[e-drug] Free essential medicines

e-drug
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Free essential medicines
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Dear E-druggers,

I like to recommend the reading of the Millennium Development Goals Task Force report on access to essential medicines, which was brought to our attention by Wilbert on 18 February (http://unmp.forumone.com/eng_task_force/essentialmedicines/TF5-medicines-Complete.pdf) [repair link!]

I think it is a useful tool for our continuing work on essential medicines. There is a lot of information and many will find that the recommendations support views we try to get across and working in our own specific situation. I specifically like the recommendations on support for human resources.

However, the call for free essential medicines may be challenged. For good understanding I quote:

"Essential medicines, along with other essential health services, should be provided at no cost to the end user in developing countries."

I tried to find in the report the rationale for this recommendation, but did not find much more than that the poor cannot afford to pay and therefore have no access, that alternative systems do not really benefit the poor and that donors more or less should use the promised funds to realize free essential health services, especially for medicines and capacity building. Please notify me, if I have missed other.

For the discussion, I want to raise some questions about free essential medicines without wanting to address all possible angles involved:

1. Will free services be appreciated as much as compared to some form of payment (also traditional medicines, much used by the poor, are not free)?
2. How to address all kind of unwanted "side effects", such as leaking into private markets (also to developed countries), irrational use (as it costs nothing)?
3. How will the for-payment medicines relate to the free medicines?

Many countries have developed payment systems (some coming from a system with free medicines) that have a history and value. This history needs to be appreciated and maybe it is better to recommend that countries need to review their funding systems in order to ensure that essential medicines are accessible to all. Provision of (some of the) essential medicines at no costs may be considered as one of the options to realize this.

I am really curious about how the MDG working group on access to essential medicines came to the recommendation for free essential medicines for all end users in developing countries. I assume that this relatively simple advice is the result of all pro's and con's considered and would like to know more about these.

[I would also be interested in knowing what they based that recommendation on! KM]

Kind regards,

Rob Verhage
Pharmacist-Consultant (Essential Medicines Programs - Procurement and Supply Management)
PO Box 4002
Paramaribo
Suriname
597 438966
verhager@cq-link.sr

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Free essential medicines (1)
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Dear colleagues,

I would like to comment on the first and second question of Mr.
Verhage regarding free essential medicines.

1) I am tired to be brainwashed by certain ideologists that health
care including medicines which are not paid for by the users will
also not be appreciated. I happen to note that the best things in life
are free of charge. How would people feel if they have to pay for the
love and care of their partners or if children have to pay for the care
from their parents? We should try and extend the moral principles
of family life to society rather than to take family values as
something from outer space.

2) This is linked to the second point: We need free education for
all and social structures which help to promote the rational use of
"free" medicines and reduce abuse. Paul Farmer in "Pathologies of
Power" has clearly demonstrated for TB treatment that the right
social incentives will promote the rational use of these medicines.

Best regards
Reinhard Huss, MD, MPH
Lecturer in Public Health
University of Heidelberg
Website: www.qu4rad.net
Department of Tropical Hygiene and Public Health
Office: Bergheimer Str.20
Im Neuenheimer Feld 324
69120 Heidelberg
Germany
Fon +49(0)6221-565048
Fax +49(0)6221-565039
reinhard.huss@urz.uni-heidelberg.de

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E-DRUG:Free essential medicines (2)
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Dear Collegues,

I just want to support the fact given by the UN report
on free essential medicines. People should understand
that it is painful to loose the loved one because of
lack of money to pay for drugs. In some African
countries patients are denied of medicines or either
they are given for 24 hours free and asked to pay. If
the people are poor doctors have a task of negociating
with the manager of the hospital to offer free drugs.
If the manager decides not to give the patient are
denied access and can die. It is estimated over half
the poorest people in sub Saharan Africa and Asia lack
access to life saving medicines. These are the people
who cannot afford even food. Please thanks to the UN
report, if this can be implemented, a lot of lives
will be saved.

Norman Lufesi
Student, Section for International Health,
University of Oslo, Institute of Community Medicine
Post box 1130 Blindern, N-0318 Oslo, Norway
tel +47 22 85 05 98
fax +47 22 85 05 90
mobil: 91348163
email:n.n.d.lufesi@studmed.uio.no
efax: 1 30 371 4853

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E-DRUG: Free essential medicines (4)
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Just another quick thought, if we wait for everything to be just right, we will wait forever. When are we ever going to have education for all, even in developed countries?. We must be able to do what we can, when we can, with what we have, while still working long range to get to the ultimate goals. Otherwise, we will wait for the developed world to "help" the developing world and the help will always be "on the way"
It is good for researchers to postulate why things will not work, but some one has to come down to reality and see what actually happens.

Have you ever seen how people scrumble for free access to healthcare when one day medical camps are held? it is out of sheer desparation that they trek miles and miles to get such access. While we call this "free", it is actually not free to the user, as most of the time, they still have to spend their scarce resources to get to the healthcare facility and possibly spend a day or more in that facility waiting (and lose any wages). In essence, they will have paid in that way.

Atieno Ojoo
Graduate student
Boston University School of Public Health, USA
atisojoo@yahoo.co.uk