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Increasing access to medicines 143
be effectively distributed. Consider the example of malaria, discussed
in the next chapter: despite the establishment of the Roll
Back Malaria initiative and the injection of specific funds, the most
modern and potent anti-malarial drugs were still not being correctly
used six years after the initiative began (Attaran, 2004).
Weak healthcare systems do not simply result in a failure to distribute
existing treatments. They also have a knock-on effect for the
demand for new drugs, and can act as a serious disincentive to
would-be innovators of new medicines. If a product is unlikely to
reach its intended market, what is the point of developing it in the
first place? Well-equipped and properly staffed modern medical
facilities are adept at disseminating the latest medical tools and
drugs (Dussault & Dubois, 2003). Conversely, inefficient distribution
and communications channels have an adverse effect on the speed
with which new medicines reach patients, if they reach them at all
(Gambardella et al., 2000).
Frequently, public spending and foreign aid injections into
national health systems do not translate into the delivery of services
and medicines to the poor. A multi-country study by Filmer and
Pritchett (1999) showed that public spending on health in lowerincome
countries has only a minute impact on mortality. The
authors showed that a significant proportion of deaths of children
below five years could be averted for as little as US $10 each, yet
even in the poorest countries, the average amount spent by governments
per child death averted is a staggering US
$50,000–$100,000.
There are many reasons for this low level of performance. First,
public health agencies tend to be woefully inefficient and corrupt,
especially in lower-income countries. As a result, the proportion of
a donor’s contribution that actually results in delivery of healthcare
services (whether they are vaccines or nurses’ salaries) is often very
low. Health officials may sell aid-financed drugs on the black market.
Studies in Guinea, Cameroon, Uganda, and Tanzania estimated that
30 to 70 per cent of government drugs disappeared before reaching
the intended patients (Filmer, Hammer & Pritchett, 2000).