ABSTRACT
Health service provision is one of the components in Universal Health Coverage (UHC). Medicines are vital for health services, and they should be affordable and accessible for safe and appropriate usage for everyone. This article is a report on the symposium “Medicines for UHC,” held in the academic meeting of the Japanese Association of International Health in December 2017. In Lao PDR, a study was conducted in urban and rural hospitals examining lists of available medicines, as well as their usage, distribution, and prices. The study showed that neurological medicines including anesthetics made up 29% of all medicines used in the urban central hospital, as it was one of the few hospitals that provided complex surgeries in Laos, resulting in a high concentration of patients. Anti-tuberculosis, ARV, and anti-Malaria medicines, as well as vaccines, were provided by Global Fund, GAVI, and other organizations, so that their costs were not included in the hospital’s procurement lists. While anti-microbial medicines only accounted for 13% of the medicines used at the urban central hospital, they accounted for 43% of those in rural hospitals, where most patients presented with upper respiratory and digestive infections. While the Ministry of Health sets the standards for evaluating and regulating the quality and cost of medicine, individuals can purchase medicines from private pharmacies without prescriptions, making it difficult to evaluate appropriate usage. Regarding the quality of medicines, distribution companies, health workers, and patients cannot distinguish between authentic and falsified or substandard medicines. As an example, after a study in Cambodia revealed the existence of inappropriate medicines, the Cambodian government required companies to provide results of dissolution tests. As the limitations on pharmaceutical regulatory authorities and their staff in developing countries impact their capabilities, we recommend supporting them in establishing effective pharmaceutical regulations internationally.
ABSTRACT
<p> In September 2015, the United Nations General Assembly’s adoption of the Sustainable Development Goals (SDGs), in place of the Millennium Development Goals (MDGs), constituted a historical landmark. Previously, developed nations provided developing nations with substantial aid for the implementation of the MDGs that entailed measurable and limited targets. Among these targets, health was prioritized, accounting for 28.6% of the total targets. The new SDGs, by contrast, entail 17 goals and 169 targets that apply not just to developing nations, but also to developed nations. The proportion of health targets (7.7%) in the SDGs, being a quarter of that in the MDGs, appears to indicate lower prioritization of health. However, health remains central for the achievement of the SDGs, given a total of 23 health-related targets associated with other goals such as no poverty, nutrition, and sanitation. Additionally, a “Health in all Policies” approach can be likely adopted for the SDGs to facilitate the implementation of effective interventions for improving social, environmental, and economical determinants of health. Decision makers may find it difficult to comprehend the objectives of the SDGs because of their ‘universality’ and obscure focus in relation to sustainable development targets. This paper presents concepts and approaches aimed at fostering ‘convergence’ to overcome these deficiencies. Health-related examples of convergence include ‘universal health coverage (UHC)’ and ‘gland convergence (GC)’. A myriad of stakeholders, with contrasting opinions and ideas, participated in the SDG formulation process. This has resulted in the inclusion of diverse contemporary health issues that are socially significant such as non-communicable diseases, mental health, substance abuse, and road traffic accidents. Competing specialists’ claims that prioritize particular diseases, saying “my disease is more important than your disease”, have probably contributed to the diversity of SDG targets. UHC and GC will play crucial roles in the future realization of the SDGs.</p>
ABSTRACT
<p> The vertical program to control tuberculosis in the 1950’s through 1960’s helped the development of the horizontal program of Universal Health Coverage launched in 1961 in Japan. Vertical and horizontal intervention do not compete each other but collaborate with each other. The same should be true for the present day context of global health, namely vertical intervention for tuberculosis, HIV/AIDS and malaria control and the horizontal UHC intervention.</p>