Antimicrobial resistance

1
World Drug Situation Differences and Gaps
Between Countries
Marthe Everard Essential Drugs and Medicines
Policy Policy, Access and Rational Use World
Health Organization
2
Production and Trade
Findings

• Global drugs production occurs mainly in high
  income countries (gt90 of production since 1985)
• Global trade is also dominated by high income
  importers and exporters this appears to be
  increasing
• of global imports 1980 1999
• Low income countries 7.2 3.4
• Middle income 22.9 17.3
• High income 69.9 79.3

3
Production and Trade
Findings
4
Access to Essential Drugs
Findings

• Differences Between Regions
• of 60 very high access countries
• 25 are in EURO, 3 in AFRO
• of 29 very low access countries
• 22 are in AFRO, 3 in EURO
• of individuals without access
• 15 are in AFRO,38 in India alone

5
Access to Essential Drugs
Findings

• Differences between Countries
• 80 of individuals without access are in low
  income countries against 0.3 of individuals in
  high income countries
• 40 of individuals in low income countries have
  no access
• against 1 of individuals in high income
  countries
• Access correlates strongly with income levels
• Av.No. of people/registered outlet, 1999
• high income countries 4,800
• middle income countries 14,400
• low income countries 27,400

6
Access to Essential Drugs
Findings

• Access to essential drugs correlates closely with
  other measures of health system performance
• access to health care
• health outcomes
• health system responsiveness
• fairness in health financing

7
Drug expenditure (out-of-pocket)
Findings
Pharmaceutical spending, as of total health
spending
Greece
Germany
Italy
France
Spain
Denmark
UK
United States
Netherlands
Norway
Bulgaria
Czech Rep.
Hungary
Croatia
Poland
Estonia
Slovenia
Lithuania
Mali
Egypt
China
Indonesia
Thailand
Tunisia
Jordan
Argentina
South Africa
0
10
20
30
40
50
60
70
8
Health insurance
Findings
9
Findings
Quality assurancemechanisms in Africa
improving - but much more work needed
100
30
33
Availability of QA mechanisms in 34 African
countries
24
50
38
46
29
0
1986
1998
QA mechanisms with QC lab.
Some QA mechanisms, no QC lab.
No QA mechanisms
10
Quality control
Findings
11
National drug policies
Findings
12
Still to do...
Conclusion

• Additional data being collected
• Main messages yet to be distilled