Who has responsibility for access to essential medical drugs in the developing world?

Abstract

Access to basic medical treatments emerges as cause and effect of health, poverty and development. Where the responsibility for improving access to essential medicines lies is, therefore, a crucial question. Millennium Development Goal (MDG) number 8, states, "In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries" (UN 1). The key stakeholders who may take responsibility for access to drugs are (1) the pharmaceutical industry, (2) governments, (3) society at large, and (4) individuals (both with and without disease). Four lenses through which responsibility can be viewed are: (a) deontological; (b) utilitarian; (c) egalitarian; and (d) human rights-based approaches. All four arguments can be used to assign responsibility for improving access to drugs to the governments, especially utilitarian and human-rights approaches. The paper concludes that it is sometimes difficult to distinguish between the four ethical approaches and that a “sliding-scale” of responsibility is the most useful way to view the roles of the four main players in access to essential drugs, depending on the country or region and its internal environment. Mots-clefs : enfants des rues, ville, travail, Cameroun, Madagascar.