Ethical issues around access to over-the-counter medicines in South Africa

South Africa is engaged in a heated debate around how to achieve universal healthcare (UHC) that will be accessible to all, affordable for the country and of high quality. Essentially, this discourse frames UHC as a right, yet there is strong evidence that certainly in the privately funded sector, healthcare functions as a commodity within a failing market system. Research has shown these failures to affect the highest cost elements of hospital, specialist and chronic disease care. In this review, we show that commoditisation also affects the primary healthcare market, specifically in the area of over-the-counter (OTC) medicines. The segment represents a multibillion-rand contribution to the economy, with stakeholders – ranging from government, pharmaceutical manufacturers and pharmacists to medical schemes and their members – driving the costs of OTC medicines up rather than down.