Access to Medicines: Why Good Governance Matters

Helena Walkowiak

Management Sciences for Health | Principal Technical Advisor, SIAPS Program

Maura Soucy Brown

Management Sciences for Health | Technical Advisor, Pharmaceuticals and Health Technologies Group
Source - Rui Pires
Mother and child in pharmacy.

Spending on pharmaceuticals is one of the largest components of total expenditures on health in low- and middle-income countries. On average, these countries spend a quarter—but sometimes as much as two-thirds—of their entire health budget on medicines and other pharmaceutical products.1 It is imperative to ensure that medicines are carefully managed to prevent inefficiencies, losses, and corrupt practices that waste scarce resources and, more importantly, prevent people from having access to medicines that are safe, effective, and of good quality.

The costs of obtaining medicines can be substantial for patients and their families and, in some cases, catastrophic, when they must pay inflated prices for medicines they need or purchase unnecessary or ineffective products. Mismanagement and corruption can also allow substandard and fake products to enter the supply chain, which can cause harm to patients and contribute to the development of antimicrobial resistance.

Good governance encourages better management and reduces opportunities for corruption across all points of the pharmaceutical system, including registration, selection, procurement, distribution, and at the point of prescribing and dispensing medicines to the patient. Moreover, important decisions are made in the development of policies, allocation of resources, and throughout the process of managing medicines. How these decisions are made and how they are implemented affects whether patients have access to the medicines they need and whether these medicines are prescribed, dispensed, and used safely and appropriately.

Good governance is an important concern for everyone—governments, health institutions, health care workers, citizens, and development partners. Better governance in pharmaceutical systems contributes to the development of stronger health systems, improved service delivery, and achievement of health and financial risk protection goals of universal health coverage.

To learn about the factors that make pharmaceutical systems vulnerable to corruption and mismanagement, the problems that can arise, and how they influence the effectiveness of health programs, we invite you to take the new USAID Global Health eLearning Center course Good Governance in the Management of Medicines. Developed by the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, this course discusses interventions to address these problems, including improving transparency and accountability at all levels of the system, involving key stakeholders in the development of policies and decision making, and enhancing performance and ethical practices. We hope this course will provide a good overview of these topics and help you to determine ways to improve governance in pharmaceutical systems.


1. Lu Y et al. 2011. The World Medicines Situation 2011: Medicine Expenditures. 3rd ed. Geneva: WHO.