Medical products, vaccines and technologies

A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use. To achieve these objectives, WHO suggests that the following are needed:

• National policies, standards, guidelines and regulations
• Information on prices, international trade agreements and capacity to set and negotiate prices
• Reliable manufacturing practices and quality assessment of priority products
• Procurement, supply, storage and distribution systems that minimise leakage and other waste
• Support for rational use of essential medicines, commodities and equipment, through guidelines, strategies to assure adherence, reduce resistance, maximise patient safety and training.

Building effective and accountable national procurement and drug management systems is an increasingly prominent component of the health systems action agenda, with a number of guidelines available to assist with this process. But in fragile states, where governance is weak, the regulation of the supply and quality of medical products is often equally weak. With the high burden of disease contributing to a high demand for medications, the lack of effective regulatory mechanisms, trained staff, and testing equipment makes fragile states inevitable “dumping grounds” for unwanted, poor quality or fake medicines. This in turn worsens a patient’s chance of receiving effective treatment and could also contribute to drug resistance.

A centralised procurement, supply, storage and distribution system seldom exists in these contexts, and where it does, it often lacks proper resources and is very vulnerable to leakage and corruption. With the high reliance on UN agencies and NGOs for health services provision, supply systems in fragile states also tend to be fragmented, with each agency responsible for its own logistics supply cycles, training and guidelines. As contracting out of health services to NGOs gains popularity, this fragmentation will likely continue to exist unless health ministries actively pursue the establishment of a transparent and reliable centralised system to reduce costs and improve efficiency.