Issues on medicine toward realizing Universal Health Coverage / 国際保健医療

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.