Access to medicines through domestic legislation and policy for universal health coverage

About this project

One in three people in developing countries cannot access medicines they need. Universal health coverage (UHC) has been proposed as a way to enable the ill in low-income settings to access health goods and services such as essential medicines while protecting against catastrophic expenses that can push the vulnerable into poverty. UHC is therefore crucial to achieving the Sustainable Development Goals (SDG) and especially SGD 3 for health.

Universal access to medicines can be achieved by national governments in various ways, such as by enshrining access in domestic law and/or developing national policies that may include medicines in UHC schemes. This project documents and analyses different legal approaches to promoting access in low and middle income countries as part of the right to health.

The most up-to-date overview of this project can be found at www.healthandgender.org/accesstomedicines.html

Project objectives & outputs

1. To translate human rights principles and public health standards into policy actions for essential medicines through legal analysis.  Download our practical policy checklist of 12 policy measures to be included in national law and policy for access to medicines.
2. To collect and analyse domestic law and policy from mostly low- and middle-income countries using the policy checklist. Consult our analyses by legal instrument (constitutional law, policy, legislation, case law) or by country case study .
3. To report on right to health indicators that reflect access to essential medicines in national health systems. Read our report on eight right to health indicators of access to medicines in 195 health systems .

Impact

This research has informed WHO positions on essential medicines, guided the development of model laws and legal reform, and supported policy stakeholders to realise change. Read more about the impact of this project at: www.healthandgender.org/accesstomedicines.html

Country data

This PhD project developed 16 country case studies on ‘Law and Policy for Access to Medicines’ from mostly low- and middle-income countries (publication is forthcoming):

• Algeria
• Chile
• Colombia
• Ghana
• Indonesia
• Jordan
• Mexico
• Morocco
• Nigeria
• Philippines
• Rwanda
• South Africa
• Tanzania
• Turkey
• Tunisia
• Uruguay

In addition, the raw data in 15 country profiles is available below and on the WHO's website .

• Australia (see ELMA report )
• Bulgaria ( report )
• Canada ( report )
• Colombia (report )
• Costa Rica ( report )
• France ( report )
• Ghana ( report )
• Indonesia ( report )
• the Netherlands (see ELMA report )
• New Zealand ( report )
• Senegal ( report )
• Singapore ( report )
• South Africa (see ELMA report )
• Spain ( report )
• Tonga (see ELMA report )

Open call for research assistance

We welcome(volunteer) research assistants to compile country profiles.

Knowledge of the country’s health or legal system and fluency in foreign languages are strong assets. You are also welcome to suggest a country to study. To get involved, submit your motivation via email to katrina.perehudoff gmail.com.

Publications & scientific achievements

This project resulted in the PhD thesis titled “ The right to health as the basis for universal access to essential medicines: A normative framework and practical examples for national law and policy ”, completed by Dr. Katrina Perehudoff under the supervision of Prof. Brigit Toebes and Prof. Hans Hogerzeil. Dr. Perehudoff defended her thesis at the University of Groningen on September 5, 2018.

Perehudoff, Katrina, and Lisa Forman. "What constitutes ‘reasonable’state action on core obligations? Considering a right to health framework to provide essential medicines." Journal of Human Rights Practice 11, no. 1 (2019): 1-21.

Perehudoff, Katrina, Brigit Toebes, and Hans Hogerzeil. "A human rights-based approach to the reimbursement of expensive medicines." Bulletin of the World Health Organization 94, no. 12 (2016): 935.

Perehudoff, Katrina, Lucía Berro Pizzarossa, and Jelle Stekelenburg. "Realising the right to sexual and reproductive health: access to essential medicines for medical abortion as a core obligation." BMC international health and human rights18, no. 1 (2018): 8.

Perehudoff, Katrina, Brigit Toebes, and Hans Hogerzeil. "Essential medicines in national constitutions: Progress since 2008." Health and human rights 18, no. 1 (2016): 141.

Perehudoff, Katrina, Nikita V. Alexandrov, and Hans V. Hogerzeil. "The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries." PloS one 14, no. 6 (2019): e0215577.

Perehudoff, Katrina, Nikita V. Alexandrov, and Hans V. Hogerzeil. "Legislating for universal access to medicines: A rights-based cross-national comparison of UHC laws in 16 countries." Health policy and planning (forthcoming).

Perehudoff, Katrina, Nikita V. Alexandrov, and Hans V. Hogerzeil. "Access to essential medicines in 195 countries: A human rights approach to sustainable development." Global public health 14, no. 3 (2019): 431-444.

Pizzarossa, Lucía Berro, Katrina Perehudoff, and José Castela Forte. "How the Uruguayan Judiciary Shapes Access to High-Priced Medicines: A Critique through the Right to Health Lens." Health and human rights 20, no. 1 (2018): 93.

Related publications

• Perehudoff, Katrina, and Ellen’T. Hoen. "Human Rights and Intellectual Property for Universal Access to New Essential Medicines." In Equitable Access to High-Cost Pharmaceuticals, pp. 67-87. Academic Press, 2018.
• Perehudoff, S. K., R. O. Laing, and H. V. Hogerzeil. "Access to essential medicines in national constitutions." Bulletin of the World Health Organization 88 (2010): 800-800.
• Hogerzeil, Hans V., Melanie Samson, Jaume Vidal Casanovas, and Ladan Rahmani-Ocora. "Is access to essential medicines as part of the fulfilment of the right to health enforceable through the courts?." The Lancet 368, no. 9532 (2006): 305-311.
• Hogerzeil, Hans V. "Essential medicines and human rights: what can they learn from each other?." Bulletin of the World Health Organization 84 (2006): 371-375.

Project history

2004-2006: This project is grounded in early essential medicines and human rights research initiated by Dr. Hans Hogerzeil at the World Health Organization's Department of Essential Medicines and Pharmaceutical Policies. His early studies examined the enforcement of access to essential medicines through the courts (Lancet, 2006) and the translation of human rights principles into practice guided by WHO's Essential Medicines Programme ( WHO Bulletin, 2006 ).

2008-2010: Dr. Hans Hogerzeil (then Director for Essential Medicines and Pharmaceutical Policies) expanded this research to national legislation. With Ms. Katrina Perehudoff he surveyed essential medicines provisions in national constitutions MSc ( masters thesis, 2008 and WHO Bulletin, 2010 ). He also worked with Prof. Michelle Forzley (then Widener School of Law) and Ms. Marie Elske Gispen LLM (then Utrecht University) to produce the first 'Essential Laws for Medicines Access (ELMA)' report (2010) including pilot studies on the legislation of Australia, the Netherlands, South Africa and Tonga.

2014-2015: Prof. Brigit Toebes (Director of the Groningen Centre for Health Law, University of Groningen) and Prof. Hans Hogerzeil (University of Groningen) further refined the Essential Laws for Medicines Access project through eleven preliminary country case studies, which are available on WHO's Essential Medicines and Health Products Information Portal for Bulgaria, Canada, Colombia, Costa Rica, France, Ghana, Indonesia, New Zealand, Senegal, Singapore, Spain.

2016-2018: Dr. Katrina Perehudoff joined Prof. Brigit Toebes, Prof. Hans Hogerzeil, and the University of Groningen team to study how international human rights law has been embedded in national law and policy, and been implemented and enforced in practice to promote universal access to medicines. The website www.healthandgender.org/accesstomedicines.html hosts the 16 country case studies  and 8 journal articles resulting from Dr. Perehudoff's PhD thesis (defended in 2018) and is a platform for her ongoing research.

Contact information

• Prof. dr. Brigit Toebes , Associate Professor and Rosalind Franklin Fellow, Department of International and Constitutional Law, Faculty of Law
• Prof dr. Hans V. Hogerzeil , Professor of Global Health and the Right to Health, University of Groningen Medical Center
• Dr. Katrina Perehudoff, post doctoral researcher at the Dalla Lana School of Public Health, University of Toronto, and the International Centre for Reproductive Health, Ghent University ( katrina.perehudoff gmail.com)