Medicine Prices Availability and Affordability in 36 Developing Middle-Income Countries: A Secondary Analysis

Essential Medicines and Pharmaceutical Policies, World Health Organization, Geneva, Switzerland.
The Lancet (Impact Factor: 45.22). 12/2008; 373(9659):240-9. DOI: 10.1016/S0140-6736(08)61762-6
Source: PubMed


WHO and Health Action International (HAI) have developed a standardised method for surveying medicine prices, availability, affordability, and price components in low-income and middle-income countries. Here, we present a secondary analysis of medicine availability in 45 national and subnational surveys done using the WHO/HAI methodology.
Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation and purchasing power parity. International reference prices from open international procurements for generic products were used as comparators. Results are presented for 15 medicines included in at least 80% of surveys and four individual medicines.
Average public sector availability of generic medicines ranged from 29.4% to 54.4% across WHO regions. Median government procurement prices for 15 generic medicines were 1.11 times corresponding international reference prices, although purchasing efficiency ranged from 0.09 to 5.37 times international reference prices. Low procurement prices did not always translate into low patient prices. Private sector patients paid 9-25 times international reference prices for lowest-priced generic products and over 20 times international reference prices for originator products across WHO regions. Treatments for acute and chronic illness were largely unaffordable in many countries. In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail mark-ups ranged from 10% to 552%. In countries where value added tax was applied to medicines, the amount charged varied from 4% to 15%.
Overall, public and private sector prices for originator and generic medicines were substantially higher than would be expected if purchasing and distribution were efficient and mark-ups were reasonable. Policy options such as promoting generic medicines and alternative financing mechanisms are needed to increase availability, reduce prices, and improve affordability.


Available from: Dennis Ross-Degnan, Oct 19, 2014
  • Source
    • "Poor availability, low affordability and high medicines prices are important barriers to access to essential medicines in many low-and middle-income countries [4]-[8]. A review of data from 36 low-and middle-income countries showed that in the public sector availability ranged from 29% to 54% and private sector patients paid 9 to 25 times international reference prices (IRP) for lowest-priced generic products [9]. "

    Open Access Library Journal 01/2015; 02(01):1-10. DOI:10.4236/oalib.1100983
  • Source
    • "In Uganda, this proportion was below 2 in 10 individuals. To our knowledge, this study is the first to provide direct evidence about the widespread lack of access to medicines for chronic conditions in resource-limited settings, complementing and reinforcing indirect evidence about the lack of availability and affordability of medicines for chronic diseases in public and private healthcare facilities of LMICs (Cameron et al. 2009; Kotwani 2010; Cameron et al. 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.
    Health Policy and Planning 09/2014; 30(8). DOI:10.1093/heapol/czu107 · 3.47 Impact Factor
  • Source
    • "Even with the efforts to improve the case management of malaria, the success of policy implementation and effectiveness is measured by the availability of the recommended drugs at the point of care [6]. Many patients in Africa use private sector as their primary source of medicines, with 50% of febrile cases reported to be treated in this sector [7], despite the fact that the manufacturer’s selling prices and final patient prices range from 56% to 358%, making treatment unaffordable [8]. On average, households in many malaria endemic countries spend up to 90% of their household expenditure on medicines, portraying high anti-malarial pricing as an important contributing factor to the lack of access to ACT [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Artemisinin-based combination therapy (ACT) has been adopted as the most effective treatment against malaria in many endemic countries like Kenya while quinine has remained the second line. The objective of the current study was to assess access to Kenya’s policy recommended anti-malarials, ACT and quinine in the public, private and not-for-profit drug outlets in western Kenya. Methods A cross-sectional survey using purposive sampling of 288 outlets (126 public, 96 private, 66 not-for-profit) was conducted in western Kenya in two regions with varying Plasmodium falciparum endemicities. Information on access (availability, price, affordability) on ACT and quinine was collected using the WHO and Healthcare Associated Infection (HAI) standardized methodologies for availability, prices and affordability of drugs. From a Ministry of Health database, the following were included in the analyses: one (1) main public hospital, followed by random selection of five hospitals under this main facility. Eight other public outlets under each of the hospitals were selected, to a total of 96. Matching number of private outlets (n = 96), all (66) not-for-profit outlets and additional 30 public health facilities were sampled to get the required sample size of 288. Results More public 111 (88.1%) and not-for-profit 27 (40.9%) outlets stocked subsidized ACT (artemether-lumefantrine, AL). Other artemisinin-based combinations were widely available for both children 93 (96.9%) and adults 82 (85.0%) in private outlets. Frequent stock-outs were in public in 106 (84%), reporting three times or more stock-outs in three months. Subsidized ACT (AL) was sold at median price of USD 0.94 and 0.75 in private and not-for-profit outlets respectively. The costs was higher than recommended price of USD 0.5 and requiring up to 0.20-0.25 days of disposable income for households in lowest economic status. Conclusion There is low availability of subsidized ACT (AL) and higher frequency of stock-outs in government facilities, while private sector sells AL at higher prices, thus making it less affordable to many households. These factors determine the adherence to the dosing schedules during the treatment course and thus the evaluation of the subsidy policy, its implementation and role in malaria burden in this region is compulsory.
    Malaria Journal 07/2014; 13(1):290. DOI:10.1186/1475-2875-13-290 · 3.11 Impact Factor
Show more