A Journal of International Development Cooperation published by the Dag Hammarskjold Foundation, Uppsala, Sweden.

Making National Drug Policies a Development Priority: A Strategy Paper and Six Country Studies

Ensuring that all citizens have access to essential medicinal drugs – and are protected form useless or harmful ones – should be a high priority for any country.  But National Drug Policies (NDPs), a vital part of overall health policy, have faced strenous opposition from powerful vested interests, and governments promoting reforms have had to stand up to the global multi-dollar pharmaceutical industry and its allies in the health sector and their political supporters.

Hard-won achievements, in the areas of drug provision, quality assurance, control over unscrupulous promotional practices, and rational use of drugs, are under further pressure today form global trends that threaten to undermine them.

 Making National Drug Policies a Development Priority consists of six country stories – from Norway, Sri Lanka, Bangladesh, Australia, India and Mexico – and a Strategy Paper on protecting and developing health and drug policies.  All the contributions are written, singly or jointly, by acknowledged experts and activists in the field.

The Editorial Note prefacing this 256-page volume situates the experience of individual countries in the context of initiatives taken by the Non-Aligned Movement, UNCTAD, the World Health Organization (WHO) and campaigning health organisations since the 1970s to promote appropriate provision and rational use of drugs.  It also outlines the activities of the Dag Hammarskjold Foundation in Uppsala within this field since the mid-1980s.

A seminar/workshop on ‘The Role of National Drug Policies in Social Transformation’, organised by the Foundation in co-operation with the Philippine Department of Health and the Philippine Centre for Investigative Journalism, was held in Manila in 1992.  Its aim was to encourage greater public participation in pharmaceutical issues.  A small working group drawn from the participants prepared enlarged country presentations for publication along with a recommended strategy for international action.

The six country stories revealing the factors that have determined the relative success that have determined the relative success or failure of individual National Drug Policies are a substantial resource for others attempting to devise and implement similar policies.

In the case of Bangladesh, the NDP was fought tooth and nail not only by transnational corporations (TNCs) but also by Western governments, especially the US, whose interests were bound up with them.  Sri Lanka, a pioneer in drug regulation, Mexico, India and Bangladesh have all found their policies diluted by the neo-liberalism of the later-1980s and the continuing ‘free-market’ philosophy of the 1990s.

A crucial lesson from all the case studies is that pharmaceuticals must be tackled as an integral part of the general development of a country, including health, education, access to information and regulation of the private sector.  Deficiency in these areas leads the author of the case study on India to a pessimistic conclusion: ‘One-and-a-half decades after its incomplete, half-hearted and uncertain experiment with a National Drug Policy, India is now back to a situation dominated by the avarice and rapaciousness of unimpeded entrenched interests.’

Norway and Australia, by contrast, have developed more comprehensive and to health and social welfare.  Since joining the European Economic Area, however, Norway has abolished its celebrated ‘needs clause’ (whereby drugs are assessed not just on scientific grounds by also in relation to health and social needs).

As the Strategy Paper implies, no country is immune to negative international pressures. Among these are new trade and ‘harmonisation’ initiatives, global and regional, which reduce the decision-making powers of national governments and tend to strengthen private TNC monopolies.

Concerted action is urgently needed to safeguard well-functioning NDPs and improve well-functioning NDPs and improve health care and drugs provision universally. The Strategy Paper argues persuasively for a holistic approach. This will involve international and multilateral organisations, national governments, health professional (including visionary leaders), non-governmental organisations, the pharmaceuticals industry itself and – perhaps most important of all – consumers.

The recommendations are not prescriptive, but clear guidelines are suggested. Priorities identified are close analysis of the impact of trade and harmonisation initiatives on the pharmaceuticals trade and drug regulation, support for WHO’s Drug Action Programme and a wide-ranging educational campaign, targeting health professionals and consumers in particular.

Copies may be obtained from the Dag Hammarskjold Centre, Ovre Slottsgatan 2, S-753 10 Uppsala, Sweden