title: Access to essential medicines in Pakistan: policy and health systems research concerns.
abstract: BACKGROUND
  Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i) gaps related to access to essential medicine in Pakistan; and ii) prioritization of emerging policy and research concerns.
  
  
  METHODS
  An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder's Roundtable.
  
  
  RESULTS
  A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review.
  
  
  CONCLUSIONS
  Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda.
authors.affiliation: Department of Community Health Sciences and Women & Child Health Division, Aga Khan University, Karachi, Pakistan. shehla.zaidi@aku.edu
authors.forename: Shehla
authors.initials: S
authors.lastname: Zaidi
authors.forename: Maryam
authors.initials: M
authors.lastname: Bigdeli
authors.forename: Noureen
authors.initials: N
authors.lastname: Aleem
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
mesh_terms: D003695:Delivery of Health Care; D003906:Developing Countries; D006291:Health Policy; D006801:Humans; D008511:Medicine; D010154:Pakistan; D004364:Pharmaceutical Preparations
chemical_list: D004364:Pharmaceutical Preparations