SEPTEMBER – OCTOBER 2024
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Ensuring that people can receive the medicines they need is an ethical and health imperative that requires the collaboration of multiple actors: governments, health institutions, pharmaceutical companies, and civil society organizations.
Medicines improve quality of life, reduce mortality and are key to strengthening universal coverage and continuity of care. However, in many countries, access to medicines and other health technologies remains unequal and limited by economic, logistical and structural barriers. This lack of access disproportionately affects vulnerable populations, compromising their well-being and perpetuating health inequality.
In a recent report, the World Health Organization (WHO) and the Economic Commission for Latin America and the Caribbean (ECLAC) have warned that “the health systems of Latin American and Caribbean countries have significant structural weaknesses, marked by chronic underfinancing, high out-of-pocket expenses, fragmentation of service provision and segmentation of people based on their ability to pay. They also face various difficulties related to institutional capacities and governance that limit the ability to respond to public health challenges. This has generated a scenario of deep inequalities that compromise universal access to health and well-being, and the financial protection of households.”
The WHO-ECLAC document cites a 2022 analysis based on data from 15 countries in the region that revealed that approximately 29,3% of the population, equivalent to around 295 million people, had unmet health care needs, including lack of access to medication.
In this context, it is important to observe two interrelated points: on the one hand, the barriers and challenges to access, but also at the same time the intersectionality with other determinants of vulnerability.
The challenges facing the region are related to economic and financing barriers, where the high cost of essential and high-priced medicines and their budgetary impact remain a critical constraint, especially for chronic diseases and specialized treatments. At the global level, the trend towards high-priced innovative medicines has created budgetary tensions, reflecting the need for new financing and management strategies, such as centralized purchasing, differentiated pricing agreements, and the promotion of generic and biosimilar medicines.
Lack of coordination in procurement and distribution within the health system also results in inefficient allocation of medicines, both in urban and rural areas. Disjointed policies related to procurement processes are major obstacles, especially in countries with fragmented or segmented health systems, or where differences in health systems between provinces and regions generate inefficiencies in access to essential medicines. Even insufficient stock control is common in several countries, facing risks of shortages. These problems are accentuated by interruptions in the supply chain and the lack of preventive storage policies. Limited regulatory capacity and organizational structures with low levels of maturity are also a challenge in several countries in the region.
In this context, from a public health perspective, access to medicines implies the implementation of effective public policies that cover regulation, pricing, acquisition, efficient distribution, financing and the promotion of rational use of medicines, among other aspects.
On the other hand, “inequality in relation to these barriers and their intersectionality with other factors represent a challenge in relation to the equity of health systems and care. These factors are related to the structuring axes of the social inequality matrix, such as socioeconomic level, ethnic-racial status, gender and territory, among others, which condition access to health and which, when combined, magnify access barriers and disproportionately affect populations in the most vulnerable situation,” point out the WHO and ECLAC. This axis must be addressed with public policies that favor universal health coverage, reducing out-of-pocket spending on the purchase of medicines and facilitating the application of appropriate allocation criteria in the use of health resources.
Ensuring access to medicines is an ethical and health imperative that requires the collaboration of multiple actors: governments, health institutions, pharmaceutical companies, and civil society organizations. Only through the coordinated efforts of these sectors will it be possible to move towards more equitable and sustainable health systems, where essential medicines are accessible to all people.
By: Maissa Havela, Political scientist and master in health services management. Senior consultant at CIIPS-IECS and director of the course “Policies on access to medicines and health technologies"