Background

The provision of essential medicines to the vast population and the availability of appropriate medical technology is an integral function of the health system. Policies and guidelines ought to exist to ensure state regulation of supply and demand for medicines which entails both the safety and quality of those produced/imported medicaments and the rational use of medicines by practitioners. 

The availability of the appropriate mix of medical technology affects greatly the outcomes of services delivered. Suitability of the technology is an important aspect that relates to effective use of resources and cost–effectiveness of the interventions both in investigative, promotive and curative services. 

Essential medicines

The establishment of the Drug Regulatory Authority under the Ministry of National Health Services, Regulations and Coordination has been a major step towards the effective regulation and ensuring the implementation of related policies and guidelines. Pharmaceuticals of Pakistan is rapidly growing with 550 plus companies and over 60 000 registered brands. Of major concern is the quality and regulation of the products based on WHO Good Manufacturing Pratices and ICH guidelines, in addition to opting to quality-based selection of medicines instead of the current price-based procurement. 

National pharmaceuticals policies ought to be reviewed and updated and eventually effective implementation. Accessibility of the population to high-quality and essential medicines is one of the major expected outcomes and a prerequisite to ensure the functioning of the health system and effectiveness of the services delivered. Expenditures on medicines represent a high proportion of out-of-pocket spending and ought not to represent a hinder to household seeking health services.

Enforcement of the policies, regulations and proper monitoring will assist in overcome of the public health concern represented in substandard/spurious/falsely-labelled/falsified/counterfeit medicines. As importantly, regulatory policies are important to guide current traditional medicine practices which represent a major portion of health seeking behaviour of the population. 

Prescription practices ought to be of focus where prescriptions errors occur due to non-adherence to treatment protocols in addition to irrational use of medicines in many instances. Update of existing treatment guidelines, update of the essential drug list and capacity-building on rational drug use are important measures on the pharmaceuticals demand side. 

Medical technology

Spending on medical technology accounts for high proportions of investment and ought to be properly planned based on the most cost-effective approaches and expected outcomes. The appropriate mix and technology is key towards better outcomes with the least cost bearable by the health system. 

WHO support

WHO’s goal in medicines is to help save lives and improve health by ensuring the quality, efficacy, safety and rational use of medicines, including traditional medicines, and by promoting equitable and sustainable access to essential medicines particularly for the poor and disadvantaged. Areas of support include:

• providing technical support to revise and effective implementation of national policies and regulations including the national essential medicines list, medical equipment and supplies standards; 
• carrying out of a health technology assessment 
• providing support for rationale medicine use and integration in medical academia 
• providing support to improved forecasting, procurement and supply chain 
• providing support to national authorities in overcoming antimicrobial resistance 
• providing support enhanced detection and response to the risk of substandard and falsified medical product.