Biblioteca Virtual en Salud

As the 2015 deadline to achieve the Millennium Development Goals (MDGs) draws near, efforts to ensure access to essential medicines face new challenges in light of new resource constraints. To help assess those challenges, a summary analysis of published data was undertaken to examine the increasing discontinuity between the geographic focus of donor-country programs on low-income countries (LICs) and the geographic location of the increasing majority of the poor and the global burden of preventable disease within middle-income countries (MICs). This disconnect has put new pressure on both donor and government resources for essential medicines, prompting greater consideration of strategies through which global health investments can leverage market resources to achieve global health goals and benefit the poor in both LICs and MICs. To help assess the policy environment for strategy change, country-level health workers from low and middle-income countries with high burdens of disease who participated in the International AIDS Conference (AIDS 2012) in Washington, DC, were surveyed to examine their views of the respective responsibilities of various institutions to finance access to essential medicines in their countries. While the 102 respondents rated the future financing responsibility of their governments higher than any other entity (4.8 versus 3.6-4.0, p<0.0001), most did not distinguish responsibility levels among a range of international organizations. Nor did the respondents anticipate any decrease in the future financing responsibilities of those entities, with seven of nine rated significantly higher in the future than in the past. The limited understanding of the roles and reach of different global health institutions is highlighted as an impediment to improving access-to-medicines strategies because it likely constrains the ability of country level stakeholders to engage in the global health strategy dialogue. Sitting at the intersection of the trade and health agendas, the access-to-essential-medicines field is built on the uneasy links between global public health programming and private sector drug research, development and marketing agendas. The two analyses combine to highlight major health diplomacy challenges inherent in reconciling the broad range of state and non-state actor perspectives within the post-2015 development agenda.