Controversy brewing over the greatest barriers to access to medicine

A worker selects medicine from the MEDS (Mission for Essential Drugs and Supplies) warehouse in Nairobi. MEDS is jointly owned by the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya. Photo: Bedad Mwengi

This was originally published on Global Health TV on July 16, 2016.

In comments last week at the International AIDS Conference in Durban, South Africa, UN Secretary General Ban Ki-moon said four things deserved credit for getting the AIDS pandemic under control — people living with HIV, biomedical companies, generic medicines and international finance.

But despite his gratitude to biomedical companies and generic medicines, the secretary-general is overseeing a process that threatens to undermine those companies' ability to improve access to medicine in developing countries.

The World Health Organization says an estimated 2 billion people (27% of the world’s population of 7.5 billion) lack access to essential medicine, most of them in Africa and Asia, but a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief treatment.

To address this staggering problem, the Secretary-General set up a High-Level Panel on Access to Medicines earlier this year. The purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

Sounds like a great and noble idea, right? But some expert commentators say the panel is on track to do more harm than good because of its terms of reference.

In West Africa, progress on family planning but millions not treated for HIV

Women gather for the launch of the national family planning campaign in a low-income neighborhood of Bamako, Mali in April.

This was originally published on Global Health TV on April 26, 2016.

BAMAKO, Mali — Last year, there were several reports of how West Africa, after decades of seriously lagging behind the rest of the world (and Africa) in family planning, was finally starting to embrace it. IntraHealth International covered this topic extensively on its Vital blog, and I wrote about my own views of family planning in Mali here at Global Health TV.

Senegal, in particular, emerged as a family planning leader in West Africa and provided hope for the rest of the region. The three main reasons for Senegal’s success were strong political will, better coordination and collaboration and innovative approaches, according to Babacar Gueye, IntraHealth country director in Senegal.

New programs here in Mali, like Keneya Jemu Kan (USAID Communications et Promotion de la Santé, in the Bambara language), are making a major push to increase health indicators beyond the anemic progress of the past three decades. For example, the percentage of married women using any modern method of family planning in Mali has only increased from 1.3% in 1987 to 9.9% in 2013, and Keneya Jemu Kan is working to bend that rate upwards. (Full disclosure: I work as a consultant for Keneya Jemu Kan).

But a disturbing new report from Médecins Sans Frontières (MSF), or Doctors Without Borders, claims that similar progress is not being made in HIV/AIDS. On the contrary, MSF claims that millions of people in West and Central Africa are being left out of the global HIV response despite globally agreed goals to curb HIV by 2020, and is calling on the international community to develop and implement an urgent plan to scale up antiretroviral treatment for countries where critical medicines reach fewer than one-third of the population in need.

West Africa finally starting to embrace family planning

A health worker counsels a client in rural Senegal on family planning options. Photo courtesy of IntraHealth International, © 2014 by Jonathan Torgovnik/Reportage by Getty Images

This blog originally appeared on Global Health TV on March 24, 2015.

BAMAKO, Mali — When my wife and I lived here in the late 1980s and early 1990s, our housekeeper, Korotumu, hid her birth control pills on the top shelf in our kitchen, so her husband would not find out she was using contraception. He was unemployed and they had two children. Koro figured that two was enough, at least as long as her husband was not working.

I didn’t realize it then, but Koro was in a progressive minority of Malian women at that time. The 1987 Demographic and Health Survey of Mali revealed only 1.3% of married women were using modern contraception and the fertility rate (the average number of children a woman has in her lifetime) was 7.1. Koro was part of that 1.3%.

Flash forward a quarter of a century and what has happened in Mali? Use of modern contraception has increased to 9.9% and the fertility rate has dropped from 7.1 to 6.1.