Abstract
The response to emergency public health challenges such as HIV, TB, and malaria has been successful in mobilising resources and scaling up treatment for communicable diseases. However, many of the remaining challenges in improving access to and appropriate use of medicines and services require pharmaceutical systems strengthening. Incorporating pharmaceutical systems strengthening into global health programmes requires recognition of a few ‘truths’. Systems strengthening is a lengthy and resource-intensive process that requires sustained engagement, which may not align with the short time frame for achieving targets in vertical-oriented programmes. Further, there is a lack of clarity on what key metrics associated with population and patient level outcomes should be tracked for systems strengthening interventions. This can hinder advocacy and communication with decision makers regarding health systems investments. Moving forward, it is important to find ways to balance the inherent tensions between the short-term focus on the efficiency of vertical programmes and broader, longer-term health and development objectives. Global health programme design should also shift away from a narrow view of medicines primarily as an input commodity to a more comprehensive view that recognizes the various structures and processes and their interactions within the broader health system that help ensure access to and appropriate use of medicines and related services.
Highlights
Low- and middle-income countries (LMICs) are undergoing a triple transition that involves a shift from development assistance to domestic resources, an epidemiological transition from communicable to noncommunicable diseases as the major source of morbidity and mortality, and a reorganisation of national health systems to meet universal health coverage (UHC) goals as expressed in Target 3.8 of the Sustainable Development Goals (SDGs) [1]
Three truths First, pharmaceutical systems strengthening is a lengthy and resource-intensive process that may not align with the short time frame for achieving targets in donorfunded programmes
This approach, along with special World Health Organization (WHO) programmes to expedite national registration based on WHO prequalification, successfully addresses the short-term goal of making products procured by global health programmes quickly available to address urgent needs [8]
Summary
Low- and middle-income countries (LMICs) are undergoing a triple transition that involves a shift from development assistance to domestic resources, an epidemiological transition from communicable to noncommunicable diseases as the major source of morbidity and mortality, and a reorganisation of national health systems to meet universal health coverage (UHC) goals as expressed in Target 3.8 of the Sustainable Development Goals (SDGs) [1]. * Correspondence: jguzman@mtapsprogram.org 1USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA, USA Full list of author information is available at the end of the article chronic respiratory infections, hypertension, and diabetes are responsible for more than 32 million deaths per year in LMICs [2].
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