The world health and drug situation ∗

This paper reviews the major health and pharmaceutical developments in developing countries for the past 25 years and suggest what may occur over the next 25 years. Major health, social, economic and development changes have occurred during this period. The Alma Ata declaration was pronounced in 1978 suggesting an approach to health and health services. An integral part of this approach was the essential drugs concept which has had a global impact. The International Dispensary Association (IDA) has been a major influence in this development. Before considering pharmaceutical issues it is necessary to consider the underlying health and development situation of countries where essential drugs are of critical importance. The health and economic situation of a country has a direct impact on the demand and use of pharmaceuticals. One of the ongoing major health developments has been the demographic transition [1]. In this phenomena death rates fall due to improved living and health conditions. As a result the population grows rapidly for a period. Once people realize that large families are no longer necessary for survival birth rates fall and the population stabilizes. When this happens the population ages. The speed at which this transition occurs varies greatly and is affected by rates of economic growth, availability of family planning technologies and government policies. In conjunction with the demographic transition the epidemiological transition is also occurring [2]. In this process, as life expectancy increases, the incidence of infectious diseases decline and the prevalence of chronic diseases increase. This leads to an increase in total health care costs as the treatment of infectious diseases is short term while chronic diseases are life long usually. There have been other health developments in the period 1972–1997 with the emergence of new and resistant diseases such as viral haemorrhagic diseases such as Ebola [3], and HIV/AIDS [4]. Malaria resistant to common antimalarials [5], and Multiple Drug Resistant Tuberculosis (MDRT) [6] have complicated therapeutic choices for these common severe diseases. Major health system developments have occurred during the period 1972–1997. The Alma Ata Conference in 1978 proposed a comprehensive approach to Primary Health Care (PHC) and advocated an integrated approach to Health for All through combining an egalitarian development approach with the use of appropriate health technologies which included essential drugs [7]. A rapid reaction to this radical approach occurred with the emergence of selective Primary Health Care approach which advocated placing emphasis on a few cost-effective technological interventions [8]. This approach held sway through the 1980s. However by the 1990s Health Sector reform including decentralization, privatization and cost recovery became the mantra of development agencies. There was also a major change