The effects of current trade agreements and IP standards on access to health services and appropriate, high-quality medicines in resource-limited countries like Uganda
Access to health care (medicines) is occasionally miss-conceived. Not only is it a matter of life and death, it also enhances the quality of life, and it is key to a life with dignity.
In the world over, billions of people have no access to essential health care. This is basically as a result of ills and clogs to mention but a few. These ills and clogs include: Intellectual property laws, lack of finances, weak health systems, poverty, inequality and discrimination among other factors contribute to lack of access to health care.
Access to health care (Medicines) involves public health, social justice and international human rights obligations. The International Covenant on Economic, Social and Cultural Rights requires States to take steps to the maximum of available resources to progressively realize the right to health, prohibits retrogressive measures, and necessitates immediate fulfillment of minimum core obligations. It also calls for international cooperation.
It is important to note that medicines in Africa are available but the challenge faced is that the laws that regulate the brands on market are weak and non-regulatory in nature. In a country like Uganda for example which is a capitalist economy, all sorts of medical brands are on the market and with this come the challenge of expired medicines, medicines exorbitantly priced, as an end result, inaccessibility of medicines (health care) to the poor people.
The governments themselves are faced with a dilemma of whether to crack the whip on the mushrooming pharmaceutical companies and frustrate employment or persist with the defective system of commercialization of the health care system. These pharmaceutical companies provide employment to the masses and yet the nation is grappling with unemployment. Also the laws are archaic to help control access.
Access to health care as a core national obligation should ensure that the medicines are affordable, acceptable, accessible, of good quality, and made available without discrimination.
In General terms access to health Care in LDC countries like Uganda is a complex and multidimensional issue calling for holistic solutions. In addition to the foregoing it is imperative to note that measures to improve the supply chain must be put in place, the underlying determinants of health must be addressed to the universally recommended standards, policy formulation coherent to primacy of human rights over international trade as a necessity, investment and intellectual property regimes and to ensure that health delivery systems are appropriate to those they serve. Inequities, including high costs borne by patients in many low and middle income countries must be eliminated.
As a point of emphasis, people’s agency and empowerment should be improved to enhance access to medicines especially for the poor. Procedural safeguards like participation and access to information must be upheld. Evidence-based guidelines and policies to promote access to appropriate healthcare services for all persons regardless of their economic status will help realize their right to health, and increase in disease assessments and formulations will strengthen access for all. Addressing stigma and discrimination and ensuring equitable access and effective treatment will help realize the rights to health.
Many a time governments like that of Uganda will always ignore the health sector and make arguments like, ‘when the ruling party came to power it found many of the health facilities dilapidated but after 30 years there is progressive realization of the right to health in Uganda and improved structural designs for the right to health to flourish.’ This is a total misconception of progressive realization of the right to health. Needless to say, resource constraints cannot be an excuse for failing to meet health needs. Reasons for disparities in health outcomes across States of similar socio-economic status must be understood and addressed.
Experience shows that publicly funded health systems are the best way to ensure equitable access to healthcare. Access can be improved through innovative financing mechanisms, enabling public policies, more health workers, technical support, better health data, administrators, transport and delivery, improved supply chains, local production and health education, and other means. Holistic, people-centered and community-driven policies and active local involvement help health systems strengthening.
Access to health is an explicit example of how economics and trade rules conflict with human rights, including the rights to life, health and development. All human beings by virtue of being human are entitled to enjoy human rights which include the benefits of being alive (right to life). In this day and error the benefit of being alive necessitates the enjoyment of the benefits of scientific progress, and traditional knowledge. This in the nutshell requires that pharmaceutical companies comply with their human rights responsibilities and ethical obligations. There is a need for several initiatives and good practices to be considered by these companies. New models of research and development must address needs, not simply manage markets and profits.
As a matter of life and death, governments in the LDC sector need to strive to ensure that they develop effective health policies including development of essential medicines lists in a bid to improve access to health care. Also they need to live up their individual and collective commitments and adopt a human rights based approach to access to all medicines, not only essential medicines. International solidarity and collective action can support access for all.
Bukenya Denis Joseph
Human Rights Lawyer.
 Human Rights Council, Twenty-ninth session, Agenda item 5. Human rights bodies and mechanisms
Report of the 2015 Social Forum (Geneva, 18-20 February 2015)