Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa Workshop Summary (2014) / Chapter Skim
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1 Introduction and Overview
1 Introduction and Overview
Pages 1-14
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defines essential medicines as "those that satisfy the priority health care needs of the population and are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and community can afford. Essential medicines are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectiveness."2 In 2011 the Grand Challenges in Global Mental Health initiative identified priorities that have the potential to make a significant impact on the lives of people with mental, neurological, and substance use (MNS)
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Among the opportunities discussed to decrease the treatment gap and improve the quality of care were: • increasing the number of health care providers with expertise in MNS disorders; and • improving access to medicines to treat MNS disorders. As a result of the discussions from the 2009 workshop, the IOM Neuroscience Forum convened two more workshops focused on these specific opportunities.
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Given the importance of access to appropriate essential medicines to help decrease the treatment gap of MNS disorders in SSA, the IOM Neuroscience Forum convened a third workshop on January 13-14, 2014, in Addis Ababa, Ethiopia. The goal of the workshop was to bring together key stakeholders to discuss opportunities for achieving longterm affordable access to medicines for MNS disorders.
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ORGANIZATION OF THE WORKSHOP AND REPORT In addition to several overview presentations, the workshop was organized around a series of focused discussions on challenge areas identified by the workshop planning committee: insufficient demand, inappropriate selection, ineffective supply chains, and high pricing and poor financing. In the first session, experts presented their individual definition of each challenge area and their perspectives on barriers and opportunities for improving access to medicines across the challenge area (see Box 1-2)
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(Hans Hogerzeil) Ineffective Supply Chains Improved access to medicines for MNS disorders requires a well-functioning supply chain that delivers these medicines to the end population affordably, reliably, robustly, and in an equi table manner.
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; and programs for two noncommunicable diseases, Novo Nordisk's program aimed at treating diabetes and Sanofi's Access to Medicines program focusing on schizophrenia. Following the overview and example presentations, individual participants engaged in focused discussions to further explore opportunities to improve access to essential medicines for MNS disorders.
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BARRIERS TO ACCESS TO ESSENTIAL MEDICINES FOR MNS DISORDERS Sub-Saharan Africa has one of the largest treatment gaps for MNS disorders. Atalay Alem, professor of psychiatry at Addis Ababa University, said that on average, two-thirds of those with MNS disorders do not receive treatment and access to appropriate essential medicines for these disorders remains a challenge.
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. Challenges specific for low- and middle-income countries include inappropriate selection of medicines, interrupted supply chains, high pricing, and inadequate financing of medicines (Bigdeli et al., 2013a)
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For example, the Strategies for Enhancing Access to Medicines (SEAM) 5 program focuses on health service delivery while the WHO access framework addresses barriers mainly at the pharmaceutical and health sector levels (WHO, 2004a,b)
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IV. Public policies • Low public accountability and transparency cutting across sectors • Low priority attached to social sectors • High burden of government bureaucracy • Conflict between trade and economic goals for pharmaceutical markets and public health goals V
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Policies and interventions can use any entry point, but Hogerzeil said that a wider picture should be kept in mind, taking a more comprehensive, systems approach. OPPORTUNITITES FOR IMPROVING ACCESS TO ESSENTIAL MEDICINES FOR MNS DISORDERS6 Throughout the workshop, individual participants discussed a number of potential opportunities to improve access to essential medicines for MNS disorders related to the four challenge areas: demand, selection, supply chains, and pricing and financing.
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In particular, several participants suggested that such champions might be able to break down stigmas associated with MNS disorders. • Partnerships: Throughout the workshop many participants noted that improving access to essential medicines might benefit from strong partnerships across all levels of the health care system, organizations, and disease areas.
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A few participants noted that selection of essential medicines at a national level, and adherence to WHO guidelines, might reduce inconsistencies in the selection and procurement of medicines for MNS disorders. Several participants stressed the importance of training and continuing education about MNS treatment guidelines to include key individuals and organizations involved with selection and procurement of essential medicines.
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A few participants noted that markets in SSA might be unattractive to manufacturers, but that increasing competition and lowering of barriers for entry might lead to decreased prices. Many participants suggested that inclusion of MNS medicines on country-specific essential medicines lists and health insurance schemes might increase coverage for these medicines, lower prices for patients, and prevent catastrophic expenditure because of long-term treatment.
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