Access to medicines for treatment of the leishmaniases is challenging in the poor countries that have the highest burden of cases.

Although efforts have been made by WHO, nongovernmental organizations and manufacturers to improve access to medicines, the problem of access to medicines persists. In the context of weak health systems in many Leishmania-endemic countries, a number of factors contribute to lack of access to medicines, including that:

• medicines are relatively expensive and therefore often unaffordable;
• national treatment protocols often do not reflect the latest developments, and few or no antileishmanial medicines are included in the lists of national essential medicines;
• medicines for which preferential prices have been negotiated for low-income countries are not always registered by the companies in these countries as there is no profitable market. Many countries with fewer cases have not also registered the medicines.
• the supply of medicines is not continuous. Most antileishmanial medicines are produced by only a single manufacturer. Problems with quality, low production capacity and lack of an adequate forecast of needs (resulting in long lead times for orders) regularly cause stock ruptures in endemic countries. There are no central buffer stocks that can be accessed in such cases, and there is no platform for indicating drug needs; this poses a major challenge in estimating the quantities needed globally and appropriate planning of drug production.

In response, WHO has made significant efforts in promoting equitable access to health services, and in particular to essential medicines. Major achievements include:

• reducing the price of two of the five existing medicines for visceral Leishmaniasis by 90% for liposomal amphotericin B and by 60% for meglumine antimoniate; and,
• including two new medicines in the WHO Model List of Essential Medicines (17th edition) (paromomycin in 2007 and liposomal amphotericin B in 2008).

In September 2016, Gilead Sciences signed a new 5-year agreement for the donation (through WHO) of 380 000 vials of AmBisome (liposomal amphotericin B for injection) and includes funding for enhanced diagnosis and treatment. This new agreement until 2021 extends the previous 2011 agreement which provided for the donation of 445 000 vials of liposomal amphotericin B injection to treat more than 50 000 visceral leishmaniasis cases in eligible endemic countries of South-East Asia and East Africa.