In 2007, global sales on pharmaceuticals amounted to US$712 billion, showing 6.4 per cent growth over previous year (Source: IMS Health, 2007). However this increase has been far from equitable with high income countries of Europe, the United States, Japan and Australasia (which comprised 14 per cent of world population) consuming 79 per cent of the pharmaceuticals with an average per capita annual spending of US$396. This is to be contrasted with the 40 per cent of the world’s population living in low-income countries spent on average US$4.40 per capita on medicines in 2000. There is thus almost a 100 times differential between pharmaceutical expenditure in the high-income and the low-income countries (Table 1). The Organisation for Economic Co-operation and Development (OECD) countries accounted for less than 20 per cent of the world's population in the 2000 but were responsible for almost 90 per cent of the world's health spending. Therefore 80 per cent of world's population spent only 10 per cent of the total expenditure on health. This includes people in the Asia-Pacific as well as African and Latin American countries. Africa accounts for about 25 per cent of the global burden of disease but only about two per cent of global health spending (Source: World health report-Today’s challenges, WHO, 2003).
The inequity is strengthened when one considers that majority of deaths happens in low- and middle-income countries and that more than half of these deaths could be prevented by fairly inexpensive pharmaceutical interventions. The per capita health expenditure, in terms of US$ purchasing power parity (PPP), is widely varied among countries, as evident from Table 2. More than half of all medicines expenditures in high income countries are publicly financed. However, in India like many developing countries health expenditure is dominated by private spending with households’ out-of-pocket expenditures make up a much larger proportion (Table 2). It is notable that India has second highest private health expenditure on health as percent of total expenditure in health among all the countries described in Table 2, including the poorest countries. Further, all the private expenditure in India (as in some other countries) is constituted by out-of-pocket expenses.
Access to essential medicines: One of the key elements, provision of essential medicines is a strong indicator of health care system of any country. Although the percentage of the world’s population without access to essential medicines has fallen from an estimated 37 per cent in 1987 to around 30 per cent in 1999, the total number of people without access remains between 1.3 and 2.1 billion. This lack of access is particularly concentrated in Africa and India. The WHO world medicine situation report estimated in 1999 that 649 million people in India (65 per cent of the population) do not have regular access to essential medicines.
In addition, India has 17 per cent of the world’s population – but has 21 per cent to 25 per cent of global burden of disease.
Challenges: In India, each year 170,000 people die from AIDS, 320,000 from TB and another 3100,000 people are HIV carriers (Source: US Global Health Policy, 2009). It is a challenge to access medicines in India where many are HIV and TB carrier, and burdened by malaria, filaria, and life-threatening infections. In addition majority of people with diseases prevalent in India do not have access to modern treatment simply because hardly any investments are made by Multi National Companies (MNCs) for the development of new drugs for such diseases. Furthermore India is smitten with recent and frequent epidemics of widespread dengue and chikungunya, for which no effective treatment is available.
Even though public sectors (Government hospitals, primary health centre and sub centre) offer free primary health care, they are often not adequately stocked with free medicines, and patients thus have to buy medicines from private pharmacies. Equitable access to medicines remains a challenge in India, especially among the rural poor population. Private pharmacies in densely populated areas are always more lucrative, often leaving sparsely-populated rural areas without access to reliable sources of medicines within reasonable proximity. Even when pharmacies are physically present, medicines are often unaffordable, and their availability can be erratic because of failing public financing. Everything is available if you are living in the urban area and if you have enough money.
Conclusion
A new World Medicines Situation 2011 chapter on Access to Medicines as Part of the Right to Health has been published recently. The first paragraph of the summary reads - “Human rights constitute an important principle of our time. These fundamental human rights translate the values of equity, freedom, fairness, social justice and non-discrimination into practical entitlements for individuals, which increasingly guide public policies and national judicial systems. Access to essential medicines as part of the right to health has been further refined in recent years.”
A website, Access to Medicine Index (http:// www.accesstomedicineindex.org) claims - “Access to medicine is a basic social and cultural right, yet each year millions of people die due to preventable and treatable diseases such as HIV/Aids, malaria and tuberculosis. Others suffer needlessly due to chronic or neglected diseases, illnesses that could be eliminated but remain untreated simply because communities around the world continue to live beyond the reach of medicine.”
The fundamental human right to access to medicines, for meeting needs specific to developing countries including India, remains a challenge and will require further action at the national and international levels. u
Authors are Associate Professors of Pharmacy Annamalai University, Annamalainagar, Tamil Nadu