Managing the Hydra: The Herculean Task of Ensuring Access to Essential Medicines

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Abstract
It is one thing to describe the Augean stables - another thing to clean them Myres S. McDougal The concept of essential medicines The task of ensuring access to essential medicines presents a complex and embedded set of problems that will remain a persistent feature of the international governance landscape for the foreseeable future. According to the definition provided by the World Health Organization (WHO): Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. The WHO's recommended list of essential medicines has been developed with a view to aiding procurement authorities in determining the supplies needed to treat local populations. The price of medicines is a significant factor in determining what should be included on the list since there is small utility in recommending expensive therapies that are not affordable. As the WHO observes: In developing countries, newer combination antimalarial medicines may be 30–200 times more expensive than chloroquine; medicines to treat multi-drug resistant tuberculosis may cost 20–30 times more than the usual DOTS treatment; and treatment of HIV/AIDS with anti-retroviral medicines may cost between $400–2500 per year. Most medicines budgets in developing countries are below $30 per person per year, with 38 countries having less than $2 per person per year.

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