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The Global Partnership for Development at a Critical Juncture

The Global Partnership for Development at a Critical Juncture

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Providing greater access to essential medicines continues to be extremely urgent
and challenging. While some countries showed some progress, on the whole, little
recent improvement has been made in providing afordable access to medicines
in developing countries. Availability of essential medicines in developing coun-
tries continues to be low, especially medicines to treat chronic diseases. Tis is of
particular concern in low-income countries, where chronic diseases have become
a main cause of mortality and are putting enormous burdens on the economic
conditions of households and national health systems.
In developing countries, essential medicines are typically available at
prices only many times higher than international reference prices. Owing to low
availability in the public sector, out-of-pocket expenditure is the major source
of pharmaceutical payments in low- and middle-income countries. As a result,
many medicines, even the lowest-priced generic medicines for chronic and acute
diseases, remain unafordable for many people in developing countries. In high-
income countries, in contrast, public funding or mainly employer-based health
insurance covers the cost of most medicines.
More progress has been made in providing medicines in the fght against
acute diseases in developing countries. Enhanced provision of antiretroviral ther-
apy as a prevention strategy for HIV has had a large impact on reducing the viral

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The Global Partnership for Development at a Critical Juncture

load of patients living with AIDS. Te Global Fund to Fight AIDS, Tuberculosis
and Malaria has provided treatments free of charge to patients and helped stem
the prevalence of such diseases. Tere have been setbacks as well, including in the
form of the spread of drug-resistant forms of tuberculosis. Furthermore, in many
countries, the capacity to respond to the AIDS epidemic has been diminished
because of falling household incomes and reduced government revenues which
have led to cuts in budgets for HIV/AIDS programmes.
Te impact of the fnancial crisis on access to medicines has been mixed.
While pharmaceutical consumption did not fall, prices and expenditure on medi-
cines have increased.

In order to reduce the burden of acute and chronic diseases and improve the
accessibility and afordability of essential medicines in developing countries, the
international community should consider taking the following actions:
y Encourage Governments of developing countries to increase the availability
of medicines in the public sector and strengthen national health systems, sup-
ported by ODA, where needed, and ensure that medicines are also afordable
for low-income families, preferably as part of a broader mechanism to establish
a social protection foor
y Tailor measures to improve availability of essential medicine to country condi-
tions by means of the following:
ƒ Countries without signifcant pharmaceutical manufacturing capacity
should take advantage of fexibilities contained in the World Trade Organi-
zation Agreement on Trade-Related Aspects of Intellectual Property Rights
(TRIPS) so as to facilitate imports of more afordably priced essential medi-
cines

ƒ Developing countries with the capacity to produce pharmaceuticals should
take advantage of public-health-related TRIPS fexibilities to manufacture
generic versions of patented medicines and promote foreign investment to
acquire new technologies for producing such medicines
ƒ Developed countries should further facilitate the export of generic medi-
cines at the lowest costs to countries without manufacturing capacity by
incorporating the relevant TRIPS fexibilities into domestic legislation
ƒ In order to facilitate the above TRIPS-related actions, the international
community should increase eforts to reduce costs incurred by developing
countries when making use of the fexibilities ofered in the Agreement, or
compensate them for such costs
y The international community should support research and development into
neglected diseases in developing countries with a view to developing medi-
cines for their treatment
y Developing countries should strengthen information-sharing mechanisms
regarding prices of medicines in order to strengthen their capacity to negotiate
lower prices with pharmaceutical companies. They could further strengthen
their bargaining power by setting up joint or “pooled” procurement or other
innovative fnancing mechanisms

Access to new technologies

Despite the global economic crisis, further progress has been made in increas-
ing access to information and communication technologies (ICT), especially to
mobile cellular telephony and the Internet. Tis growth in the use and application

xvii

Executive summary

of ICT has signifcantly boosted its potential as a catalyst for development across
sectors. Increased use of “e-Government” has helped improve the management
of education, health and environmental programmes, which can have an impact
on the achievement of the MDGs.
Mobile cellular subscriptions grew to 4.6 billion by the end of 2009, reach-
ing 68 per cent of the world’s population. Growth continues to be strongest in
developing countries, where mobile cellular penetration grew rapidly from 38 per
cent in 2007 to 57 per cent in 2009.
As a result, the digital divide narrowed further in 2008, though disparities
between developed and developing countries remain. Large regional disparities in
the use and uptake of ICT services also persist. For instance, access to the Internet
at broadband speeds remains very low in developing countries and is practically
negligible in LDCs. Given the lack of access to Internet services, high-speed (3G)
mobile broadband networks can play a leading role in boosting the number of
Internet users, especially in areas where fxed-line penetration is very low, as is
the case in many parts of Africa.
Te economic crisis has afected new investments in the sector and this
could delay leapfrogging to new technologies. Tere is evidence of reduced invest-
ments in planned network upgrades, and the introduction of “next generation”
networks into the market has been delayed or abandoned as a result of fnancial
constraints.

ICT is increasingly provided by the private sector and is open to competi-
tion, particularly in mobile and Internet services. While this has generally helped
drive down prices, making services more afordable, it may not always hold true
for developing countries.

Te challenges of addressing climate change require further access to tech-
nologies for renewable energy production and environmental protection for sus-
tainable development. But economic and market barriers, particularly lack of
fnance, have been identifed by developing countries as the main obstacles to
technology transfer. At the 2009 United Nations Climate Change Conference in
Copenhagen, developed countries agreed to ensure that predictable and adequate
new and additional funding would be mobilized and improved access to tech-
nologies would be granted, particularly for developing countries, so as to enable
enhanced action and further technology development and capacity-building for
climate change mitigation and adaptation.
Natural disasters afect the poorest countries the most, especially if meas-
ured in relation to the size of their economies. Implementing disaster risk reduc-
tion measures has long-term benefts, from reduced future losses and reconstruc-
tion costs to less vulnerable livelihoods, resilient communities and protective and
productive ecosystems.

In order to improve the accessibility and afordability of new technologies, the
international community should take the following actions:
y Support the development of concrete targets and indicators to monitor access
to new technologies
y Strengthen public-private partnerships in support of the use of Internet serv-
ices, including in the form of regional communication networks and e-Govern-
ment and its application towards improved social service delivery

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The Global Partnership for Development at a Critical Juncture

y Encourage ICT investment in developing countries in order to enhance access
to broadband Internet services. To this end, in countries that currently have
very low levels of coverage of fxed broadband, especially those in Africa, prior-
ity should be given to expanding wireless networks
y Strengthen both competition and regulatory frameworks for markets of Inter-
net service providers in order to promote the spread of new technologies and
reduce prices
y Enhance internationally concerted eforts to promote the development and
transfer of technologies for mitigation of and adaptation to climate change in
developing countries, and provide the necessary fnancial resources and tech-
nical assistance in order to address urgently the needs of developing countries
in dealing with its adverse efects
y Increase development assistance to support developing countries vulnerable
to natural hazards in adopting disaster risk prevention programmes as part of
national development strategies

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