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The need to build on recent progressHowever, in some countries, access to
medicines, particularly new ones, can be
problematic due to organisational problems
of the health system, limited resources or
poor planning. Failing to obtain new medicines
through the regular channels, patients may
resort to legal action against the state. This
situation is common in many of the countries
examined, such as Ecuador, Colombia or
Brazil,^70 and can affect the system as a whole:
“The discrepancy between constitutional
commitment and lack of planning creates
problems for sustainability of the system,”
says Dr Ruales. Experts therefore suggest
a more organised pharmaceutical strategy
from the government. Dr Simon proposes a
co-ordinated negotiation by the government
with the industry, while “risk-sharing is another
modality”. “In Mexico, we have established
the unification of drug purchases in one single
catalogue for oncological treatment to 2020,”
adds Dr Mohar.^71seen in the latest data from the WHO. Such is
the case in Argentina, Chile, Mexico, Panama,
Paraguay and Peru. Consistent with these
results, most of the countries do not have
community or home-based palliative care
solutions offered through the public health
system. Even though palliative care is often
addressed in cancer plans, there are concerns
around actual implementation. Dr Murillo gives
an example from Colombia, where there are
no incentives for palliative care to thrive, as it
is not profitable. Nevertheless, in Argentina,
recent developments are a source of pride.^72
“There is a palliative care programme that is
becoming a regional benchmark. It has been
supported by the local production of opioids
that has been scaled up,” notes Dr Ismael.Improving quality
Although many of the countries are
progressing on access targets, the next step
will be improving the quality of services. But
advances in this area may be hindered by
systemic problems. Fragmentation is common
across most of the examined countries, and
this affects quality in different ways. In the
case of Colombia, Dr Murillo notes a system
dominated by multiple insurers, offering care
through competing and disjointed service
providers, where patients have little choice.
“The focus is on fees as opposed to quality, and
services are delivered in a fragmented way,”
he adds. Fragmentation may delay patients’
access to the care they need. According to(^70) K Strasser-Weippl et al., “Progress and remaining challenges for cancer control in Latin America and the Caribbean”, The Lancet Oncology, 2015.
(^71) América Economía, “Los retos de la compra consolidada de medicamentos en México”, 2019.
(^72) Secretaría de Gobierno de Salud, “El INC recibió partida de opioides de origen nacional para distribuir en hospitales públicos”.
In some countries, access to
medicines, particularly new
ones, can be problematic due to
organisational problems of the
health system, limited resources or
poor planning.
Availability of oral morphine seems to still be a
challenge, with half of the countries not making
it generally available in the public sector, as