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E-drug: Re: MSH-Bill Gates Foundation Essential Medicines Franchise (cont)
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As I have been at the origin of this discussion around the application of
the old commercial concept of franchising to essential medicines, I had like
to come again on few points not really clarified by the interesting
statement of Jim Rankin.
A new initiative wherever it comes from and aiming at enhancing medicines
availability is obviously totally welcome given the recurrent and unsolved
problems of both availability and accessibility to essential medicines.
Moreover the franchise concept proved itself to be an economically viable
project in the commercial sector.
1. Regarding the MSH-B&M Gates new initiative a critical question still not
fully understood and above all unresolved in many countries is: may we
consider essential medicines as mere commodities, and then may we apply to
medicines the basic rules of the commercial sector without any social
safeguard? Availability does not mean "de facto" accessibility: the former
comes clearly within the competence of the commercial sector, the latter as
any public goods is usually the responsibility of the community usually
through the state's role or devolution of its authority, in addition either
on minimalist grounds (eg, medicare/medicaid system in the US) or maximalist
grounds (eg, "solidaristic" publicly financed social security scheme in
European countries).
2. Is there not an actual risk - as most countries did not resolve so far
the issue of accessibility to essential medicines and its solidarity
component - that such a new northern-designed initiative blending together
two different aspects of the issue (ie, availability and accessibility) and
"sold" to governments as a way of "improving access to essential drugs
through a public health franchise model" (extract from MSH slide show on
franchise) throws people into confusion, and may be used by some governments
as a way of shunning their own responsabilities vis-�-vis the health care
provision?
MSH-B&M Gates initiative will certainly improve where it works the
availability of essential medicines of good quality, accompanied by good
advice. This is part of any national drug policy. It will as well probably
give a new breath to the private sector particularly in several regions in
want. The whole lot will work provided:
- (1) that the philantropic support from the B&M Gates Foundation lasts and
persists for a long time enough to avoid any possible shift from a private
not-for-profit scheme to a private for-profit scheme;
- (2) that its approach and philosophy is incorporated and adapted at the
local level of each countries.
Such a fulfilment would be a pretty good deal.
But please, to avoid any mix-up and confusion, don't associate this
"essential drugs franchise" model with a public health venture. This model
can only be an instrument or a tool for public use. It will become a true
public health instrument among other instruments only when a state or a
community will incorporate it in its own health policy.
In conclusion may I only remind you that historically only solidaristic
health care systems (meaning accessibility and health for all) characterised
by extensive risk pooling and few or no financial at the point of use proved
to be fair and equitable systems. And here, for developing countries the
challenge is huge and will require heavy and constant investments from local
governments.
Patrice Trouiller
PharmD, MB
M�decins sans Fronti�res
MSF Campaign for Access to Essential Medicines, http://www.accessmed-msf.org
PTrouiller@chu-grenoble.fr
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