Table 2 Treatment: some proposed legal and regulatory priorities for improving access to treatment for the leading NCDs

Universal access to essential health services and medicines

● Formal legal recognition of the right of all members of the population to access a minimum basket of essential health care services, essential drugs, and essential technologies, at prices they can afford, on basis of medical need. This legal entitlement provides a foundation for planning and budgeting by governments, and a legal pathway for disadvantaged groups to challenge discrimination and the denial of basic health rights.

● Protection from discrimination in access to health services: under the ICESCR, countries have an immediate obligation to respect the right to health by preventing discrimination in access to curative, palliative and preventive health services. To protect vulnerable individuals and groups from being excluded, complaints mechanisms should exist for investigating and remedying discriminatory practices, on grounds including: race, colour, caste or social status, sex, language, religious or political opinion, national origin, physical or mental disability, health status (including HIV status) and sexual orientation.

Health financing for the provision of health care services

● Effective implementation of the right to access essential health services will require governments to formally define the parameters of safety nets and health care entitlements under publicly provided and publicly subsidised schemes.

● Governments should develop a national list of essential medicines and technologies that are available in primary health care centres and/or district hospitals. Governments can use their power as purchaser or subsidiser of medicines to negotiate lower prices.

● Governments should also consider establishing a national procurement authority with responsibility for monitoring prices, encouraging the use of generics, reducing waste and inappropriate prescribing practices, and reducing duties, taxes and other mark-ups on essential drugs.

● Governments should ensure that national patent laws authorise the use of the flexibilities recognised in the Agreement on Trade Related Aspects of Intellectual Property (“TRIPS”), and avoid entering bilateral agreements that exclude their right to use these flexibilities.

● Governments should consider establishing a competition regulator to encourage competition and enforce competition laws in the health sector, in order to reduce overall costs, and to fight corruption and collusion.

Training and retention of the health workforce

● The compulsory licensing of medical and allied health professionals enables authorities to prescribe the training and qualifications required for practice, to prescribe ongoing professional training, to monitor quality and to improve accountability. The administering agency or body may also investigate complaints and impose conditions on practice.

● Governments should investigate performance-based payment systems to encourage community-based healthcare clinics and posts to reach out to local communities, and to follow-up and manage health risks within their population.

● Laws authorizing non-physician prescribing could increase access to drugs for chronic conditions and improve pain relief.

● All countries should implement the WHO Global Code of Practice on International Recruitment of Health Personnel (2010). Countries suffering high levels of migration of domestically-trained health care workers may consider worker retention strategies, including compulsory service requirements and financial incentives.

Development of an effective health information system

● Building on a system for registration of all births and deaths, countries should implement compulsory reporting requirements for designated communicable diseases and privacy protection for health information and medical records.

● Legislation may create a mandate for the collection and protection of a minimum national data set (comprising census data, civil registration data, notifiable diseases data, household survey data and medical records data) administered by a health information authority.