![]() The role of essential medicines in health systems has evolved tremendously, enjoying moments of favourable attention and episodes of policy uncertainty and controversy. Although the importance of medicines can be traced back centuries, the discovery of “wonder drugs” in the mid-1940s and their dramatic promotion represents a significant milestone in pharmaceutical management. ![]() Regardless of their intended use, the utilization of medicines imposes an undue financial burden at individual, household, community and national levels, particularly in low- and middle-income countries (LMICs). In relation to quality healthcare, medicines play a critical role as curative, rehabilitative and palliative agents. Medicines play a key role in fulfilling the key dimensions of UHC, namely access to quality healthcare and protection from financial hardship. Despite the central role of essential medicines in health systems, an estimated one third of the global population lacks access to them. UHC is an aspiration that all individuals and communities receive the health services they need without suffering financial hardship. These lessons from the PHC era could prove useful in improving the approach to contemporary UHC policies.Īccess to essential medicines has regained prominence as part of universal health coverage (UHC) and Sustainable Development Goals. We found that effective implementation of an essential medicines policy under PHC was constrained by prioritization of trade over public health in the politics stream, inadequate systems thinking in the policy stream and promotion of economic-oriented reforms in both the politics and policy streams. During implementation, policy contradictions emerged as political and policy actors framed the problems and perceived the effectiveness of policy responses in a manner that was amenable to their own interests and objectives. A window of opportunity presented when provision of essential drugs was identified as one of the eight components of PHC. As a policy response, the essential drugs concept was introduced. We found that unsustainable rise in drug expenditure, inequitable access to drugs and irrational use of drugs were considered as problems in the mid-1970s. ![]() Kingdon’s model was used as a lens to interpret the findings. We also reviewed the timeline of essential medicines policy milestones contained in the Flagship Report, Medicines in Health Systems: Advancing access, affordability and appropriate use, released by WHO in 2014. Policy documents were obtained through hand searching of selected websites. We used selected search terms in EMBASE and MEDLINE electronic databases to identify relevant published studies. We retrospectively analysed 49 published articles and 11 policy documents. We used Kingdon’s model to analyse agenda setting for essential medicines policy in sub-Saharan Africa during the formative phase of the primary healthcare (PHC) concept. Although it is acknowledged that essential medicines policies do not rise and stay on the policy agenda solely through rational deliberation and consideration of technical merits, policy theory is rarely used to direct and guide analysis to inform future policy implementation. Lack of access to essential medicines presents a significant threat to achieving universal health coverage (UHC) in sub-Saharan Africa. ![]()
0 Comments
Leave a Reply. |