This paper is part of a series of research papers prepared for the Working Group on Health and International Economy of the Commission on Macroeconomics and Health (CMH). The Commission was set up in January, 2000, by the Director General, World Health Organisation, under the Chairmanship of Prof. Jeffrey Sachs. As a member of the CMH and Co-chairperson of this Working Group, I have had the privilege of commissioning research papers on issues of importance for health and the international economy. This paper by Dr. Harvey Bale, Director-General, International Federation of International Pharmaceutical Association & President Pharmaceutical Security Institute, Geneva, spells out the problems relating to the access to older, patent-expired essential medicines in developing countries. The author highlights spending priorities, inadequate infrastructure for public health care, inadequate external financing and insufficient political commitment as the crucial barriers to improving access to quality health care in developing countries. The paper is bound to be controversial given the sensitivity of the issues raised. But an integrated approach to quality health care makes it necessary to address these problems along with the problems emerging from the TRIPs regime and globalisation. I hope that the analysis in this paper serves to improve the quality of informed debate and discussion
