Impact Of The Trips Agreement On Public Health Access In Rwanda

Contents

Background Information. 1

Purpose of the Study. 3

Necessity for Development to Address Public Health Problems in Rwanda. 4

Introduction of Rwanda. 6

Reasons why Rwanda is a LDC and why it is as such especially effected by TRIPS. 8

Socio-Economic and Political Indicators in Rwanda before Becoming WTO Member. 9

Former Health and Patent Policy in Rwanda. 10

The TRIPS Agreement. 12

Motivation and Incentives for TRIPS Agreement. 12

Provisions for TRIPS. 13

Intended Ideas of TRIPS. 14

Rwanda’s Development affected by TRIPS. 14

Arising Thresholds. 15

Need for Interpretation and Implementation, Guidance. 16

Socio-Economic and Political Development since joining the WTO.. 16

The Way to Doha. 19

The Doha Declaration. 19

Motivation, Incentives and Needs that lead to the Declaration. 20

Legal Analysis in regard to Health and IP Policy. 21

What still has to be done – Obstacles in National Law to benefit from TRIPS. 22

Socio-Economic and Political Development since 2003. 22

Background Information

The Rwandan healthcare has always been a critical factor in the country because of the low levels of economic development and the high poverty rates. The economy of Rwanda was significantly affected by the genocide in 1994, which killed about one million people. The country had existed as a failed state with a myriad of problems including poverty and chaos in the different levels of government. The genocide destroyed the health facilities and workforce in Rwanda allowing infectious diseases to become rampant. This also resulted in increased child mortality rates where one in four children was dying before their fifth birthday (Lievens 78). These conditions crippled the economy by crippling the workers and leaving the country poor and unable to lower the disease burden effectively. It had a life expectancy of 38 and the possibility of a turnaround looked grim.

This is a country that is endowed with numerous political and economic issues. Indeed, this is the only country that has met all its millennium development goals (MDGs) in the whole of sub Saharan Africa. It has a direct relationship to the TRIPS policy introduced by the WTO. Due to this, it is important to revisit the overview of TRIPS. The acronym TRIPS stands for the Trade Related Aspects on Intellectual Property Rights. This body was established by the World Trade Organization (WTO) in the year 1994 to help facilitate issues that were arising from the companies participating in the international trade through patent recognition (T’Hoen & Ellen 87).

Most of the developing countries suffered a big blow with these legislations as it surely reduced the development programs in such countries in a wide scale and this led to the deterioration in the health sector of these countries especially due to the part on the access to medicines and drugs by the general public. Indeed, the program was an annex from the WTO in an attempt to control trade especially in the medical supplies by the member countries. The legislation program had very complex procedures that most countries especially in Africa could not adhere (ICTID 145). This as a result brought in a lot of issues that declined the development agendas in these countries. This implies that Rwanda was not an exceptional to this kind of trade restrictions in its plight to foster an affordable health care to its citizens. Basically, the whole process led to the rise in the prices of the drugs in several health institutions in the country. This was commensurate to the hoarding of most drug supplies in the drug stores and other government health institutions (T’Hoen & Ellen 127).

Rwanda’s move to implement the medical program was a total disgrace to the community that it served. It was a negative step towards the addressing of the imbalance in the ability to access the medicines between the lower income countries and those from the rich countries. It would be great disgrace for Rwanda to consider it as a way of substituting their medical supplies. The implementation of this program will not help solve the problem of medical insufficiency in the developing countries at all especially in Africa and Rwanda (Correa 89). The developed countries like Australia call it a very important step to the development of the medical system in these countries but what is the essence of this whole idea if it cannot in itself solve the medical insufficiency in Rwanda (Hestermeyer 111). This is because the whole idea is only meant to supplement and supply the countries with emergency medical supplies especially during turmoil and these can never be of importance to the development of the overall healthcare sector of the same country.

Developed countries like the US claim that the whole idea is meant to subsidize and provide essential medicines to the developing countries like Rwanda, but in real sense this is a total disgrace to the society (Hassan and Ohid 123). The developed countries are even further gearing their companies to manufacture medicines that are generically reported to be exported to the developing countries. Yes, it could look a good gesture, but who could be quite sure of the safety and standard of the medicines to the people of Rwanda. This is a mere plot by these developed countries to derail the health standards in Africa and especially in Africa. They attain this by constantly changing the packaging on the drugs in order to confuse the users in these countries (Hassan and Ohid 123).

Purpose of the Study

The paper seeks to address the discrepancies that these laws of TRIPS have caused in the economy of the Rwandese people and the effect of the trade law especially from the developed countries to the developing countries like Rwanda. It tries to link this whole idea to the LDCs like in the Rwanda system of health care. There are several research questions to be asked in this paper. The main question is the reliability of the TRIPS program to the Rwandan health program. Are they compatible or not?

The question is why these pharmaceutical companies in the developed countries are under obligation to manufacture export medicines and other pharmaceutical products to the developing countries. It is even absurd as to why these drugs are just destined to the developing countries like Rwanda and not their fellow developed countries. As much as these developed countries tend to claim that they are indeed helping the developing countries to develop their own generic drug plants, it is still not a good gesture to the Rwandese community. This is because little of no effort is being conducted to help meet the requirements of these countries in the health sector. The best way could be to provide these developing countries with the necessary financial aid in order to set up their own independent pharmaceutical companies.

Necessity for Development to Address Public Health Problems in Rwanda

Over the recent years, Rwanda has been under pressure to undergo several policy changes in the health sector. Indeed, the major health challenge in Rwanda lies with the development on the strategies to deal with the menace of the diseases consisting of malaria, TB and HIV/AIDS. The last ten years has seen a series of deaths from these major killers in Rwanda (Hestermeyer 101). However, with the relevant policies in place, all these have changed and a significant drop has been achieved with the death toll lowered by about 80 %. The life expectancy has indeed doubled during this very period with the maternal mortality rate dropping by 60 %. This period has also seen a drop in the average of the cost of health care in most public hospitals to about $ 55 per person annually (Lievens 67).

Indeed, coupled with the wake of the genocide that killed thousands in the year 1994, the realization of this dream seemed impossible in the eyes of the common man and any sensible person. Most people of the world and the neighboring countries like Kenya, Uganda and Tanzania took Rwanda as a completely failed state (Langley 567). This was not with the case as the government headed by President Paul Kagame took very radical steps like developing stringent rules that could yield these fruits in just less than a decade.

The genocide literally crippled the country and this led to destruction of property and equipment in the health sector in a massive manner that the world could ever imagine. The entire health sector was decimated and the workforce paralyzed as over half the population died in the genocide attack. This made the infectious diseases to spread in a mighty and unexpected way as the over 25 % of the children died just before the age of 5. The disease prevalence crippled the country in that the population was weakened by the diseases and the work force was ever sick. The life expectancy was settled at about 38 year old just the year after the genocide. The country was then posed to follow the serious economic downturn that would further cripple the health sector as many would imagine (Hestermeyer 107).

All these changed in a span of less than a decade and by the year 2004, Rwanda was indeed the only country in the sub-Saharan Africa who has surely met all its Millennium Development Goals (MDGs). These were to fight the major diseases in the country that were the cases of TB, malaria and HIV/AIDS through proper medical and public awareness campaigns. Indeed these parameters have dropped by over 40 % even with a larger percentage drop as stated in their MDGs proposal that was slated for about 25 % drop during the same period of time. The overall population has since increased by more than 35 % currently (Lievens 34). These medical advances have since escalated the economic growth in the country since the Gross Domestic Product (GDP) of Rwanda has significantly tripled to over $ 580 between the year 2000 and the year 2010. This means that millions of the Rwandese residents have lifted themselves to wealth and a good percentage of the population currently live above the poverty line as indexed by the World Food Program (WFP). It is a good rise in a very short span of time and this could be wholly attributed to the negative effects felt by the Rwandese citizens from the case on the genocide attack (Langley 579).

This whole issue of the genocide agenda was the foundation to the economic developments in the country including the heath sector. Indeed it provided a good and clean slate that the country could use in its plight to the development of the health sectors. It is absurd to say that at times it could be common to claim that some bad actions usually precede good issues (Langley 599). This does not mean that the whole idea of genocide in Rwanda was a blessing, nor do I acknowledge this act of atrocity; I am simply putting the fact plain and clear that the whole idea of genocide gave Rwanda the opportunity to develop and revamp the whole system of health and thus gave the road map to economic success. This could be partly attributed to influx of the medical aid by the developed countries especially from the UN bodies like UNHCR, USAID among others. These could then be of importance in the revitalizing of the health system of the country since they gave some aid to the country in a temporary basis (Lievens 44).

However, the whole idea of the medical aids to the country could not auger well in the current state of events in the country as it does not follow the policies set by the Latin America and the Caribbean (LACs) that were set in place to help revamp the medical sector in the country. This program aimed at aiding the health care research sector in the country.  Initially, this collaboration was to come as an aid as the country was in dire need of the financial and the health sector revamping which greatly helped bring them back to their feet. This cannot be echoed in the current system of government as the LACs are no longer at ease with the aid as they no longer view the country as an endangered country any more (Hoen 342). This has led to country attaining the best health plan so far in Africa and it enjoys a whopping $ 55 Government spending in the health care provision and this is making Rwanda 22^nd ranked among the 49 sub Saharan countries in Africa (Njogu 213). This is considered a good gesture relating to the nature and size of the country in comparison to other countries in the region like Kenya that boasts of a stable economy.

Introduction of Rwanda

Rwanda is a country that has undergone a lot of political developments which has also greatly impacted on her healthcare system since the genocide effect in 1994. Healthcare has always been a critical factor in Rwanda because of the low levels of economic development and the high poverty rates. The economy of Rwanda was significantly affected by the genocide in 1994, which killed about one million people (Njogu 233). The country had existed as a failed state with a myriad of problems including poverty and chaos in the different levels of government. The genocide destroyed the health facilities and workforce in Rwanda allowing infectious diseases to become rampant. This also resulted in increased child mortality rates where one in four children was dying before their fifth birthday during the genocide period.

Figure 1: Economic Trend in Rwanda since 2009

(Source ICTID)

The country has taken effective strategies that include the prevention measures and also the public awareness campaigns to reduce the disease burden from HIV, TB, and Malaria among others. One of the central reasons for this turnaround is effective use of healthcare funding and enhancing access to foreign aid. Rwanda provides universal healthcare insurance and bases its policies on available healthcare data (Roffe, Geoff and David). The turnaround in the performance of Rwanda’s healthcare system has been aided by the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement formulated by the WTO. This strategy was developed in order to aid member countries in relation to IP protection. The agreement provides guidelines and exceptions for developing countries to benefit from IP protection and exemptions of the agreement. All in all the idea was not a bed of roses as it would have been thought, but had some negative effects as it nearly paralyzed the development of the pharmaceutical industries in Rwanda (Johnson 56).

The TRIPS policy in Rwanda highlights how the system has influenced developing countries on technical and financial cooperation by limiting their access to the main aspects of the pharmaceutical industries. This dissertation will be operationalized by highlighting how the system works through negotiators who aid in addressing the needs of different countries. The focus of the system in developing a viable technological base works by obliging developed countries to create incentives for technology transfer by the World Trade Organization (WTO). Rwanda was a pioneer in use of the patent flexibility provided by the WTO in the TRIPS agreement. The country used the exemptions to enhance accessibility to drugs for HIV/ AIDS from Canada (Abbott 45). This has provided a case study and an example for other countries to emulate. Rwanda used the agreement to import patented medicine that is produced without the compulsory license from the patent holder from Canada. This reduces the cost of drugs and enhances accessibility in order to improve public health in the country.

Reasons why Rwanda is a LDC and why it is as such especially effected by TRIPS

LDC is a common acronym among the African nations. It denotes the Least Developed Countries. It describes a group of countries according to the WTO that are ranked the poorest in relation to the following characteristics. These countries have low income criterion. Their gross national income is rated to be below the $ 750 mark and their GDP per capita is also way below the $ 500 mark. This could be above the $ 900 mark for graduation (Hassan and Ohid 32). They are characterized by the human resource weaknesses criterion. This would involve the indices of human assets like the nutrition, education, adult literacy and health. The last criteria used in this category is the economic vulnerability which are pegged on the instability of the agricultural sector, unstable export and import mechanism, the reliance on the nontraditional activities, concentration of the merchandise export plus the handicap of the economic smallness (Hassan and Ohid 35)

With all these factors related to the LDCs in the world, Rwanda is clearly an LDC. This is because Rwanda clearly meets these attributes that are concerned with the LDCs in a global perspective (GlaxoSmithKline 167). The question to ask at this stage is as to why Rwanda still falls in the bracket of the LDC despite the progress they made as stated in the earlier sections of the paper. The main factor that has left Rwanda to lag behind could be attributed to the fact that the TRIPS policies only concentrated on the specific issues that were related to the health and the combating the infectious diseases that befell the country immediately after the 1994 genocide. These policy holders and the stakeholders in the programs did not consider other sectors of the economy that were also vital to the economic development of the country. This implies that this policy did not auger well to culminate all the stakeholders in the field (GlaxoSmithKline 78). 

Socio-Economic and Political Indicators in Rwanda before Becoming WTO Member

Rwanda became a member of the WTO on the 22^nd February, 1996. This was just about a year after the genocide in the country where the two major tribes butchered each other in an attempt to reach political supremacy. There were a number of social, economic and political indicators that dogged the country all through this time in history (Hoen 65). A few years just prior to this period of time in the history of the country was dogged with a lot of political fights for the supremacy in the country. Rwanda gained its independence from the Belgium in the year 1962, where it stood alone but governed in some form of crooked indirect colonialism as part of the Belgian Congo (Njogu 45).

It was considered the kingdom of the royal Tutsi. The rivalry of the Tutsi and the Hutus dates back when the Tutsi struggled to fit into the program of the elite Hutus who were educated by the missionaries in the region. This led to the breeding of the ethnic animosity that politically crippled the country for ages till all these culminated into the genocide in the year 1994 (Njogu 76).

During all this period, the country had very scanty resources especially the mineral deposits that could help in the generation of wealth to the country in one way or the other. There was little improvement in the economy of the country despite numerous efforts by the foreign donors to bring sanity to the country’s system of economic development. The country however relied on some form of agriculture that was subsistence in one way or the other. This was basically for the survival of the homes for those that were primarily peasant farmers like the Hutus. It imp-lies that the economy lacked diversity and some sort of market dominance in order to concentrate on the intensive farming and other mineral exploitation mechanisms that would be beneficial in the management and development of the economy of Rwanda (Johnson 123).

Former Health and Patent Policy in Rwanda

During the earlier years before the country joined the WTO, the population had a great percentage of unskilled workers and most individuals were unemployed. There existed no clear rules for employment and the contractual issues in the country. This implied that the rights of most unskilled workers were constantly violated by their employers. The rights to work and employment were only accorded to the qualified personnel only. During the better part of this period, about 85 % of the population still did not access the full force of the provision of essential services like the provision of safety nets in the combating of the menace of malaria and other mosquito related illnesses (Vujicic, Kelechi and Susan 657).

Figure 2: Health Expenditure and Progress in Rwanda between 2000 and 2011

(Source Hoen)

The traditional solidarity has been weakened by the extreme poverty in the country. This disrupted the neighborhoods and thus the ethnic animosity between the elite and the poor in the society soared to higher levels in the country. All these factors culminated into the 1994 genocide attacks which is a milestone history in the politics of the country plus other important sectors like the health sector and the patent sectors. This is because the emergency responses to the situation in the country gave the foundation of a better and revamped system in the health sector (Johnson 567).

The major health centres and the basic health requirements in the country were run by the religious groups and other foreign based organizations. These have been traditionally accepted within the rural set up of the country while the urban set up tends to rely on the public health care system. This went on like this till the genocide attack in the year 1994, where several health workers were brutally murdered in the horrific massacre. This was a total disaster to the country as the people continued to languish in poverty and the most hit parts were the rural areas where the war was very rife as compared to the urban centres that were stable relatively (Lievens 76).

The TRIPS Agreement

TRIPS have been used widely in the economic forum for most countries mainly in the health and financial sectors. This could be attributed to the mean and imbalanced actions by the developed countries onto the developing and other LDC in the world agenda for economic peace. The acronym TRIPS stands for the Trade Related Aspects on Intellectual Property Rights. This body was established by the World trade Organization (WTO) in the year 1994 to help facilitate issues that were arising on the imbalance of trade especially between the developed and the developing countries (Abbot 213).

This could also be attributed to the fact that Rwanda clearly meets these attributes that are concerned with the LDCs in a global perspective. The question to ask at this stage is as to why Rwanda still falls in the bracket of the LDC despite the progress they made as stated in the earlier sections of the paper. The main factor that has left Rwanda to lag behind could be attributed to the fact that the TRIPS policies only concentrated on the specific issues that were related to the health and the combating the infectious diseases that befell the country immediately after the 1994 genocide (Ashiya 765). These policy holders and the stakeholders in the programs did not consider other sectors of the economy that were also vital to the economic development of the country. This implies that this policy did not auger well to culminate all the stakeholders in the field (Abbot 212).

Motivation and Incentives for TRIPS Agreement

The main motivating factor that geared the implementation of the program in most countries was the issues of easy enforcement of the patents in a global perspective. Their major concern was the issue of HIV/AIDS and Malaria in Africa. As much as the developed nations claim to be in possession of expensive drugs in the health stores that has led the revision of the motives presented by the TRIPS program. The 2003 agreement during the administration of Bush’s change.............