Medicines and Universal Health Coverage: The need for a people-centred approach

A recently published thematic series on Universal Health Coverage in Journal of Pharmaceutical Policy and Practice presents a different, potentially innovative framework for considering medicines in health systems. Guest blogger Maryam Bigdeli of the Alliance for Health Policy and Systems Research, hosted by the World Health Organization, tells us more.

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Universal Health Coverage (UHC) is a paradigm under which context-specific reforms can be undertaken to improve access to health services and patient health outcomes. UHC reforms offer an opportunity to use a set of policy instruments that can improve access to medicines [1] and in turn, medicines policies can support stronger foundation for UHC.

However, the multiple choices involved in designing these policy instruments and the processes by which they are implemented are inherently context-specific; they need to take into account competing and converging interests of multiple health system actors operating within the constraints of their respective environments.

Indeed, health systems are heterogeneous, and medicines access within health systems is influenced by this diversity. This includes international development efforts; global and bilateral trade agreements; local politics; public and private market forces; research and development priorities; industry priorities; formal public and private health providers; informal, unregulated providers; and, choices, preferences and constraints of patients, households and communities.

Different set of actors operate in each of these areas. They have their own interests and priorities, and their interactions influence the outcomes of pharmaceutical policies in a given context.

Unfortunately, current published research on medicines has essentially focused on quantification of availability, price or affordability; on appropriate use and its determinants; or on impacts of policies and interventions. It has seldom explored the interplay of context, actors and processes in the formulation and implementation of pharmaceutical policies in complex and fast changing health systems.

It has also been noted that the health policy and system researchers have overlooked the importance of medicines in health systems: in contrast to numerous research articles in the area of access to medicines, there are only few studies that adopt a health systems approach to the field.

In many instances, medicines are just considered as mere products: chemical products that need to be developed and produced in industrial settings, commercial products that need to be marketed and sold or bought, health commodities that need to be regulated and supplied to facilities, treatments that need to be swallowed or injected.

This “product” lens on medicines brings about clinical and technical solutions to lack of medicines access. In contrast, when we seek to apply a health system lens on medicines, we emphasize the notion that people are actually at the heart of medicines in health systems.

When we seek to apply a health system lens on medicines, we emphasize the notion that people are actually at the heart of medicines in health systems.

By people, we don’t mean only patients, but all health system actors: it is through people’s converging and competing interests, their economic and political power, and their evolving relationships in a given context that medicines realize their so-called “social efficacy” [2].

Pharmaceutical systems, as any subsystems of health, are social institutions, operating through actors and chains of reactions between them [3,4]. Acknowledging this in research, policy formulation and implementation will move the field of essential medicines into the 21st century.

The power to improve access to medicines is shared across all health system actors; tomorrow’s solutions to medicines access are those that take into account these actors, synergize their interests, make use of the information they detain and transparently use and share their knowledge.

This approach is put forward in the latest Flagship Report of the Alliance for Health Policy and Systems Research, Medicines in Health Systems: advancing access, affordability and appropriate use”.

The Sustainable Development Goals, especially goal 3.8  – “Achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all”, offer the framework for a health system reform in which medicines play their due role.

We must seize this opportunity to set a new agenda for medicines in health systems that puts people rather than products at the heart of medicines policies and interventions.

  1. Faden, L., Vialle-valentin, C., Ross-degnan, D., & Wagner, A. (2011). Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: A systematic review of current evidence. Health Policy, 100, 134–143. [PubMed]
  2. van der Geest. (2006). Anthropology and the pharmaceutical nexis. Anthropology quarterly. Vol 79 (2): 303-314
  3. Shiekh K., Ranson M.K., Gilson L. (2014). Explorations on people-centeredness in health systems. Health Policy and Planning 29: ii1-ii5 [PubMed Central]
  4. Sheikh, K., George, A., & Gilson, L. (2014). People-centred science: strengthening the practice of health policy and systems research. Health Research Policy and Systems 12(1), 19. [PubMed] [Full text]

 

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Cheyenne

I recently did a health policy brief on value-based pricing (VBP) in medicines within a UHC system. As with any health policy there were advantages and disadvantages I found, yet in comparison I found the advantages to have a people centered outcome. Does anyone else have any thoughts on VBP and how it would work in a UHC country?

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