Medicine donations: a review of policies and practices | Globalization and Health

We analyzed 38 policies on donations from donor countries (1 policy), pharmaceutical companies (6 policies), NGOs (6 policies) and recipient countries (25 policies). Twenty-five policies were implemented in 2010 or later and 16 of those incorporated all 12 recommendations from the most recent Guidelines revision. We also found that the large majority of donors in all three categories who had documented participation in donations either did not have policies governing those donations or those policies were not publicly available.

Recommendations 11 and 12 were the most likely ones to be missing, primarily in the recipient countries. These two recommendations focus on ensuring that the value of donated medicines match the wholesale price of the equivalent in the recipient country, and that all logistical donation costs are covered by the donors, respectively. The lack of implementation of these recommendations into recipient countries’ policies could allow for donors who also may have not incorporated them into their policies to leave wholesale price matching and donor accountability of logistical costs out of the conversation. This absence creates a cycle whereby recipient countries that do not have highly developed economies are sometimes be forced to pay out of pocket for some of the costs associated with the medicines they are being donated to them, creating a financial burden to them.

In addition, some authors have raised the risk that large-scale donations may distort pricing in the global commercial market for pharmaceuticals [13]. This distortion could affect alignment with the 2010 WHO Guidelines because recommendation 11 states that all donated medicines should match the wholesale price of the generic equivalent in the recipient nation. If this recommendation is not fulfilled, prices with higher mark-ups coming from donor countries can make the overall pharmaceutical market too expensive for citizens in recipient countries and pose another barrier to essential healthcare. Recommendation 12 also states that donors should cover logistical costs in the donation process, as recipient countries should not have to incur additional financial burdens if they are facing a crisis or do not have a large enough healthcare budget.

The findings from our study point out the need for stakeholders to focus on the economic implications that their donations can have on other participating actors, especially recipient countries. In-other words, donations that do not comply with the Guidelines can hurt those countries they are intending to help by creating additional financial burdens. This precaution and consideration when incorporating the WHO recommendations into donation policies can mean the difference between pharmaceutical aid that is genuinely beneficial, and aid with underlying financial hinderances for recipients to endure once the medicine arrives [14].

We also found that there are many actors across all categories (donor and recipient countries, NGOs and pharmaceutical companies alike) that do not currently have medicine donation policies or possibly their policies are not accessible to the general public for reference. This was evident in our search especially amongst donor countries, as we were only able to discover medicine donation policies for 1 out of the 12 countries.

A lack of transparency in medicine donation policies must be addressed. If actors do not currently make medicine donation policies publicly available, other actors and individuals outside of their organization will lack valuable information which may impact potential donation partners who are looking to work with them to donate or receive medicines. If all medicine donation actors shared their current policies, actors could hold each other accountable and provide suggestions to improve their policies to be more in line with the 2010 WHO Guidelines. Actors could also hope to gain more trust from the general public if they make audiences aware of how medicine donations operate within their organizations, which could in turn provide them with more support, funding opportunities and international partnerships in the future.

The difficulties in implementing the guidelines that we identified in the literature strongly suggest the need for a new round of revisions.

Recommendations

There are six suggestions for revision to the Guidelines recommendations that were synthesized based on our findings. They are as follows:

  1. 1.

    Include a distinct definition of who is a “recipient” in the donation process to improve clarity between stakeholders. This will allow for all parties involved in the donation process to understand their roles and the roles of others to maximize efficiency and communication.

  2. 2.

    Synthesize a list of successful global case study examples to assist guideline users.

  3. 3.

    Provide a mechanism for recipient countries to decline donations.

  4. 4.

    Use flowcharts to represent the mechanics of medicine donations.

  5. 5.

    Create visuals to illustrate how stakeholders can efficiently operate pharmaceutical interventions to provide aid to recipients.

  6. 6.

    Donors that do not have a donation policy should reference the 2010 WHO Guidelines to lead their medical humanitarian aid efforts.

Overall, we also found very minimal academic and public discourse on emergency preparedness in the context of disaster relief efforts and medical donations. One potential area for further action, is the implementation of “virtual” donation exercises for disaster preparedness training [13]. This would enable users to better plan for receiving donations of essential medicines by simulating real life scenarios in different settings of urgency and could assist in shaping disaster relief protocols and procedures.

Limitations

Although we believe that our search criteria were comprehensive, we may have missed finding policies of some donors and recipients, including because the policies were not publicly available. It is almost certain that there are other donors and recipients who fell outside our inclusion criteria who may have policies that we failed to capture and our results do not apply to these actors. We also did not evaluate how rigorously policies were applied by either donors or recipients. Finally, even in the absence of policies, donors in all three categories are making donations and countries are receiving donations.

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