who medicines strategy - libdoc.who.int - World Health Organization

WHO MEDICINES STRATEGY 2004-2007 | 60Figure 15:Per capita spending on pharmaceuticals by main source, 1990and 2000, by country income groups400350300250A World – 1990B World – 2000C Low – 1990D Low – 2000E Middle – 1990F Middle – 2000G High – 1990H High – 2000US$200150PrivateGovernment100500A B C D E F G HSource: WHO National Health Accounts DatabaseEO 3.2Public funding of medicinesincreased through increasedorganizational capacity toimplement sustainable drugfinancing strategies and systemsRationaleIn many countries today, private out-of-pocketspending on medicines is the largest componentof household spending on health. In manylow-income countries in particular, private outof-pocketspending accounts for 50%-90% ofpharmaceutical sales. (Figure 15) During the1990s, the private share of global expenditure onmedicines increased 23 . Yet governments have theresponsibility to ensure that medicine financingmechanisms are established and managed in sucha way as to achieve equitable access to essentialmedicines.While health financing reform should improvethe use of public resources, it should not beaimed at reducing public spending on health andmedicines 24 . Market-oriented reform policies arenot geared to protecting the needs of the poorestpeople and, without public financial support, thepoor may be denied access to medicines. There isa critical need to assess the effect of user chargesfor medicines in the public sector, in particulartheir impact on public health objectives.ProgressRecent progress in increasing public fundingof medicines has been inadequate due to thewidespread emphasis on health sector reform.However, all WHO regions have identifiedmedicines financing among their priorities andWHO has provided technical support in severalcountries. In SEARO, for example, WHO supportedthe appraisal of new financing options such asrevolving funds or social insurance coverage. Muchof the recent focus in medicines financing has beenon the mobilization of additional funding resourcesinternationally, through the Global Fund and theCommission on Macroeconomics and Health. Inaddition, WHO input to the Millennium Projecthas stressed the importance of rethinking domesticmedicine financing strategies, in particular therole of user charges, and of ensuring that nationalEssential Medicines Lists are recognized as astatement of resource needs for public medicinesfinancing. In recent years, WHO has developedtechnical material on health financing generally andon medicines financing in particular. 25