Universal Access to Essential Medicines: Recent South American Experiences and Challenges for the Region18/09/2018
Health as a fundamental right and regional integration are part of the welfare goals agreed upon by all countries in South America. Although we have some achievements in access to medicines, it is a priority to seek and promote regional access scenarios that do not violate the precepts of essentiality and relevance of medications as part of our Universal Health Systems.
One of the main strategies, championed regionally by South American countries in terms of high prices of medicines, has been the creation of the UNASUR Medication Price Bank (BPMU).
As part of the progress towards a comprehensive medication policy, since mid-2015 UNASUR set out to create a data bank with information on pricing for public procurement medications in all the region’s countries, as a strategy to press for cost reduction. The data bank’s objective is to strengthen management capacity of purchasing processes, by making available a computerized system with information on medication prices and related data among UNASUR Member States.
In order to have a fair return on public investment, governmental actors and providers of public funds require transparency and clear information. The BPMU project focused its purpose on this objective, converging in this way with key drivers of the UN 2030 agenda, such as adequate governance, strong accountability mechanisms and transparency.
There are some public databases of medicines pricing for vaccines and medical devices which, in general, refer to multilateral organizations or civil society organizations, but which represent specific conditions for medicines procurement. One of the mechanisms that some regions have implemented to face the economic power of the pharmaceutical industry is public procurement, which on the one hand allows demand to be added and on the other hand links mechanisms of transparency and competitiveness in public procurement processes.
So far, 10 countries have registered purchases of 30 medications and 7 vaccines, and a total of 313
acquisitions, made between 2011 and 2015, have been uploaded. In 2017, the UNASUR Technical Group for Universal Access to Medicine (GAUMU) focused its efforts on advancing a second phase of drug collection and loading.
The development of this project has fostered an active interaction between the technology and information area of the UNASUR General Secretariat and the national members of GAUMU, as well as those responsible for the public purchases sector and financing of medicines in the UNASUR Member States. As a result of this interaction, the BPMU becomes a strategic facilitator for the block. In fact, this consolidation allows a dialogue with other regional organizations such as MERCOSUR, ORAS / CONHU and the Pan American Health Organization (PAHO).
The BPMU is an unprecedented regional achievement for the South American countries, a platform that represents one of the most concrete results for regional policy on the universal access to medicines.
In 2017, ISAGS developed a study on the public purchase processes of medication, describing the current situation in all South American countries. Here are some of our main findings:
- Referential price setting for medication is an indispensable tool prior to the start of an acquisition process. This is done through different methodologies, depending on the countries, currently nine countries applied it.
- Information technology platforms are a tool for transparency in medication acquisition and purchase processes.
- Most of the countries that make up UNASUR have a national list of basic medicines, which is a health policy instrument that identifies those medications considered essential to basic care for the population.
Although the BPMU represents a great regional achievement, today there are several challenges, such as maintaining active participation and the exchange of information on medication prices between the region’s nations; On the other hand, this platform could represent important regional advances in relation to good governance, the promotion of accountability mechanisms and greater transparency tools in compliance with the 2030 Agenda. That is, its applications could be expanded to promote consultations from different levels of the medication value chain in the region, including South American citizens themselves.
Another Regional project financed by UNASUR is the study “Mapping of Productive Capacity of Medicines and Health Supplies of the South American Region”. The development of this regional research, launched in 2018, aims to give a response to the need for updated information regarding the existing capacity of UNASUR countries for medicine production, both from the public and private sectors. This input would be key for eventual regional medicines production efforts, and the use of patent flexibilities, seeking solutions to common problems of essential medication shortages.
Finally, during 2017, ISAGS provided scenarios for understand, exchange and addressing the situation of medication judicialization in the region, which allowed the visibility of signals related to cases of medicines not included in the national lists –mostly of biological origin, or biotechnology, and recently introduced innovations with high levels of spending for our Public Health Systems. In this regard, greater efforts must be invested to strengthen adequate decisions on incorporation and financing of medicines in South American countries.
Through the sovereign recognition of regional needs, the experiences and challenges described here have led to results thanks to the integration processes built within UNASUR and the sum of the political will of its countries.
Specialist of Medicines and Health Technologies