Medicines and universal health coverage: challenges and opportunities

The goal of Universal health coverage (UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them [1]. This goal is based on the idea of an affordable continuum of care from preventive to curative and rehabilitative services for which essential health system resources are required. These resources include health workers, essential medicines and technologies [1]. Universal health coverage (UHC) is also the focus of ongoing high-level discussions, a momentum created by the World Health Report 2010 and a pathway to which many agencies and governments now commit [2,3]. Essential medicines are considered an integral part of UHC; they are an indispensable element for delivery of services and are also a requirement for high-quality care. It is obvious that careful consideration must be given to ensuring reliable access to quality assured essential medicines when designing benefit packages. Policy instruments that contribute to the effectiveness of the concept of essential medicines include National Essential Medicines Lists, formularies, standard treatment guidelines and measures to ensure access to affordable quality assured medicines. Aside from being a commodity that is required for service delivery, medicines also contribute significantly to government and household spending on health. Medicines account for over a quarter of total health expenditures with some Low and Middle Income Countries (LMICs) spending up to 67% of their total health expenditures on pharmaceuticals [4]. In low and middle income countries, more than half and sometimes up to 90% of expenditures on medicines are out of pocket [4], putting the most vulnerable households at great risk of financial hardship and catastrophic health expenditures. While part of this spending brings good value for money, medicines contribute to the leading sources of health system inefficiency [3].