Examining the Impact of Controlling Essential Medications

May 2, 2017

Second-year MPA students Sebastian Soto and Aron Suba recently returned from an extended trip to India where they conducted fieldwork for their Applied Policy Project (APP), a nine-month capstone project in which teams of students work for an external client on a defined project. “The trip to India was an extraordinary opportunity,” remembers Soto, “and also invaluable in terms of the data we were able to collect for our project,” adds Suba. Their project was to examine the socio-economic impact on marginalized communities and/or rural areas in developing countries in Asia due to the lack of essential medicines whose availability is controlled by national legislation and international conventions on drugs.

Every two years the World Health Organization (WHO) issues a list of “essential medicines” – medicines that it determines are needed for a basic health-care system. Some of the medicines on that list, such as benzodiazepines, have also been identified within the context of the international drug treaty framework as “controlled medicines.” This causes enormous problems and real hardship for the individuals who need these controlled medicines.

Soto and Suba’s first task was to come up with a list of medications that are both “essential” and also “controlled.” They then wrote briefing papers on four countries (Myanmar, Vietnam, Cambodia, and India) focusing on opioid analgesics that are used in palliative care (such as morphine) and other medicines related to maternal and mental health, to explore the socio-economic impact that restricting the availability of these drugs had on the health profile of each country. “It’s complicated,” explained Soto, “because there are many reasons, like bureaucracy and inadequate infrastructure, why access to these drugs is restricted. It’s not just that they have been identified as controlled substances.”

During their visit to India in April, Soto and Suba made several visits to five hospitals in Punjab and Gujarat where they met with cancer patients and their families, doctors and health care workers, and administrators. “The purpose was to get a first-hand look at the effect of controlling these essential medications,” said Suba. They conducted semi-structured interviews to identify what obstructs access to opioid analgesics at the state level and to understand the socio-economic and health impact of the lack of access on patients, their families, and communities.

Organizing the trip was challenging – securing the necessary permissions, figuring out how to get from one place to another, etc. So too was conducting the interviews themselves. “We were interviewing cancer patients – almost always in very distressing circumstances. We heard stories about sick patients traveling 400 kilometers to get the morphine they need – and having to do this every month because they could not get a prescription for more than one month,” remembers Suba. They heard also about families that had to take out loans to pay for the medications they needed and about children who had to quit school so they could start working and earn money to pay back those loans.

Soto and Suba are now finalizing their report that their client plans to publish for national decision makers and the UK-based international development donor and NGO community. They agree that they have learned a lot while working on their APP – not just about the topic itself but also about how to work together as a team and with an outside client. “The APP has been a great experience for both of us. We have worked hard, interviewed many interesting people, and received a lot of support and advice from recognized experts in the field,” says Soto.