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.

Download full-text


Available from: Dennis Ross-Degnan, Oct 19, 2014
  • Source
    • "Further, they take into account the income distribution of the population. The WHO/HAI method only considers the wage of the lowest paid public sector worker, which was acknowledged to be higher that what some groups of the population earn (Cameron et al. 2009b; Niëns and Brouwer 2009). In addition, it does not consider other basic expenses households experience. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: To assess progress in improving affordability of medicines since the introduction of mandatory health insurance in the Republic of Moldova. Method: Using data from national health insurance, we estimate affordability of partially reimbursed medicines for the treatment of non-communicable diseases, and analyse which factors contributed to changes in affordability. Results: Affordability of subsidized medicines improved over time. In 2013, it took a median of 0.84 days of income for the lowest income quintile (ranging from 0 to 3.32 days) to purchase 1 month of treatment for cardiovascular conditions in comparison to 1.85 days in 2006. This improvement however was mainly driven by higher incomes rather than deeper coverage through the reimbursement list. Conclusion: If mandatory health insurance is to improve affordability of medicines for the Moldovan population, more funds need to be (re-)allocated to enable higher percentage coverage of essential medicines and efficiencies need to be generated within the health system. These should include a budget reallocation between secondary and primary care, strengthening primary care to manage chronic conditions and raise population awareness, implementation of evidence-based selection and quality use of medicines in both outpatient and inpatient settings, improving monitoring and regulation of prices and the supply chain; and alignment of national treatment guidelines and clinical practice with international best practices and evidence-based medicine.
    Preview · Article · Feb 2016 · Health Policy and Planning
  • Source
    • "In fact, Tchacondo et al. (2011) report that 80% of the population rely on medicines from plants for their primary healthcare needs. This is hardly surprising given the high cost of orthodox medicines (Cameron et al., 2009), coupled with the fact that almost two-thirds of the population live in rural areas, and the country consists of 42 different ethnic groups, each with its very own traditions and rituals (Kuevi, 1981; Goeh-Akue and Gayibor, 2010). The extensive use of such plants – and products derived from them – in the treatment of various diseases has also resulted in different scientific studies, which have explored the diversity in the use of plants in Togo in general, and the regional folk medicine in particular (Agody, 2007; Moukaïla, 2010; Tchacondo et al., 2011; Amegan, 2012; Tittikpina et al., 2013; Franck, 2014; Zabouh, 2014; Sema, 2015; Lawson-Viviti, 2015). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Many African countries suffer from endemic diseases which are often caused by infections and which seriously affect the social and economic development of these nations. While access to proper medication is still limited, many of these countries are, at the same time, rich in medicinal plants. Materials and Methods: A review of relevant scientific (and grey) literature was carried out and information obtained from local authorities in medicinal plants. A synthesis of the data obtained was thereafter performed and recommendations for the future proposed. Results: Plants such as Cissus aralioides, Securidaca longipedunculata, Piliostigma thonningii, Nauclea latifolia, Ocimum gratissimum and Newbouldia laevis are widely reported to be used in the treatment of endemic diseases in Togo and her neighbouring countries. These plants often contain highly potent chemical compounds, such as quinones, xanthones, tannins and terpenes and therefore may provide an alternative avenue to short-term treatment. A combination of further analysis of plant materials and their active ingredients on the one hand, and modern technology to turn such natural products into commercial equivalents on the other, is required in order to identify the targets and modes of action of these natural materials, unlock access to them, and ultimately produce valuable medicines and phytoprotectants based on locally grown plant materials. Conclusion: The production of plant-derived products, as advocated in this paper, is in line with the WHO’s traditional medicine strategy 2014-2023, and will eventually yield a sustainable health-and-wealth generating cycle that will benefit countries in the region, economically and ecologically. Key words: Togo, redox active secondary metabolites, phytochemicals, antimalarial activity, antidiarrheal activity, tropical diseases
    Full-text · Article · Jan 2016 · African Journal of Traditional, Complementary and Alternative Medicines
  • Source
    • "Even in India, which is a producer of around 8% of medicines to global market, around sixty percent of its population is lacking access to essential medicines[4]. One of the major reasons behind the lack of access to essential medicines is the low expenditure of governments on healthcare and the unaffordability of medicines[5]. The World Health Statistics report reveals that the USA spends 12.8% of its gross domestic product on health while the developing countries, especially in South-East-Asian region such as Pakistan spends only 4.7% of its GDP on healthcare[6,7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Access and affordability of medicines and healthcare is becoming a matter of global concern, especially in the developing countries where nearly one third of the population is lacking access to essential medicines. Pakistan has a population of above 185 million and the majority is living in rural and remote areas where is lack of access to even basic healthcare facilities. The major barriers to access and affordability of medicines are the lack of facilities at the primary healthcare level,lack of coordination among healthcare levels, and the lack of effective policies.
    Full-text · Article · Dec 2015
Show more