International loans from the World Bank and aid agencies have supported the procurement of essential drugs. A fourth strategy is to improve the rational use of essential drugs by health workers and consumers, especially in the private sector, because market purchases represent a major source of access to pharmaceuticals in developing countries. Despite past controversies, a broad consensus has emerged on strategies to improve access to essential drugs in poor countries, and substantial progress has been achieved. One option is to use the market. For example, a government can purchase the new drugs.
Mandates are a second option.
Compulsory licensing would allow a national government to require licensing by a nonpatent-holder that would manufacture the new drugs within the country under certain conditions. So far, compulsory licensing has not been widely used to expand access to new drugs in developing countries. A third approach is to rely on munificence. Pharmaceutical manufacturers could expand product donation programs for new drugs that treat diseases of public health importance to poor countries. For markets, mandates, and munificence to work well, public and private actors must resolve their conflicting interests and establish partnerships and principles for access to new drugs.