|Public-private roles in the pharmaceutical sector: Implications for equitable access and rational drug use (WHO/DAP, 1997, 115 p.)|
|3. Essential state responsibilities|
Recognition of health as a fundamental human right brings with it the responsibility of the state to ensure access to health care, including essential drugs. This does not mean that the state should necessarily finance and provide all drugs. A share of drug needs - in many countries a very large share - may be met through private financing and supply mechanisms. However, the state has a responsibility to ensure that together the public and private sectors make essential drugs accessible to the entire population.
The poor bear a larger part of the burden of disease than do the affluent. In order to ensure equitable access to essential drugs for the poor, government will need to subsidize their drug costs. Government may also wish to subsidize the costs of essential drugs for high priority groups such as children.
For tuberculosis, sexually transmitted and other communicable diseases there are high costs to society if full drug therapies are not geographically and financially accessible to all. In order to ensure effective control programmes for these communicable diseases government may need to subsidize their costs. The issue of making drug prices affordable is dealt with in detail in Section 6.3.
Geographical accessibility of essential drugs may be promoted through the public and/or private sector. Regardless of the strategy or mix of strategies chosen, government should ensure the availability of essential drugs in public health care facilities. Without such drugs the credibility of the public sector is damaged, other inputs such as staff time are wasted and inappropriate drug consumption patterns may be encouraged.
A variety of mechanisms are available to promote geographical accessibility in the private sector (see Section 6.2).