G268(P) Are essential medicines available, reliable and affordable in low-middle income countries?

Abstract

BackgroundThere is increasing anxiety worldwide that the World Health Organisation recommended Essential Medicines may not be universally available,accessible,affordable and of good quality.Aims/methodsWe wished to seek the perceptions of 10 lead paediatricians treating children with cancer in 9 low-middle income countries. We used a 17 point semi-structured questionnaire to gather the information. this study involved doctors in Cameroon,Ghana, Malawi,Tanzania,Zambia, Bangladesh,Myanmar, The Philippines,and Colombia. Collectively the centres were seeing overr 2000 new patients annually of whom a median of 65% (range 5%–90%) received ‘curative intent’ therapy.ResultsOnly Bangladesh produced any but not all the required cytotoxics. All countries were required to import some or all the medicines.In only 3 countries did the Ministry of Health directly oversee procurement/importation of drugs.In 5 delegated pharmacies or a single hospital was responsible. in Bangladesh there was a free market approach for procurement and importation. Inconsistent supplies were cited by all respondents especially of critical drugs including antibiotics,morphine,6-mercaptopurine, methotrexate,cytosine, asparaginase, and vincristine. Reasons cited for no-importation were non/or late renewal of licences to import, reluctance to procure low profit or low volume drugs and anxieties regarding importation of opiates. Medicines were imported from a range of countries most commomly from India (7/9) and China (often via India), argentina,Brazil, South Kores, Cyprus and Malaysia. All respondents expressed anxiety about drug quality imported with no International Quality Certification. High rates of treatment refusal/abandonment (20% median range <5%–50%) were most often attributedto non-affordability by parents unless some subsidies were available.ConclusionsFrom these perceptions there are major obstacles to be overcome to ensure that all children can receive the medicines they need for any chance of cure certainly those living in low-middle income countries. There are challenges at each stage from production to the bedside and only a truly global effort by all interested parties including the WHO and the Pharmaceutical Industry can resolve these issues.