[Ip-health] Oxfam letter to the Lancet: Action to preserve WHO's core medicines-related roles—1 year on

Thirukumaran Balasubramaniam thiru at keionline.org
Wed Jan 23 09:16:24 PST 2013


The Lancet, Early Online Publication, 18 January 2013
doi:10.1016/S0140-6736(12)62201-6Cite or Link Using DOI
Action to preserve WHO's core medicines-related roles—1 year on

Philippa Saunders a, Mohga Kamal-Yanni a

The future of WHO and levels of financial and other support will depend on successful completion of reform in 2013. Member States are due to complete the first phase—prioritisation—of the three-part plan to rationalise WHO's budget against its workplan at the World Health Assembly in May. The second step will be an open pledging conference at which all funders will declare their contributions. Finally, a monitoring exercise will assess the results and reveal any gaps that remain. The Member States will decide in May which functions uniquely belong within WHO—these decisions will dictate their financial support.

A year ago, Oxfam highlighted the serious impact of the WHO financial crisis on WHO's core functions, focusing on access to medicine. In letters to The Lancet,1, 2 we stressed the need to preserve the integrity of the work of WHO on medicines as a prerequisite for the achievement of well functioning health systems. National health services are doomed to fail without essential health products. Moreover, many Member States spend 30% of their health budgets on medicines, yet access to medicines is unreliable, and faulty and badly used health products continue to injure patients and waste resources.

Although a year on our concerns about the future remain, it is encouraging that the Director General has called for WHO to lead a movement that delivers universal health coverage, which is “the single most powerful concept that public health has to offer”.3This leadership, however, requires a strong, credible, and independent agency with a global mandate to ensure access to affordable, safe medical products.

WHO's medicines work underpins access to such products. In addition to country support to Member States for development of pharmaceutical services, WHO's medicines functions include the selection and rational use of medicines, pricing and supply policies, addressing of antimicrobial resistance, production of evidence for policy making, and many more. Poorly resourced Member States depend heavily on WHO support that has for 30 years improved access to essential medicines for the most disadvantaged people in the world.

Inadequate resourcing for the medicines functions is straining to the limits WHO's ability to support Member States. For example, although the production of pain guidelines is a constitutional obligation of WHO, normative work on access to controlled medicines, including pain treatment guidelines, ended in October, 2012. At present most of the world's people in intolerable pain owing to serious accidents, obstructed deliveries, cancer, and HIV do not receive adequate—or often any—pain relief.

The WHO unit that deals with the safety, efficacy, and quality of active pharmaceutical ingredients (APIs) and finished medicines, capacity building for drug regulation, and safety of products cannot adequately support essential work, including quality assurance of APIs. One consequence is that, despite 80% of APIs for all essential medicines coming from India and China, it is not clear whether WHO will be able to provide these countries with adequate support to assure quality of their APIs into the future.

We therefore urge WHO and Member States, through the reform process, to commit to: (1) prioritise and restore the full range of activities that are needed to support Member States to manage medical products; (2) support, with adequate finance from the central WHO budget, medicines-related functions that require independence from the interests of individual donors; and (3) maintain and increase technical expertise in countries through the National Pharmaceutical Officers scheme to build national pharmaceutical capacity for universal health coverage.

The coming year will be crucial for WHO. Member States, donors, and all interested parties should remember that every major health initiative must be built on sound technical and normative foundations at global and country levels. They must recognise the parlous state of the organisation's underlying machinery and resist concentrating only on high-profile health issues while starving to the point of extinction WHO's ability to provide cross-cutting systems support and independent universal standards.

We declare that we have no conflicts of interest.


1 Kamal-Yanni MM. Action to preserve WHO's core functions cannot wait for organisational reform. Lancet 2012; 379: 309. Full Text | PDF(78KB) | CrossRef | PubMed
2 Kamal-Yanni MM, Saunders P. Urgent need for WHO's reform to prioritise core functions. Lancet 2012; 379: 1878. Full Text |PDF(78KB) | CrossRef | PubMed
3 WHO. Best days for public health are ahead of us, says WHO Director-General.http://www.who.int/dg/speeches/2012/wha_20120521/en/index.html. (accessed Jan 14, 2012).
a Oxfam GB, John Smith Drive, Oxford OX4 2JY, UK


Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International (KEI)

thiru at keionline.org

Tel: +41 22 791 6727
Mobile: +41 76 508 0997

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