Putting the priorities first: medicines for maternal and child health.

Perspectives In recent years, there has been much work done due to increasing recognition that children need better medicines. The United States of America 1,2 and the Euro-pean Union 3 have adopted regulations to encourage research and development of medicines for children; the World Health Organization (WHO) has been promoting " Make medicines child size " ; and researchers and academics are starting to respond to the many unanswered questions about medicines for children, through research and international collaboration. Countries that are working to meet the United Nations Millennium Development Goals related to maternal and child survival, however, need additional support to ensure access to medicines that will help achieve the specified targets. Fragile medicine supply systems, out-of-pocket payments and poor quality products are a particular challenge. These countries need urgent action to improve the quality, availability, supply and price of a small set of vital medicines. The burden of disease data published by WHO list the major causes of maternal and child mortality. 4 Effective medicines exist for the major causes of mortality in children: pneumonia, neonatal infections, malaria, human immunodeficiency virus (HIV), diarrhoea and tuberculosis. However, data from country surveys show that less than 50% of 20 medicines 5 needed to treat priority conditions are available in health facilities. If these data are generally applicable to medicines for children, it is hardly surprising that child mortality is a problem. The availability of medicines that are needed for treating the causes of maternal death is less well known but, in general, availability of medicines in resource-limited settings is problematic. 6 What are the priority products in addition to contraceptives and vaccines that might make a difference? WHO, the United Nations Children's Fund and the United Nations Population Fund have identified a list of the top 30 medicines based on burden of disease and evidence of benefit, as recommended in current WHO treatment guidelines. These diseases/conditions and medicines are listed in Table 1. These medicines need to be made available as appropriately packaged, affordable quality products, for use throughout the health system – especially in first-line facilities in the community. Table 2 is the " wish list " of products that could make a difference, if they were available. For some medicines, what is needed is a commercialized product – perhaps a dispersible tablet – in a pack size that is designed to provide a full treatment course. The evidence …