Strategies to Improve Health Systems

Collaborate on Group Purchasing of Essential Medications to Increase their Access and Affordability

Because medications play a key role in achieving improved clinical outcomes among people with NCDs, assuring that patients have access to the appropriate medication is important. However, the context in South Asia makes this goal hard to achieve. All countries in the region spend a considerable proportion of total health expenditures on drugs, and much of this is paid by patients themselves, including the poor.

This is largely due to the unavailability of essential drugs in the public sector because of

inadequate public purchasing practices, and large mark-ups in the private sector (Cameron et al. 2009), and public policies that may not provide drugs.Most of the countries in the region lack the expertise and facilities to produce a wide range of pharmaceuticals.

As a result, essential drugs for NCDs are likely to be imported. India, however, has an

extensive drug manufacturing program that caters both to internal and external markets, the latter mainly within South Asia. Bangladesh also has an extensive manufacturing industry for some medications, but nearly all are consumed domestically.

Quality control and good manufacturing practices for medications are both issues that challenge these two markets.While the market place is likely to develop drugs that respond to demand from people who can pay for them, many institutions and individuals cannot afford to. Country collaboration (to gain better bargaining power and affordability to drugs for NCDs) is likely to help provide real gains on this preventable burden.