While spending on healthcare in the developing world has increased in the last ten years, governments have to clearly define the levels of care they are prepared to offer their citizens.

That is the view of Unni Karunakara, international president of Medecins Sans Frontieres (Doctors Without Borders) who was speaking at The Economist Global Healthcare summit in London. He noted that governments need to step up to the plate now that "donors have less appetite for giving" and it is a bad time for aid agencies to be scaling back with funds "as there does not seem to be anywhere to scale back to".

Dr Karunakara spoke about the situation in the Central African Republic, where life expectancy is 48 and "the system does not work". He spoke to the country's president recently who acknowledged that healthcare is not a priority at the moment, but contrasted this with the system in Niger where the government is showing leadership in tackling malnutrition and poor access to medicine.

He went on to lament the role of ministries of health which find it hard to make the case for increasing funding and argued that "a multi-sector approach" is needed. Dr Karunakara said that the private sector has played a significant role in helping the lower-income countries that have achieved universal healthcare, whereby the rich pay for their drugs and the poor get assistance. However, governments have to recognise their responsibilities to the latter, "there's no getting around that".

MSF has been highly vocal in criticising certain firms in the pharmaceutical industry and their attempts to defend their intellectual property in countries, most notably India. Dr Karunakara told PharmaTimes World News that he is in favour of a strong patent system but there is a problem "when patents trump people".

MSF's position on patents

Expanding on this area, he went on to say that "the current intellectual property regime has two major drawbacks. The system relies on monopolies that exclude competition, resulting in high prices for medical tools". Dr Karunakara claimed that the consequence is that "life-saving treatments are priced out-of-reach of people in developing as well as developed countries".

Secondly, he added, the current way of paying for R&D "drives research into areas of highest financial reward and not areas of greatest health need. This is why we at MSF object to the continued drive to use litigation and free trade agreements to push stronger patent laws and why we support new ways of ensuring innovation and access such as through an R&D Convention, and the use of new incentives that de-link the cost of R&D from the price of products and deliver innovation that is affordable and accessible".