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Non-governmental Action to Improve the Access of the Poor to Good Quality Low Cost Drugs


Maureen Mackintosh, The Open University
Sudip Chaudhuri, Indian Institute of Management Calcutta, Kolkata, India
Phares Mujinja, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
Meri Koivusalo, STAKES, Finland


Funding is gratefully acknowledged from the Economic and Social Research Council, UK. All content on this page is the sole responsibility of the project investigators. Grant period 1 January 2006-30 June 2008.

Summary and aims

This research aims to analyse the scope for non-governmental action to improve access by low income people to quality-assured low cost medicines. It concentrates on problems of access by the poor in India and in Tanzania to reliable drugs from Indian pharmaceutical companies. Our key objectives are to understand the current successes and failures of non-governmental action in seeking to improving access of the poor to drugs; and to analyse the scope within current market structures for improving non-governmental local and international action for this purpose.

Key research questions

The research will:

  1. examine the experience of and scope for non-governmental action, including social enterprise, autonomous public companies and non-governmental organisations, to improve access to quality-assured low cost drugs in India;
  2. analyse problems of sourcing, importing, pricing and quality assurance of drugs from low cost sources, notably India, in an African market (Tanzania), and assess the scope for non-governmental public action, including faith based organisations, social enterprise and consumer activism, to improve access by the poor;
  3. analyse the role of and scope for international non-governmental action, including international NGOs, European-based social enterprises, consumer groups, and campaigning groups on trade, public health and access to drugs, including identification of issues, perceptions of shared and conflicting South/North interests, the scope for alliances, and successes and failures;
  4. contribute to development of relevant methods of analysis of ethical and effective non-governmental intervention in highly perverse markets - in this case pharmaceuticals - including the sources of effective resistance to market incentives.

Research findings

  • In Tanzanian rural areas, exclusion for inability to pay and purchase of part-doses of medicines from unregulated drug shops is widespread; NGO facilities charge medicines prices that are not lower than shops despite lower wholesale buying prices but display somewhat better dispensing practice; solutions require moves towards access to essential medicines without charge at point of use.
  • Rural consumers of medicines lack information about their appropriate use; regulation of shops and reliance on dispensers to provide information is insufficient; non-governmental and civil society organisations are needed to spread information and campaign for consumer rights.
  • Top Indian pharmaceutical exporters lack interest in the African medicines market, while local manufacturers are key to sustaining rural medicines access in Tanzania; local manufacturing in African can and should be developed taking advantage of TRIPS concessions for least developed countries before 2016.
  • NGOs have played a major role in shaping the market in international wholesaling of essential medicines; that role is now under threat; solutions include African-based NGO wholesalers supplying the local NGO sector.
  • In public action for global health, commercial actors are increasingly involved in framing and influencing policy measures for access to pharmaceuticals; other NGPA actors need to move from identifying key issues to shaping alternative solutions on the basis of common health policy interests between Northern and Southern actors concerned with medicines access.


Working papers

Koivusalo M. (2009) 'Common health policy interests between North and South in pharmaceutical policy and global public policies' IKD Working Paper 47 (PDF document, 106 KB)

Chaudhuri S. (2009) 'Non-Government Intervention and Prices of Medicines in India: Case Studies of CDMU and LOCOST' IKD Working Paper 46 (PDF document, 123 KB)

Koivusalo M. and Mackintosh M. (2009) 'Global public action in health and pharmaceutical policies: politics and policy priorities' IKD Working Paper 45 (PDF document, 178 KB)

Phares G. M. Mujinja (2008) 'Consumer Rights and Non-Governmental Action in Medicines Markets: Knowledge, Risk and Trust in Rural Tanzania' IKD Working Paper 39 (PDF document, 179 KB)

Sudip Chaudhuri (2008) 'Indian Generic Companies, Affordability of Drugs and Local Production in Africa with Special Reference to Tanzania' IKD Working Paper 37 (PDF document, 167 KB)

Mackintosh M. and Mujinja P.M. (2008) 'Pricing and competition in essential medicines markets : the supply chain to Tanzania and the role of NGOs' IKD Working Paper 32 (PDF document, 158 KB)

Mackintosh M. (2008) 'Social Enterprise as Market Regulation: non-governmental interventions in essential medicines wholesaling to low income countries' IKD Working Paper 30 (PDF document, 112 KB)

Chaudhuri S. (2007) 'Is Product Patent Protection Necessary in Developing Countries for Innovation? R&D by Indian Pharmaceutical Companies after TRIPS', Indian Institute of Management Calcutta Working Paper Series WPS No. 614 (PDF document, 141 KB)

A repository of IKD Working Papers and other research outputs can be viewed at IKD Publications.

Articles and book chapters

Koivusalo, M. and Mackintosh, M. (2011) 'Commercial influence and global nongovernmental public action in health and pharamceutical policies' International Journal of Health Services 41(3) 539-363.

Mackintosh Maureen, Chaudhuri, Sudip, Mujinja, Phares G.M. (2011) 'Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines' Globalization and Health 2011 7:4.

Chaudhuri, S., Mackintosh,M. and Mujinja,P.G.M. (2010), 'Indian generics producers, access to essential medicines and local production in Africa: An argument with reference to Tanzania', European Journal of Development Research, 22(4) 451-468.

Mackintosh, M. and Mujinja, P.G.M. (2010) 'Markets and policy challenges in access to essential medicines for endemic disease' Journal of African Economies Supp 3 iii166-iii200.

Chaudhuri, S. (2009) 'Is Product Patent Protection Necessary in Developing Countries? R&D by Indian Pharmaceutical Companies after TRIPS' in Netanel, Neil (ed.) The Development Agenda: Global Intellectual Property and Developing Countries, Oxford, Oxford University Press.

Chaudhuri, S. (2007) 'The gap between successful innovation and access to its benefits: Indian pharmaceuticals' in Mackintosh, M., Chataway, J. and Wuyts, M. (eds.) 'Promoting innovation, productivity and industrial growth and reducing poverty: bridging the policy gap' Special Issue of the European Journal of Development Research Vol. 19 (1) 49-65.

Other publications

Hakkarainen O, and Koivusalo M. (2010) Common interests in health policies between North and South [In Finnish] Discussion document/pamphlet.
Publisher: Into, Helsinki

Workshops and dissemination

2-3 July 2010

Invited presentation, on 'Trading NGOs and access to essential medicines in low income contexts: regulatory lessons from India and Europe' at the International Workshop on Health Systems, Health Economies and Globalisation: Social Science Perspectives, London School of Economics.
Presenters Sudip Chaudhuri and Maureen Mackintosh

24-25 May 2010

Presentation on 'Assessing supply chain innovations in essential medicines' at the conference on 'Beyond Scaling Up : Pathways to Universal Access'
IDS, Sussex
Presenter: Maureen Mackintosh

15-16 May 2010

Presentation on 'Essential medicines supply chains and inequality' at the DIME / FINNOV / IKD Workshop on Innovation and Inequality: The Need for New Indicators from Pharma and Beyond, Sant'Anna School of Advanced Studies, Pisa, Italy
Presenter: Maureen Mackintosh

19 April 2010

Presentation at the Global Health Forum, Geneva, Switzerland
Presenters: Phares Mujinja and Maureen Mackintosh
Presentation: Consumer Rights and the Limits to Trust in an African Market for Essential Medicines: Regulatory implications in rural Tanzania.

November 2009

ID21, the DfID-funded research reporting service based at the Institute of Development Studies in the UK, featured in their research highlights a summary of the project working paper : Koivusalo M. and Mackintosh M. 'Global Public Action in Health and Pharmaceutical Policies: Politics and Policy Priorities'

6 April 2009

Presentation at an Innogen international workshop on Technology and Health Systems, Milton Keynes. Participants included private sector and PPP representatives, African policy stakeholders, and academics.
Presenter: Maureen Mackintosh
Presentation 'Health systems and access to essential medicines: learning from the Global Fund?'

15 February 2009

Presentation at the International Studies Association 50th Annual Convention Exploring the Past, Anticipatng the Future, New York
Presenter: Meri Koivusalo
Paper: Koivusalo, M. T. and Mackintosh, M. M. 'Common Interests and the Politics of Global Public Action on Pharmaceutical Policies'

14-15 January 2009

Presentation at the ESRC Nongovernmental Public Action Programme, Final Conference, London
Presenter: Maureen Mackintosh
Paper: Can NGOs help to regulate perverse pharmaceutical markets?

30 November 2008

Invited presentation at the African Economic Research Consortium Biennial Conference, Nairobi, Kenya.
Markets and policy challenges in access to essential medicines for endemic disease (PDF document, 103 KB)
Presenters: Maureen Mackintosh and Phares Mujinja

18 November 2008

Presentation to Panel on Innovation and Patents in India, International Institute for Advanced Asian Studies, Torino
Presenter: Sudip Chaudhuri
Paper: 'Pharmaceutical Innovation in India after TRIPS: Status and Implications'

10-14 November 2008

Presentation at an Advanced Technical Briefing Seminar on Medicine Prices, Availability and Price Regulation, WHO, New Delhi
Presenter Sudip Chaudhuri
Paper: 'Affordability of Drugs and Local Production: Tanzania and India'

4 November 2008

ESRC NGPA programme - One day workshop
Are there common interests? Exploring common and conflicting interests in public action between 'North' and 'South'
Convenors: Meri Koivusalo and Maureen Mackintosh

25 October 2008

Presentation at the MEDSIN annual conference, Plenary on Economic Issues, London
Presenter: Maureen Mackintosh
Paper: Mackintosh and Koivusalo: 'Markets in the wrong place? The paradox of economic policies for health'

5-11 July 2008

Presentation of some project results for Tanzania at the Policy Meeting concerning the Accredited Drug Dispensing Outlets (ADDO) project, Dodoma, Tanzania
Presenter: Phares Mujinja
Note: ADDO is a major Tanzanian project to improve regulation of private drug shops, managed by the Ministry of Health and Management Sciences for Health. ADDO officials attended our final project workshop.

7 June 2008

Research and Policy Workshop, Bagamoyo, Tanzania

12-15 May 2008

Presentation at IKD International workshop on Innovation in Pharma and Equity in Health Systems, Milton Keynes.
Presenters: Maureen Mackintosh, Phares Mujinja and Tanzania researcher Paula Tibandebage: 'Local manufacturing, equity and access to medicines'

7 May 2008

Presentation to Nongovernmental Public Action Programme, Theory Workshop
Presenter: Meri Koivusalo
Paper: Common interest and the politics of global public action in pharmaceutical policies: NGO agenda setting and the framing of policy issues'.

12 April 2008

Presentation at Seminar on Pharmaceutical Pricing and Regulatory Framework for Affordable Prices, NPPA in collaboration with DFID, New Delhi
Presenter: Sudip Chaudhuri
Paper: Pharmaceutical Prices and India

11 October 2007

Presentation to the ICTSD/UNCTAD Roundtable, Geneva
Presenter: Sudip Chaudhuri
Paper: 'Is Product Patent Protection Necessary in Developing Countries for Innovation? R&D by Indian Pharmaceutical Companies after TRIPS'

4-5 October 2007

Invited participation in the DFID Medicines Transparency Initiative (MeTA) workshop on equity issues, London
Participants: Phares Mujinja and Maureen Mackintosh

18-20 September 2007

Presentation as part of a Round table 'Opening the Gates', Deelopment Studies Association annual conference, Sussex
Presenter: Maureen Mackintosh
Paper: 'The impact of the new institutions on the market for essential medicines: issues and questions'

11-12 March 2007

Presentation in Seminar on Intellectual Property and Developing Countries: The WIPO Development Agenda, UCLA, Los Angeles:
Presenter: Sudip Chaudhuri
Paper: 'Is More IP Good for Developing Countries? The Case of India's Pharmaceutical Industry'

31 March 2007

Presentation at the Jenny Lanjouw Memorial Conference, University of California, Berkeley
Presenter: Sudip Chaudhuri
Paper: 'The Indian Pharmaceutical Industry After TRIPS'


Prof Maureen Mackintosh,

Contact us

To find out more about our work, or to discuss a potential project, please contact:

International Development Research Office
Faculty of Arts and Social Sciences
The Open University
Walton Hall
Milton Keynes
United Kingdom

T: +44 (0)1908 858502