# \[e-drug\] MSH-Bill Gates Foundation Essential Medicines Franchise **URL:** \ **Category:** e-drug\ **Created:** [June 4, 2002, 3:06pm UTC](https://talk.edrugplus.org/t/e-drug-msh-bill-gates-foundation-essential-medicines-franchise/14462 "2002-06-04T15:06:05Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![ptrouiller](https://avatars.discourse-cdn.com/v4/letter/p/bc79bd/32.png) [@ptrouiller](https://talk.edrugplus.org/u/ptrouiller)\ **Post date:** [June 4, 2002, 3:06pm UTC](https://talk.edrugplus.org/t/e-drug-msh-bill-gates-foundation-essential-medicines-franchise/14462/1 "2002-06-04T15:06:05Z")
\<6960B7D154C2D511851C00B0D03D82A60223ECDB@expnt37.chu-grenoble.fr\> Sender: owner-e-drug@usa.healthnet.org Precedence: bulk E-drug: MSH-Bill Gates Foundation Essential Medicines Franchise ------------------------------------------------------------------------- MSH-Bill Gates Foundation Essential Medicines Franchise: towards a "macdonaldisation" of health care? [The full title could not fit in the subject heading. This is hot topic! I hope many E-druggers will participate in the debate which has already started on sister E-med. KM, moderator] On April 4, 2002 Management Sciences for Health (MSH), the Bill & Melinda Gates Foundation, and the Cry for the World Foundation (CFW) announced that some developing countries (eg, Ghana, Tanzania, El Salvador, later on Senegal and elsewhere) have been selected to launch an "essential medicines franchise" programme (see: [http://www.msh.org/features/gates/kenya-release.html](http://www.msh.org/features/gates/kenya-release.html) and [http://www.msh.org/features/gates/countries-release.html](http://www.msh.org/features/gates/countries-release.html)). The goal of this effort is to establish by countries a network of private-owned and operated franchised outlets which will provide "a range of quality essential medicines and services at reasonable prices". Each outlet owner - "the franchisee", will have incentives and benefits to encourage provision of "high quality medicines and services at affordable price", and will sell among others branded medicines (according to the MSH arguments, "branded medicines are often preferred to medicines sold under generic names: brand name associated with quality". In MSH slide show: Franchise: improving access to essential drugs through a public health franchise model). We can be surprised and baffled that such an initiative did not spark off any reaction and controversy, apart from a discussion just starting on the E-Med network. Such a mixture between the franchise concept on the one hand, and public health concerns on the other hand is surprising and distressing. It's a mismatch. We can observe sadly that the powerful proposition - first emerged around 150 years ago during the formative years of the public health movement, putting forward that "social justice is the foundation of public health" is still contested (see: Krieger N, Birn AE. A vision of social justice as the foundation of public health: commemorating 150 years of the spirit of 1848. American Journal of Public Health 1998; 88: 1603-06). Confusing healthcare delivery (ie, medicines and healthcare services) and micro-enterprise or franchise business is the best way of widely opening the door to the selection of patients and diseases, economic criteria (eg, patients creditworthiness) taking priority over social concerns or recognized public health concerns. One can understand but without acquiescence the motivations of some governments enticed by such a simplistic credo, as a way of reducing quickly their health care expenditures but above all a way of avoiding their own responsibilities. With the 1978 "Health for All" campaign already off the WHO agenda and a move away from the primary health care concept, the "consumer responsiveness" is becoming the substitute for the "community participation" of patients, health care facilities having now to act as client-responsive services (eg, the CFW health shops). Patients and their health needs are turned into consumers of health goods and services, provided they pay for. With this initiative we are witnessing a strong comeback of the 1980s ideas dominated by the free market economy school of thought relayed by the International Monetary Fund (IMF) and the World Bank (WB) through the "structural adjustment" programmes imposed to developing countries, trotting out again the nineteenth century commonplace notion that economic growth results inevitably in development with improvements in health and welfare. We have a feeling of re-reading the World Bank World Development Report (Investing in health, 1993) when WB encouraged developing countries governments to "promote competition and diversity in the provision of health services" and concentrate their efforts in adopting minimal packages of health care. Such reforms, according to the WB, could "translate into longer and healthier lives for people" considering that "good health increases the economic productivity of individuals and the economic growth rate of countries". We have already observed the disastrous consequencies of those policies on the conditions of health care facilities and the immediate effects on the HIV/AIDS crisis management. While agreeing with MSH that new strategies for enhancing access to essential medicines are highly and urgently needed, - May we reasonably and ethically propose the "franchise concept" as a response to this challenge? - And what about the essential medicines concept? We are far from the concept of health as a human right. Sometimes it is good to come back to basic principles. Patrice Trouiller PharmD, MB M�decins sans Fronti�res MSF Campaign for Access to Essential Medicines, [http://www.accessmed-msf.org](http://www.accessmed-msf.org) PTrouiller@chu-grenoble.fr -- To send a message to E-Drug, write to: e-drug@usa.healthnet.org To subscribe or unsubscribe, write to: majordomo@usa.healthnet.org in the body of the message type: subscribe e-drug OR unsubscribe e-drug To contact a person, send a message to: e-drug-help@usa.healthnet.org Information and archives: [http://www.healthnet.org/programs/edrug.html](http://www.healthnet.org/programs/edrug.html)