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Access to medicines and supplies

  • Page updated onMarch 22, 2025
Access to medicines
Photo: Bruno Abarca

A good health system must ensure equitable access to medicines, vaccines, medical supplies and health technologies at affordable prices. It must also implement a robust system of regulation and control of these products to ensure their quality, safety and efficacy. All this is necessary, not only for the good performance and equity of the system, but also to achieve universal health coverage. However, in practice, more than two billion people do not have access to the medical products they need, especially in middle- and low-income countries.

When there is also a humanitarian crisis, health sector actors face additional challenges to ensure the availability of quality medicines. In these contexts, local market regulation is often deficient and importation is fraught with administrative, logistical and technical obstacles. Even when medicines are made available, it is difficult to ensure proper use.

In fragile contexts, there are major problems of access to medicines.

In low- and middle-income countries, even after overcoming barriers to accessing health services, people encounter numerous problems in obtaining the medicines they need.It is estimated that more than half of the drugs prescribed to them are not available at public health facilities. As a result, patients must go with their prescription to buy them out of pocket at prohibitive cost, in environments where around 15% of the drugs on the market are of poor quality or counterfeit. This particularly penalizes those with the least resources. This problem is further exacerbated when there is a high proportion of inappropriate prescriptions. The WHO estimates that 9.5% of all spending by the poorest families in middle- and low-income countries goes on medicines.

Public investment in essential medicines is needed

It is recommended that countries determine a national list of essential drugs. This can be done by adapting the WHO model list, which has been updated periodically since 1977. This type of list prioritizes the drugs that are most important and effective in addressing the needs of the population.

The public financing (and with international collaboration in some cases) of these drugs allows them to be included in the benefit packages and the different prepayment and health insurance schemes available in the country. This also contributes to reducing the population's out-of-pocket expenses as much as possible.

A huge barrier to investment in access to medicines is their high cost, especially when there is no local manufacturing capacity or generic versions are not available. However, it is not always possible to obtain the prices of these drugs, given the lack of transparency of the pharmaceutical industry and its commercial agreements. It is estimated that to cover the needs in essential medicines each government should invest annually, on average, from 13 to 25 dollars per capita. This amount, however, is far from the current level of investment in poor countries.

Managing the medical supply chain is a challenge in fragile contexts

Everything is complicated when resources are lacking: from the procurement and production of raw materials (when there is local manufacturing capacity) to the logistics of storage, transport and distribution at all levels of care in the system (to reach users in their communities). In addition, these difficulties often occur in a weak health system in its infrastructure, resources for storage and transport, procedures, information systems, regulation, and staff with sufficient capacity and means to sustain the entire logistics cycle.

The pharmaceutical logistics cycle
JSI, 2020.

There are risks linked to the quality of the drugs and their prescription

Most middle- and low-income countries lack regulatory agencies with sufficient capacity to prevent the circulation of substandard drugs. These products may be affected by inadequate transport and storage procedures, fail to meet manufacturing standards, or be directly counterfeited. This is not a minor problem. An estimated 122,000 deaths occur each year in children under 5 years of age in 39 countries in sub-Saharan Africa as a result of the use of counterfeit or substandard antimalarial drugs.

The problem increases when prescriptions in health units are inadequate. This can occur with unnecessary prescriptions (such as antibiotics for viral infections), with prescriptions of brand-name drugs (instead of generic versions of identical quality), or with erroneous prescriptions. When drug prescriptions are not rational, additional risks and economic burdens are added for patients and the health care system in general.

For many health problems, there are no effective treatments.

There are important pathologies and health problems affecting low- and middle-income countries for which there are no effective drugs available. This is partly due to the lack of investment in research and development for markets that are not particularly lucrative for pharmaceutical companies. This, in turn, occurs within the framework of a global model of intellectual property protection that does not generate adequate incentives for research into drugs with a high impact on public health.

There is insufficient research into the development of drugs for pathologies that affect the poorest people (such as malaria or tuberculosis). In addition, there is a lack of innovation in drug formulations such as oxytocin or insulin with the capacity to withstand high temperatures in contexts where it is impossible to maintain the cold chain.

This leads to a serious additional issue: antimicrobial resistance.

In complex humanitarian crises, mortality and death resulting from limited access to essential drugs also increases as a consequence of antimicrobial resistance. This is a serious problem, poorly studied in these settings, with causes linked to the fragility of health systems and barriers to accessing health services:

  • Limited access to health services. Displaced populations face significant physical and economic access barriers, in addition to discrimination, lack of information about their rights, institutional racism and even fear of detention and deportation. This impedes and delays health care.
  • Weakness in the supply chain. The interrupted supply of antimicrobials encourages self-medication with low-quality drugs, acquired without prescription, and from unlicensed suppliers, when there is also little regulation of the pharmaceutical market.
  • Lack of hygiene and infection prevention measures. This increases the overall risk of infectious diseases, and especially vulnerability to in-hospital infections, which are often resistant to antimicrobials.
  • Lack of diagnostic resources. Without laboratory capacity, the inappropriate use of broad-spectrum antibiotics increases and adequate surveillance of the appearance of resistance is impossible, which makes it invisible and undetected.
  • Inadequate prescriptions. The absence of trained personnel, or the dilemma of sacrificing quality and oversight of health care in exchange for making it available quickly and in remote areas, sometimes results in overprescribing of antibiotics.

Addressing this problem, which is most prevalent among vulnerable groups such as young children and those with malnutrition, is complex and, to date, has not received sufficient attention in the humanitarian response.

The use of medicines in humanitarian interventions

In the midst of a complex humanitarian emergency, everything is made even more difficult

In humanitarian contexts, the usual difficulties of middle- and low-income countries in securing access to medicines, supplies and health technologies multiply. It is the result of violence, the disruption of some essential health system functions and the acute increase in population needs. In these emergencies, many humanitarian actors in health seek to intervene. Whether with the goal of supporting the provisioning and supply chain of the public health system or getting hold of the products needed to be able to provide health care directly where they do not exist, these actors encounter numerous obstacles.

Selecting the necessary drugs and supplies is not an easy task.

Knowing precisely what medicines and supplies are needed and in what quantity can be an almost impossible task in the midst of a humanitarian emergency. Often in these environments, there are no up-to-date standard listings of essential medicines and medical supplies, nor adequate pharmacy stock controls.

In these cases it is common to purchase specially designed kits. The Interagency Emergency Health Kit, for example, is a set of several modules of medicines and medical supplies weighing approximately one ton and designed to cover the emergency needs of medical products for 3 months for a population of 10,000 people. There are also additional kits for mental health or sexual and reproductive health, for example.

However, the kits are not designed to replenish health units and equipment. After delivery of a kit, proper management should be carried out to determine the average monthly consumption and to estimate more accurately the needs for medical products after the initial three months.

In many cases, however, NGOs and humanitarian agencies intervene in contexts of prolonged crises where, although it is no longer logical to make a "generic" purchase of a kit, local health services do not adequately monitor consumption and find it difficult to make reliable estimates of needs. In these cases, and if there is sufficient epidemiological information and information on the activity of the health services, it is possible to approximate the needs of the health services. estimates based on activity and morbidity. This requires calculating the number of units of a drug that are necessary for the standard treatment of an episode and estimating the number of episodes we anticipate or believe we will be able to treat with the equipment and time we have available.

It is advisable to purchase drugs through validated international suppliers

There is a huge risk of circulation of low-quality drugs and counterfeits in local markets. This can result in lack of therapeutic efficacy, toxicity and even the generation of serious adverse effects.

For this reason, most donors, international NGOs and humanitarian agencies have strict purchasing procedures for medicines and medical supplies. These determine that, if there are insufficient guarantees of being able to find safe and quality products manufactured or distributed locally, these must be imported from international humanitarian purchasing centers and specialized suppliers. Some of these suppliers are organizations such as IDA Foundation or Farmamundi, which specialize in supplying quality medical products at reasonable prices to humanitarian actors and countries in need.

In certain contexts where for many organizations importation is not a possibility, due to legal and administrative constraints imposed by local authorities, the final decision on whether or not to source locally is based on a risk-benefit analysis. The work of other organizations such as QUAMED, which audits and evaluates the local drug market, helps agencies and NGOs to identify suppliers that meet GSDP, MQAS, and GMP standards.

In any case, whether through international channels or with a local purchase (as a last resort and following the necessary procedures to ensure quality and safety), a drug purchase requires several weeks or even months for its launch and delivery. Therefore, if it is not well planned or managed in a manner with agile and well-established procedures, there is a risk that it will arrive much later than desired. Sometimes the only way to ensure on-time delivery is through prepositioning, a strategy that sometimes clashes with the rigidity of humanitarian funding in short-cycle projects.

A good strategy for inventory and utilization of medical products is needed

Once medicines and other medical products are already available, humanitarian organizations must ensure that there is an adequate inventory and management strategy for storage, transport and distribution. The work of these organizations can also help improve rational prescribing practices, the information that health care providers (from medical staff to community health workers) give to users, and promote correct use to ensure efficacy and safety.

Advocacy is key for access to medicines

From the perspective of a nexus approach, it is logical to complement short-term humanitarian action with cooperation projects that have a more transformative purpose. In these cases, along with technical assistance, influencing decision-makers should be a priority.

These actions can be directed at increasing public investment in medicines, vaccines, medical supplies and health technologies, develop essential drug lists and policies aimed at the use of generics, implement regulatory mechanisms and control of the local market for medical products, strengthen the inventory and supply chain strategy, or develop training and supervision programs that address prescription and rational use of medicines.

Some organizations even carry out important actions of social mobilization, communication and political advocacy to demand fair intellectual property laws that balance innovation and access to medicines. Some alliances work to seek justice in cases where pharmaceutical companies use commercial strategies to abuse laws and raise prices or negotiate them in an opaque manner.

Health systems

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