Access to Medicines: A Missing Link for Health and Peace

Editor's Notes

• #5 Picture of medicines in pharmacy of Burkina Faso FROM HAI WEBSITE: 20% availability - means needs to go to five pharmacies to find basic medicine, probably have to pay out of pocket. data is from 2009 - private sector prices 1 days wage to purchase a salbutamol inhaler for monthly asthma treatment (100 mcg/dose); 10 days wage to purchase a months supply of simvastatin for high cholesterol Not available in the public sector
• #6 2 billion to go. Major problems is stock-outs in the public sector (where medicines are subsidized) that forces patients to buy in the private sector, often at much higher prices. Households must choose between being pushed into poverty to afford the medicine or foregoing treatment at the risk to a person’s health and wealth. Impacts are health, wealth, but also social stability. In this way Initiatives for peace and health are not siloed
• #7 Human rights arguments catalysed change: Right to health means it is unacceptable that lifesaving medicines are priced out of reach of millions of people who need them Real responses : Human rights upheld Claims were taken seriously - Court cases Decisions to help the worst off These responses prevented the situation in part from escalating. Your own experiences with health and peace?
• #8 2017: soaring infant and maternal mortality rates. Pregnancy-related deaths rose 66% and 11,466 infants died -- a 30% increase. (first data in 2 years) 2018: The Pharmaceutical Federation of Venezuela estimates the country is suffering from an 85 percent shortage of medicine amid an economic crisis also marked by severe hyperinflation and food scarcity. However, in other world regions, a lack of access to medicines and health care has compounded the social grievances. Venezuela Tunisia Uganda Point 1: Access to medicines and health services can both fuel unrest when unavailable/unaffordable and quell conflict before it starts. What is your experience with health and peace in low- an middle-income countries? Context is everything: Midst of gross social deprivation. We know this from end of WWI leading to WWII. Deprivation breeds resentment, hostility, violence.
• #9 Besides resolving the immediate danger to health and wellbeing, social spending reduces the likelihood of political conflict escalating Social deprivation and poverty breeds discontent, hostility, and violence. Most of the world’s conflicts have occurred in the poorest nations Social spending should not be used to pacify social grievances.Those need to be addressed.
• #11 What do we mean by social spending ? What does this entail? What would it take to address this problem? 12-25 USD per person per year Collectively, the international community spends enough to purchase a basket for everyone. The question is how efficiently are we spending it? And how much is the government spending
• #12 When government is spending money on social services like health, then: Point 2: Certain criteria need to be met to effectively stem social unrest
• #13 Our role is to help foster those conditions through our programmes and projects. Mainly addressing our international projects, global grants, etc. people are looking for quick fixes (in terms of peace and health, in silos). we need to think about longterm, integrated approaches
• #15 Ownership is accepting responsibility for something and taking control of how it develops Government ownership increases when donors are not involved in all stages of emergence, funding, implementation, and evaluation Rotary should be invited to sit at the table.
• #16 Government ownership and donor influence can co-exist! Conditionality of funding: Equity Ex. Basic health insurance programs: International donors successfully encouraged governments in Africa to include the most vulnerable who could not provide for themselves. Donors convinced governments to except the poor and vulnerable from user fees / criteria of eligibility in Uganda, Mali, Ghana, Senegal, Burkina Faso, Niger Mali: User fee exception for malaria treatment THIS WILL REDUCE INEQUALITIES AND INCREASE FAIRNESS IN SYSTEM
• #17 Explore what the local health system offers, collaborate with its physicians, apply its standards. I.e. use their national formulary as your formulary for continuity of care when your project ends This will mean you need to be open for bi-directional learning - learning how the local health system copes with complexity and unpredictability. Gain a new appreciation for its resilience in difficult times. THIS WILL BUILD TRUST IN THE SYSTEM
• #18 We should set an example. Help countries strive to meet those standards by striving towards them yourself Human rights law Right to health: non-discriminatory, basic services to everyone first. Don’t know where to start? Establish a human rights and ethics advisory committee for your projects - include local and international experts National law Local rules: Standard clinical guidelines - know them, respect them. it is important for Rotary’s credibility and that of the government you are working with THIS WILL INCREASE TRUST IN STATE INSTITUTIONS