World Drug Situation: Differences and Gaps Between Countries Marthe Everard Essential Drugs and Medicines Policy Policy, Access and Rational Use World Health Organization

WHO - EDM 2 Production and Trade n Global drugs production occurs mainly in high income countries (>90% of production since 1985) n Global trade is also dominated by high income importers and exporters; this appears to be increasing: % of global imports Low income countries Middle income High income Findings

WHO - EDM 3 Production and Trade Findings

WHO - EDM 4 Access to Essential Drugs n Differences Between Regions ä of 60 “very high” access countries: 25 are in EURO, 3 in AFRO ä of 29 “very low” access countries 22 are in AFRO, 3 in EURO ä of individuals without access: 15% are in AFRO,38% in India alone Findings

WHO - EDM 5 Access to Essential Drugs n Differences between Countries: ä 80% of individuals without access are in low income countries against 0.3% of individuals in high income countries ä 40% of individuals in low income countries have no access against 1% of individuals in high income countries ä Access correlates strongly with income levels : Av.No. of people/registered outlet, 1999 high income countries 4,800 middle income countries 14,400 low income countries 27,400 Findings

WHO - EDM 6 Access to Essential Drugs n Access to essential drugs correlates closely with other measures of health system performance : ä access to health care ä health outcomes ä health system responsiveness ä fairness in health financing Findings

WHO - EDM South Africa Argentina Jordan Tunisia Thailand Indonesia China Egypt Mali Lithuania Slovenia Estonia Poland Croatia Hungary Czech Rep. Bulgaria Norway Netherlands United States UK Denmark Spain France Italy Germany Greece Pharmaceutical spending, as % of total health spending Transitional economies (15-30 %) Developed countries ( %) Developing countries ( %) Findings Drug expenditure (out-of-pocket)

WHO - EDM 8 Health insurance Findings

WHO - EDM 9 Quality assurance mechanisms in Africa improving - but much more work needed 29% 38% 33% 46% 24% 30% 0% 50% 100% QA mechanisms with QC lab.Some QA mechanisms, no QC lab. No QA mechanisms Availability of QA mechanisms in 34 African countries Findings

WHO - EDM 10 Quality control Findings

WHO - EDM 11 National drug policies Findings

WHO - EDM 12 Still to do... n Additional data being collected n “Main messages” yet to be distilled Conclusion