Equitable health services

The Community Working Group on Health (CWGH) in Zimbabwe, with a membership of about 35 civil society organisations representing a wide range of constituent groups, has called on the World Health Organisation to address the severe decline in heath and in the health system in Zimbabwe. It recognises that the current health crisis does not emanate from the health sector but from wider economic collapse. The CWGH urges WHO and partners to more widely address what needs to be done and what resources and support are needed to rebuild health systems from primary health care level upwards, and to involve communities in deliberations and plans on the way forward. Zimbabweans, they indicate, are not numbers of cholera cases or fatalities but people who have responded to an increasingly difficult situation, who are entitled to health as a right and who should be central in any response and rehabilitation of the health system.

Integrating mental health services into primary care is the most viable way of ensuring that people get the mental health care they need and primary care workers need adequate training and support for this. Integration is most successful when mental health is incorporated into health policy and legislative frameworks and supported by senior leadership, adequate resources and ongoing governance. To be fully effective and efficient, primary care for mental health must be coordinated with a network of services at different levels of care and complemented by broader health system development. Numerous low- and middle-income countries have successfully made the transition to integrated primary care for mental health. Mental health is central to the values and principles of the Alma Ata Declaration; holistic care will never be achieved until mental health is integrated into primary care.

In spring 2009, the EU’s executive branch will present the findings of an investigation into the pharmaceutical sector. This is a preliminary report of this probe, launched in January this year, which found that leading pharmaceutical companies are using the patent system to delay the entry of generic medicines onto the market. Patent holders tend to embark on a long, legal battle to delay the release of a generic. Examining a sample worth about 10% of the Union’s €150 billion-a-year prescription drugs market, the Commission estimated that €3 billion could have been saved to public health budgets if generic entry had taken place immediately once patents expired. This is based on data indicating that the price of a drug falls by about 20% after a year once it moves from being branded to generic.

Amid fears that huge quantities of counterfeit medicines and pesticides are pouring into Africa, the international law enforcement agency INTERPOL is leading the way to invest more effort and money to bring authorities up to speed on the threat faced by those who depend on the imports, from hospital patients to pharmacists to farmers. Among the first of the OASIS anti-counterfeiting moves was Operation Mamba, a police action in Uganda and Tanzania in September and October that led to the seizure of more than 100 kinds of medical products, including anti-malarial pills, multivitamins, skin medicines and heart drugs. Four pharmacies in Tanzania were shut down; in Uganda, police are investigating 38 shops on suspicion that they are working illegally. INTERPOL is investing more effort and attention to Africa as the staggering extent of the counterfeiting problem on the continent becomes clearer. While precise numbers are difficult to come by, the World Health Organization believes that 30 percent of drugs sold in developing countries are counterfeit; in some parts of Africa, that number could be as high as 90%.