Table 1.

Assessment tool for access to essential medicines in national law and policy

Principles	Human rights principle	WHO essential medicines policy
Legal rights and obligations
1. Right to health	Right to the highest attainable standard of health (UN General Assembly, 1966b; UN CESCR, 2000)	Human rights are a ‘value’ (Bigdeli et al., 2013)
2. State obligation to provide essential medicines	Core obligation to provide essential medicines defined by WHO (UN General Assembly, 1966b; UN CESCR, 1991, 2000, 2008, 2016)
Good governance
3. Transparency	Transparency (UN General Assembly, 1966a,b; UN CESCR, 2000)	Includes information to assess service access and coverage, and publicly available price information for medicines. A component of good governance for medicines (Hodgkin et al., 2001; WHO, 2007, 2014)
4. Participation and consultation	Participation (UN General Assembly, 1966a,b; UN CESCR, 2000)	Collaboration and accountability of all health systems actors, and stakeholder consultation is required. Referenced in good governance for medicines (Hodgkin et al., 2001; WHO, 2007, 2014)
5. Monitoring and evaluation	Monitoring (UN General Assembly, 1966b; UN CESCR, 2000)	Achieved through explicit government commitment, indicator-based surveys and independent impact evaluation. A component of good governance for medicines (Hodgkin et al., 2001; WHO, 2007, 2014)
6. Accountability and redress	Accountability (UN General Assembly, 1966a,b; UN CESCR, 2000)	Accountability of all health systems actors (WHO, 2007)
Technical implementation
7. Selection of essential medicines	(Assured) quality of health services (of the AAAQ) (UN General Assembly, 1966b; UN CESCR, 2000)	Includes the essential drugs concept, procedures to define and update the national list(s) of essential drugs, explicit, evidence-based criteria that includes cost effectiveness and selection mechanisms (Hodgkin et al., 2001; WHO, 2004)
	Duty to adopt appropriate legislative, administrative, budgetary and other measures to a maximum of its available resources Core obligation to provide essential medicines as defined by WHO (UN General Assembly, 1966b; UN CESCR, 1991, 2000, 2008, 2016)
8. Government financing		Requires adequate funding and mobilizing all available public resources and increase funding for priority diseases, and the vulnerable (Hodgkin et al., 2001; WHO, 2004, 2007)
9. Pool user contributions		Medicines reimbursement with user charges is a (temporary) financing option (WHO, 2004, 2007)
10. International assistance and technical cooperation	Duty to seek international assistance and technical cooperation (UN General Assembly, 1966b, 2008; UN CESCR, 2000, 2007)	Includes the possibility of using development loans for medicines financing (World Health Organization, 2004)
11. Efficient and cost-effective spending	Duty for the efficient use of available resources Duty to take appropriate steps to ensure that the private business sector is aware of, and consider the importance of, the right to health in pursuing their activities Duty to prevent unreasonably high costs for access to essential medicines from undermining the rights of large segments of the population to health Duty to seek low-cost policy options (UN General Assembly, 1966b, 2008; UN CESCR, 1991, 2000, 2008)	Includes the efficient use of resources and affordable pricing through: price control; a pricing policy for all medicines; competition through generic policies and substitution; good procurement practices; price negotiation and information; and TRIPS-compliant measures such as compulsory licensing and parallel imports (Hodgkin et al., 2001; World Health Organization, 2004, 2007)
12. Financial protection of vulnerable groups	Duty toward non-discrimination and attention to the vulnerable (UN General Assembly, 1966b; UN CESCR, 2000, 2008)	Increase government funding for poor and vulnerable groups and reduce the risk of catastrophic health spending (World Health Organization, 2004, 2007)

Abbreviations: WHO, World Health Organization; AAAQ, availability, accessibility, acceptability and quality.