Different stakeholders including public interest organisations have decided to chalk out a series of measures to advocate and influence policy decisions on universal access and rational therapy in India.

At a recent two-day workshop, organised jointly by Centre for Health and Social Justice, Centad, AIDAN and University of Edinburgh, the participants including donors, international organisations, government and regulatory body representatives, activists and academicians called for pressing the authorities to ensure universal access to medicines and rational use of drugs.

The issue of access and rational use of medicines is very much ingrained in the dynamics of global political and economic factors. In the changing global political and economic context, there is also a growing realization that the IPR and quality standards prescribed by the intergovernmental organizations such as WHO and WTO have become an impediment to access to medicines despite the existence of flexibilities such as compulsory licensing and parallel importation.

"However, amidst these uncertainties and ambiguities mounting from the existing trade regime, countries of the South are being compelled by the Northern countries to change their domestic laws in such a way that these available flexibilities become unusable. The new turn towards the rapid harmonization of standards is seen as major threat to access to medicines," the workshop felt.

Speakers such as Prof. Patricia Jeffery from the University of Edinburgh and Dr Sharad D Iyengar from ARTH, Rajasthan brought to light the fact that an indiscriminate and unmonitored use of oxytocin is increasingly becoming a cause for maternal deaths and complications at the time of child birth. This has implications not just for the health of the mother and the child but also social and economic consequences. It was pointed out that the key policy dilemma today is how to balance the risk of oxytocin with the benefits of the drug.

Dr Saroj Pachauri from the Population Council drew attention to the fact that it is imperative for policy makers to interact with people who work at the ground level. Prof Allyson Pollock and Dr Stefan Ecks from University of Edinburgh and Dr K S Jacob from Christian Medical College, Vellore brought to light the fact that the problem with the drugs used to cure depression, especially with fluoxetine, is its sheer proliferation and its misuse. In recent times, a drug like fluoxetine which may be available without prescription even with a village pharmacist, is being used for problems which may not even be related to depression.

Speaking at the workshop, Dr Zafarullah Chowdhury from Gonoshasthaya Kendra, Bangladesh noted that there is increased emphasis on the 'medicalisation' of health care. "As long as profit remains the driving force, universal access will be a problem," he said.

There was also a discussion on the various means of promotional practices used by pharma companies and the implications it has for the cost and rational use of medicines. Related to the issue of cost and access to drugs was the issue of production of drugs. It was pointed out that most drugs in India are supplied by the Small Scale Industries (SSIs) but the quality parameters pushed by the government are increasingly being seen as a threat to the SSIs.