In 2011 the Grand Challenges in Global Mental Health initiative identified priorities that have the potential to make a significant impact on the lives of people with mental, neurological, and substance use disorders. Reduction of the cost and improvement of the supply of effective medicines was highlighted as one of the top five challenges. For low- and middle-income countries, improving access to appropriate essential medicines can be a tremendous challenge and a critical barrier to scaling up quality care for mental, neurological, and substance use disorders. Reduction of cost and improvement of the supply of effective medicines has the potential to significantly impact the lives of patients with these disorders.

Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa is the summary of a workshop convened by the Institute of Medicine Neuroscience Forum in January 2014 in Addis Ababa, Ethiopia to discuss opportunities for achieving long-term affordable access to medicines for these disorders. This report examines challenges and opportunities for improving access to essential medicines in four critical areas: demand, selection, supply chains, and financing and pricing. The report also discusses successful activities that increase access to essential medicines both within Sub-Saharan Africa and in other developing countries, and considers the role of governments, nongovernmental organizations, and private groups in procurement of essential medicines for mental, neurological, and substance use disorders.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE ON IMPROVING ACCESS TO ESSENTIAL MEDICINES FOR MENTAL, NEUROLOGICAL, AND SUBSTANCE USE DISORDERS IN SUB-SAHARAN AFRICA
• FORUM ON NEUROSCIENCE AND NERVOUS SYSTEM DISORDERS
• BOARD ON GLOBAL HEALTH
• Reviewers
• 1. Introduction and Overview
  • ORIGINS OF THE WORKSHOP
  • ORGANIZATION OF THE WORKSHOP AND REPORT
  • BARRIERS TO ACCESS TO ESSENTIAL MEDICINES FOR MNS DISORDERS
  • A HEALTH SYSTEM FRAMEWORK FOR ACCESS TO MEDICINES
  • OPPORTUNITITES FOR IMPROVING ACCESS TO ESSENTIAL MEDICINES FOR MNS DISORDERS
• 2. Challenge: Insufficient Demand
  • THE CONTEXT OF MNS CARE IN SSA
  • LESSONS LEARNED FOR ADDRESSING INSUFFICIENT DEMAND
  • CHALLENGES AND OPPORTUNITIES FOR ADDRESSING INSUFFICIENT DEMAND
• 3. Challenge: Inappropriate Selection
  • APPLYING THE ESSENTIAL MEDICINES CONCEPT TO MNS DISORDERS
  • CHALLENGES AND OPPORTUNITITES FOR ADDRESSING INAPPROPRIATE SELECTION
• 4. Challenge: Ineffective Supply Chains
  • THE EFFECT OF DEMAND ON THE SUPPLY CHAINS
  • LESSONS LEARNED FOR ADDRESSING INEFFECTIVE SUPPLY CHAINS
  • CHALLENGES AND OPPORTUNITIES FOR ADDRESSING INEFFECTIVE SUPPLY CHAINS
• 5. Challenge: High Pricing and Poor Financing
  • THE COST OF ACQUIRING ESSENTIAL MEDICINES
  • LESSONS LEARNED FOR ADDRESSING HIGH PRICING AND POOR FINANCING
  • CHALLENGES AND OPPORTUNITITES FOR ADDRESSING HIGH PRICING AND POOR FINANCING
• 6. Perspectives on Next Steps
  • CONSIDERATIONS FOR MOVING FORWARD
  • CLOSING COMMENTS
• APPENDIXES
  • A Access to Essential Medicines: Program Examples
  • B References
  • C Workshop Agenda
  • D Registered Attendees

Rapporteurs: Diane E. Pankevich, Sheena M. Posey Norris, Theresa M. Wizemann, and Bruce M. Altevogt.

This project was supported by contracts between the National Academy of Sciences and the Alzheimer's Association; CeNeRx Biopharma; the Department of Health and Human Services' National Institutes of Health (NIH, Contract No. HHSN26300026 [Under Master Base # DHHS-10001018]) through the National Eye Institute, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, National Institute on Aging, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and NIH Blueprint for Neuroscience Research; Department of Veterans Affairs (101-D27015); Eli Lilly and Company; Fast Forward, LLC; Foundation for the National Institutes of Health; GE Healthcare, Inc. (2580261187); GlaxoSmithKline, Inc.; Johnson & Johnson Pharmaceutical Research and Development, LLC; Lundbeck Research USA; Merck Research Laboratories; The Michael J. Fox Foundation for Parkinson's Research; the National Science Foundation (Contract No. OIA-0753701); One Mind for Research; Pfizer Inc.; the Society for Neuroscience; and Wellcome Trust. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for this project.

Suggested citation:

IOM (Institute of Medicine). 2014. Improving access to essential medicines for mental, neurological, and substance use disorders in sub-Saharan Africa: Workshop summary. Washington, DC: The National Academies Press.

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.