Markets and policy challenges in access to essential medicines for endemic disease created by Maureen Mackintosh and Phares G. M. Mujinja

Access to essential medicines is a core element of the effective health systems that are required to deal with endemic disease. Cost-effective access relies in turn on efficient market functioning and on appropriate polices towards the role of markets at national and international levels. This article argues that current international policy frameworks for promoting access to essential medicines lack coherence and display weak empirical foundations for proposed market interventions. A study of medicines markets in Tanzania questions some assumptions about market functioning underlying international policy, and shows how exploratory field studies can reduce the knowledge gap. Medicines policy should aim for rational use of essential medicines and for universal access free at the point of use to medicines essential to treat endemic diseases and other major causes of death. Unregulated retail market competition in essential medicines should be progressively constrained by government and NGO action. Wholesale market competition, in contrast, should be promoted, while the rebuilding of African pharmaceutical manufacturing is important for promoting and sustaining access. At each market level, public and non-governmental non-profit traders and providers can play a regulatory role alongside greater citizen information and civic activism.