The paper spells out the problems relating to the access to older, patent-expired essential medicines in developing countries. The author highlights spending priorities, inadequate infrastructure for public health care, inadequate external financing and insufficient political commitment as the crucial barriers to improving access to quality health care in developing countries. The paper is bound to be controversial given the sensitivity of the issues raised. But an integrated approach to quality health care makes it necessary to address these problems along with the problems emerging from the TRIPs regime and globalisation.