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Health systems research on access to medicines: unpacking challenges in implementing policies in the face of the epidemiological transition
  1. Maryam Bigdeli1,
  2. Zubin Cyrus Shroff2,
  3. Isabelle Godin3,
  4. Abdul Ghaffar2
  1. 1 World Health Organization, Rabat, Morocco
  2. 2 Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
  3. 3 Université Libre de Bruxelles, Brussels, Belgium
  1. Correspondence to Dr Maryam Bigdeli; bigdelim{at}

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Access to medicines is defined by WHO as ensuring that medicines are ‘available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and community can afford’.1 The availability of essential medicines in public health facilities is often poor in the public sector of low-income and middle-income countries (LMICs). For selected generic medicines, availability is between 38% and 46%. Availability is better in the private sector but also suboptimal at around 70%.1 In some LMICs, prices of selected lowest priced generics can be more than twice the international reference prices, making these unaffordable for patients and the system.2 The recently concluded Lancet Commission on Essential Medicines for Universal Health Coverage has proposed a larger set of indicators that monitor the formulation and implementation of national medicines policies,3 including quality of essential medicines and disaggregation of indicators to reflect specific access issues for vulnerable populations.

However, despite these efforts at defining, measuring and improving access, the underlying systemic causes of lack of access to medicines are seldom investigated. Bigdeli et al argue that access to medicines should be examined more broadly than within the narrow boundaries of the pharmaceutical sector4: critical factors determining medicines’ access are also found in other sub-systems of the health sector (including health financing, human resources for health and health information), at all levels from local to international and on both the supply-side and the demand-side.

In 2011, the Alliance for Health Policy and Systems Research, WHO issued a call for research to generate new knowledge to inform this broad understanding of access to medicines.5 The objective of the call was to examine issues around access to medicines beyond the usual indicators …

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