Q&A: WHO essential medicines director on achieving UHC in Africa

ABIDJAN — A lack of affordable medicine contributes to the out-of-pocket health expenses that push some 100 million people into poverty each year, the World Health Organization estimates. On the African continent, fake medicines — often sold cheaper — complicate the challenge of getting the right care to those who need it.

Countries need strong policies — and political will — to improve access and lower costs, Dr. Suzanne Hill, WHO director of essential medicines and health products, told Devex. She said governments should consider ways to lower costs by purchasing medicines in bulk, for example, and work to build a sound regulatory environment.

Regulators must also keep close watch of supply chains. Increasing the technical capacity of health care workers and reinforcing policies on who can distribute medicine can also contribute to lower costs in the long run for consumers.

“There are a number of strategies that need to be put in place,” Hill said. “No one system is perfect for every country, but the principle guide is that there must be investments in regulatory systems and there must be investment in managing supply chain.”

Hill spoke with Devex about how these guiding principles are key to building sustainably affordable health systems. The conversation has been edited for length and clarity.

Many cities across sub-Saharan Africa have a black market of fake medicines. How can we minimize the selling of fake medicines in these low-income countries where cost is usually the greatest concern?

Countries have to be prepared to invest in enforcement of their regulatory system. [There is] no point of having a regulatory authority if you don’t enforce the law. You have to have a law that defines who can sell real medicines and ensure that this is enforced. If a law says that you can’t buy certain medicines over the counter, then you have to enforce that.

The next thing is you have to have in place systems that are supplying the medicines people need. Fake medicines enter the supply chain whenever there’s a shortage or when there’s an increase in demand. You also have to have systems in place that can detect fake medicines and can respond to fake medicines appropriately.

We have a pilot in Tanzania of a mobile phone-based app for reporting prospect fake medicines. The data goes straight to the regulatory authority, which can then investigate. We have case studies that will report what happened with these kinds of systems, but you do have to have a strong health system and a real political will to manage this.

In addition to access to affordable essential medicines, what are some of the other ways Africa can move toward universal health coverage?

In order to make medicines affordable in the long term for the system, we have to make sure that they are used wisely. You have to have good diagnostic tests available, so you know what [illness] people have and you can prescribe the appropriate medicines. That’s another part of the puzzle. It’s not just medicine. It’s medicines and diagnostic tests, and the right kinds of devices to use them appropriately.

We also recommend that prescribers of medicines know what they are prescribing. We see in sub-Saharan Africa, for example, there’s quite a good availability of antibiotics, but that results in overuse. Viral infections don’t respond to antibiotics. But unless you know what [the illness] is, you may be inclined to treat it with [antibiotics] as a precaution. Having quality treatment guidelines and well-trained health care workers remains critical to ensuring that access to medicines remains affordable and the most quality for the user.

Can you talk about the economic impact of adopting universal health coverage?

Investing in health is actually a gain. It leads to economic development. It leads to growth. It’s not a cost. Even though health care systems are always seen as expensive, what we know is that to invest in health care you improve your development, improve the industry, and improve population and economic growth.  

Is there any particular challenge, risk, or opportunity that you’d like to highlight in Africa’s push toward universal health coverage?

One of the big challenges, particularly in sub-Saharan Africa, is in making sure that good governance systems are in place in the health care sector, particularly with respect to the supply of medicines, because the risk of extra payments and corruption is high. That’s one of the big political challenges that has to be addressed.

I think there’s a huge opportunity with the increased political interest in universal health coverage and the commitment of African countries to making sure that their citizens have medicines. They are interested in manufacturing of quality medicines coming out of Africa, and I think that’s an opportunity. But it has to be looked at as a long-term goal with a lot of investment required.

Finally, I think that the political will that is developing around the issue of universal health coverage is part of achieving the Sustainable Development Goals and has provided an opportunity to work, as WHO, with many countries to enhance the delivery of health care so that everybody has a chance to live a healthy life.

How do we ensure that people worldwide get the care they need without the risk of being pushed further into poverty? Devex explores the path to universal health coverage. Join us as we ask what it will take to achieve UHC for all by visiting our Healthy Horizons site and tagging #HealthyHorizons, #Health4All and @Devex.