
TRIPS, it should make full use of compulsory licensing to ensure its
population
has access to such medicines.[3]

Burkina Faso has achieved major success in driving down the cost of
medicines,
at least in the public sector. However, mark-ups along the supply chain
often
result in final prices at the point of delivery being considerably
higher. The
system is also still largely based on cost recovery and 37% of medicines
costs
are financed by the patient. Medicines remain the single largest healthcare
cost
for households. Given that the majority of the population lives on less than
$1.25 a day, the cost of medicines, even at low prices, represents a major
challenge.

Affordability of medicines could be improved by addressing the various
mark-ups
in the system, improving medicines availability in hospitals and in the
longer
term through investments in local production of medicines either at the
national
or regional level. In the short term however, Burkina Faso is dependent on
imports of generic medicines especially from India. This is another reason
why
India should not accept European demands to introduce stricter intellectual
property protection, which is likely to hinder generic competition and lead
to
higher overall prices for importing low-income countries.

[1] TRIPS is the Intellectual Property framework to which all members of the
World Trade Organization have to adhere. However, in order to protect public
health, some flexibilities and safeguards have been explicitly introduced.
These
were reconfirmed in the Doha Declaration on TRIPS and public health.
[2] The Bangui Agreement (1977) governs intellectual property in the 16
member
states of the African Intellectual Property Organization (AIPO). This
agreement
is incorporated as national law. It was revised in 1999 to bring the
legislation into line with the TRIPS Agreement.
[3] Compulsory licensing is when a government allows a third party to
produce
the patented product or use the patented process without the consent of the
patent holder. This is one of the flexibilities provided in the WTO
Agreement on
TRIPS on patent protection. While under the WTO agreement the compulsory
licence would be open to manufacturers all over the world, the Bangui
agreement
limits its use to manufacturers in the African region. Considering the
region’s limited production capacity, this should be reviewed.

Katrien Vervoort was the Essential Services Policy Officer for Oxfam
Solidarité, Belgium until December 2011.

To view the latest post or submit comments please visit
http://www.globalhealthcheck.org/?p=505


Anna Marriott
Email:amarriott at oxfam.org.uk
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