Oxfam’s Policy Paper

Health

Oxfam’s health programme addresses four broad themes:

access to basic health services (including the issue of financing)
access to essential medicines
access to water and sanitation
responding to HIV/AIDS

Oxfam programme work focuses on reducing inequities, including those based on gender, and improving the quality of services. Local projects support some of the most marginalised and impoverished groups. Others address the health needs of communities affected by conflict or natural disasters. Drawing on this experience and on research findings, Oxfam seeks to work with others to change policies, practices, ideas, and beliefs that affect poor people’s health.

Oxfam's strategy to respond to HIV/AIDS is based on mainstreaming HIV concerns into all programmes. This means that Oxfam analyses the impact of the disease on the affected population, and adapts its development and humanitarian programmes to address this impact.

In Southern Africa we are piloting programmes to integrate responses to HIV/AIDS into development work.

In India, Oxfam’s HIV/AIDS programme aims to increase access to prevention, treatment, care, and support for those infected and affected, as well as raising public awareness about the disease.

In Sri Lanka, South Sudan and Liberia, Oxfam supports the rehabilitation of community health centres and the development of basic services, including medicine supply.

In the Caucasus, Oxfam runs community-based health schemes which provide communities with treatment and essential drugs, and provide training for health workers. We operate a similar scheme in Yemen, where we are also training midwives and traditional birth attendants.

The Network for Consumer Protection, an Oxfam partner in Pakistan, promotes people’s access to, and the rational use of, essential drugs. In Afghanistan, Oxfam has ensured that basic health services have been made available to remote communities in the highlands.

Oxfam is widely known for its public health work in emergencies. The rapid supply of clean water to populations displaced from their own homes is vital, and Oxfam has particular expertise in this area. In recent years, major programmes have been established in the Great Lakes Region of Central Africa, in the Balkans, in Angola, and in the State of Orissa in India.
.
.
.

The challenge to ensure that millions of poor people can get the medicines they need remains huge, given the appearance of new diseases; the re-emergence of ‘old’ diseases; the threat of pandemics; and the growing burden of non-communicable diseases in developing countries. Malaria claims the lives of one million people every year – mostly children and pregnant women.2 Two million people die annually from TB. Half of the global cancer deaths are in developing countries. The World Health Organisation (WHO) estimates that the occurrence of asthma is increasing on average by 50 per cent every ten years in cities in the developing world.3 Currently 85 per cent of the world’s population is being priced out of the industry’s market.4

It is clear that there are pressures on the pharmaceutical industry to change course. Increased financial burdens on health systems due to ageing populations and changing disease burdens are stimulating calls for lower prices from both North and South. The industry is now challenged to be more transparent about its price rationale so that governments and public-health advocates can request greater alignment between the prices set and purchasing power. The intellectual property regime and the market-driven model of drug development are criticised for not delivering real innovation required to relieve the global public-health crisis.

At the same time, investors are clearly concerned that this industry is not delivering the profits that it used to. Emerging market economies are being identified as the possible panacea to this flagging growth. There are enormous opportunities in these markets, including lower costs to conduct R&D and clinical trials, and low-cost manufacturing. These economies also offer substantial market potential. However, for this to be realised, the industry will have to recognise that serving these markets requires a vastly different approach: one which reflects the significance of massive income disparities, the impacts of high prices on increasing vulnerability and insecurity, and the need for medicines that are relevant and adaptable to poor settings.

The epidemiology of public health is changing, with a more diverse range of diseases that require appropriate products. For developing countries particularly, their specific contextual realities need to be taken seriously: new products are needed, formulations need to be usable, and drug information and labelling should be comprehensible. R&D will have to be tailored to end-use realities.

Now is the time for companies to take a bold look at new ways of doing business, incorporating a social equity bottom line into their thinking, working more flexibly, transparently, and practically with a wide range of stakeholders. The current inertia on access to medicines can be overcome by placing concerns about affordability and availability at the core of business decision-making processes and operations. To do so will require strong leadership and long-term vision.

Oxfam also believes that integrating access to medicines into the core business model will institutionalise a framework for the industry to predict, respond to, and satisfy the needs of people in developing-country markets. Investors who are encouraging pharmaceutical companies to enter emerging market economies identify the need to adapt prices, to have more flexible distribution systems, and to make products that are relevant to the markets being served, as necessary elements of a business strategy.

Source: Oxfam Policy Paper; Investing for Life, Nov 2007

2 www.theglobalfund.org/en/about/malaria/ (last accessed January 2007).
3 World Health Organisation (2005) ‘Preventing chronic diseases: a vital investment’, Geneva: WHO. Available at: www.who.int/chp/chronic_disease_report/en/ (last accessed October 2007).
4 “15 per cent of the world’s population consumes over 90 per cent of the world’s pharmaceuticals” which translates to 85 per cent of the population consuming less than 10 per cent of the world’s pharmaceuticals. P. Hunt (2007) ‘Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines’, draft for consultation prepared by the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.