This inter-agency coordination exercise, with international experiences as inputs, made it possible to establish a roadmap for the national policy on rational use of medicines.

Up to the year 2013, gaining access to medicines was a luxury for a large part of the Salvadoran population. As the Deputy Minister of Health, Eduardo Espinoza, acknowledged, the country was in a dire situation: “the highest prices in the world, supply shortages of 50%, 80% of health spending by the poorest quintile dedicated to the purchase of medicines”. Advancing towards a law on medicines that would guarantee an effective right to health had become a priority for the government, and in 2012, after two years of resistance and legislative debates, it approved a solid regulatory framework.

Since then, considerable improvements in supply have been achieved (85% according the Deputy Minister of Health) and in price control. But one challenge remains: limiting irrational use of medicines, which has negative consequences for the health of the population and for health spending, and affects the most vulnerable members of society (those most inclined to self-medicate, who are also those most receptive to disinformation and most harmed by their spending on medicines). Today, 70% of annual spending on medicines is private (paid directly by patients without any contribution from the public system), and 80% of this spending is without a doctor's prescription. In addition, the most widely consumed medicines are unrelated to the epidemiological profile of the country.

Irrational use, driven by the commercial interests of the pharmaceutical industry, is aggravated by lack of independent information for medical personnel. Improving transparency and creating (and disseminating) independent information are therefore two priorities for the Ministry of Health which, along with the National Department for Medicines, is adding its efforts to a national programme for rational use of medicines and a virtual centre for independent information.

The workshop on independent information and rational use, held on 24th and 25th March with the support of the European Union's EUROsociAL cooperation programme, represented a milestone in national pharmaceutical policy. Inaugurated by the Deputy Minister of Health and the National Director for Medicines, it brought together for the first time all the stakeholders (ministry, regulator, insurance institutions, academia) to address the issue of rational use. Also noteworthy was the participation of two institutions; on the one hand, the National Health Forum, a group of civil society organisations whose role is key in ensuring dissemination of rational use among the population and different communities, and facilitating the necessary cultural change with respect to medicine use; on the other, the Secretariat of Transparency and the Institute for Access to Public Information, key institutions for addressing transparency in drug information.

EUROsociAL mobilised for this workshop the experiences of Spain, Argentina and Colombia. The Andean country, which since 2013 has had the support of EUROsociAL in implementing its national rational use programme, in this way started a sustained partnership with El Salvador, product of a reflection on the successes and obstacles in its own process.