The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries

Persistent barriers to universal access to medicines are limited social protection in the event of illness, inadequate financing for essential medicines, frequent stock-outs in the public sector, and high prices in the private sector. We argue that greater coherence between human rights law, national medicines policies, and universal health coverage schemes can address these barriers. We present a cross-national content analysis of national medicines policies from 71 countries published between 1990–2016. The World Health Organization’s (WHO) 2001 guidelines for developing and implementing a national medicines policy and all 71 national medicines policies were assessed on 12 principles, linking a health systems approach to essential medicines with international human rights law for medicines affordability and financing for vulnerable groups. National medicines policies most frequently contain measures for medicines selection and efficient spending/cost-effectiveness. Four principles (legal right to health; government financing; efficient spending; and financial protection of vulnerable populations) are significantly stronger in national medicines policies published after 2004 than before. Six principles have remained weak or absent: pooling user contributions, international cooperation, and four principles for good governance. Overall, South Africa (1996), Indonesia and South Sudan (2006), Philippines (2011–2016), Malaysia (2012), Somalia (2013), Afghanistan (2014), and Uganda (2015) include the most relevant texts and can be used as models for other settings. We conclude that WHO’s 2001 guidelines have guided the content and language of many subsequent national medicines policies. WHO and national policy makers can use these principles and the practical examples identified in our study to further align national medicines policies with human rights law and with Target 3.8 for universal access to essential medicines in the Sustainable Development Goals.

实现药品普遍可及面临的长期阻碍包括：疾病发生时社会保障覆盖不足、基本药品筹资缺口较大、公共部门药品频繁断供以及私营部门药品价格高昂。本研究认为，强化人权法、国家药品政策与全民健康覆盖计划之间的协同契合，可有效破解上述阻碍。本研究对1990年至2016年间发布的71个国家的国家药品政策开展了跨国内容分析。世界卫生组织（World Health Organization, WHO）2001年发布的《国家药品政策制定与实施指南》，以及全部71份国家药品政策，均按照12项评估原则进行了分析，该原则体系将基本药品的卫生系统路径与保障药品可负担性、为脆弱群体提供筹资支持的国际人权法相衔接。国家药品政策中最常见的内容为药品遴选以及高效支出/成本效益相关措施。相较于2004年前发布的政策，2004年后发布的国家药品政策在四项原则上的体现显著更强，这四项原则分别为：健康的法定权利、政府筹资、高效支出以及脆弱群体的金融保护。另有六项原则始终体现薄弱或未被纳入政策，包括：使用者缴费统筹、国际合作，以及四项善治相关原则。总体而言，南非（1996年）、印度尼西亚与南苏丹（2006年）、菲律宾（2011-2016年）、马来西亚（2012年）、索马里（2013年）、阿富汗（2014年）以及乌干达（2015年）的政策文本最贴合相关要求，可作为其他国家/地区的借鉴范本。本研究结论表明，WHO 2001年发布的指南已为后续诸多国家药品政策的内容与表述提供了指引。WHO与各国政策制定者可借助本研究提出的评估原则及识别出的实践案例，进一步推动国家药品政策与人权法、《可持续发展目标》中“全民享有基本药品”的目标3.8相契合。