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Hailemariam FH, Shifa M, Kassaw C. Availability, price, and affordability of antiseizure medicines in Addis Ababa, Ethiopia. Epilepsia Open 2023; 8:1123-1132. [PMID: 37469205 PMCID: PMC10472410 DOI: 10.1002/epi4.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE Up to 70% of people living with epilepsy could become seizure-free with the appropriate use of antiseizure medicines. However, three quarters of people with epilepsy living in low-income countries do not get the treatment they need and also do not access antiseizure medicines. The purpose of this study was to assess the availability, price, and affordability of antiseizure medicines in Addis Ababa, Ethiopia. METHODS A cross-sectional study was done in selected pharmacies using a questioner developed after the modification of World Health Organization/Health Action International methodology. Data on the availability and price of lowest-priced generics and originator brand antiseizure medicines from essential medicines list in Ethiopia were collected from seven public sectors, five private sectors, and seven other sectors (five Kenema Public Community and two Red Cross Pharmacies) in Addis Ababa between 09 May and 31 2022. The data were analyzed using the modified World Health Organization/Health Action International workbook part I excel sheet. Descriptive results were reported in text and table format. RESULTS The overall availability of lowest-priced generics medication was 52%. The availability of lowest-priced generics was 62.86%, 30%, 55%, and 50% in public, private, Red Cross, and Kenema Public Community Pharmacies, respectively. The median price ratio in the public, private, Red Cross, and Kenema Public Community Pharmacy was 1.45, 3.72, 1.46, and 1.7, respectively. All the medications were unaffordable. Patients may be required to pay more than 6-month wage to purchase standard treatment for 1 month only. SIGNIFICANCE The overall availability of antiseizure medicines was lower than the WHO target for noncommunicable diseases. All the available medicines were unaffordable.
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Affiliation(s)
- Fikreselam Habte Hailemariam
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
| | - Mekdes Shifa
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
| | - Chalelgn Kassaw
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
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Habte F, Shifa M, Berhanu H. Availability, Price and Affordability of Psychotropic Medicines in Addis Ababa, Ethiopia. Risk Manag Healthc Policy 2023; 16:957-970. [PMID: 37250433 PMCID: PMC10216867 DOI: 10.2147/rmhp.s409929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Background Access to affordable, quality-assured essential medicines is crucial to reduce the burden of disease. However, one third of the world's population lacks regular access to essential medicines. The purpose of this study was to assess the availability, price, and affordability of medicines for mental disorders in Addis Ababa, Ethiopia. Methods A cross-sectional study was done in selected pharmacies after modification of a WHO/HAI methodology developed questionnaire. Data on the availability and price of 28 lowest priced generics and originator brand essential psychotropic medicines were collected from seven public sectors, five private sectors, and seven other sectors (five Kenema Public Community Pharmacies and two Red Cross Pharmacies) in Addis Ababa between May 9 and May 31, 2022. The data were analyzed using the developed WHO/HAI workbook part I Excel sheet. Descriptive results were reported in text and table format. Results The overall availability of lowest-priced generics medication was 41.69%. The availability of lowest-priced generics and originator brand medication was 54.68% and 1.7% in the public pharmacies; 24.14% and 0.0% in private pharmacies; 43% and 0.0% in Red Cross Pharmacies; and 42% and 3.2% in Kenema Public Community Pharmacies. The median price ratio in the public, private, Red Cross, and Kenema Public Community pharmacies was 1.26, 3.72, 1.65, and 1.59, respectively. Most of the medications were unaffordable. A patient could be required to pay up to 73 days wages to purchase a standard treatment for 1 month. Conclusion The availability of psychotropic medicines was lower than the WHO target for non-communicable diseases and most of the available medicines were unaffordable.
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Affiliation(s)
- Fikreselam Habte
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekdes Shifa
- Department of Pharmacy, Universal Medical and Business College, Addis Ababa, Ethiopia
| | - Hana Berhanu
- Department of Pharmacy, Universal Medical and Business College, Addis Ababa, Ethiopia
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Zhang M, Zou K, Liu Z, Liu D, Wang X, Shi Y, Chen Z, Cheng X, Lang B, Li H, Zeng L, Tang Y, Zhao S, Jiang Y, Choonara I, Zhang L. Availability of essential medicines, progress and regional distribution in China: a systematic review and meta-analysis. Front Public Health 2023; 11:1149838. [PMID: 37181691 PMCID: PMC10167309 DOI: 10.3389/fpubh.2023.1149838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Essential medicines are the backbone of healthcare and meet the priority healthcare needs of the population. However, approximately one-third of the global population does not have access to essential medicines. Although China formulated essential medicine policies in 2009, the progress of availability of essential medicines and regional variations remains unknown. Therefore, this study was conducted to evaluate the availability of essential medicines, their progress, and regional distribution in China in the last decade. Methods We searched eight databases from their inception to February 2022, relevant websites, and reference lists of included studies. Two reviewers selected studies, extracted data, and evaluated the risk of bias independently. Meta-analyses were performed to quantify the availability of essential medicines, their progress, and regional distribution. Results Overall 36 cross-sectional studies conducted from 2009 to 2019 were included, with regional data for 14 provinces. The availability of essential medicines in 2015-2019 [28.1%, 95% confidence interval (CI): 26.4-29.9%] was similar to that in 2009-2014 (29.4%, 95% CI: 27.5-31.3%); lower in the Western region (19.8%, 95% CI: 18.1-21.5%) than Eastern (33.8%, 95% CI: 31.6-36.1%) and Central region (34.5%, 95% CI: 30.6-38.5%); very low for 8 Anatomical Therapeutic Chemical (ATC) categories (57.1%), and low for 5 categories (35.7%) among all ATC groups. Conclusion The availability of essential medicines in China is low compared with the World Health Organization goal, has not changed much in the last decade, is unequal across regions, and lacks data for half of provinces. For policy-making, the monitoring system of the availability of essential medicines is to be strengthened to enable long-term surveillance, especially in provinces where the data has been missing. Meanwhile, Joint efforts from all stakeholders are warranted to improve the availability of essential medicines in China toward the universal health coverage target. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=315267, identifier: PROSPERO CRD42022315267.
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Affiliation(s)
- Miao Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zheng Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xiuli Wang
- Healthcare Evaluation and Organizational Analysis (HEOA) Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuqing Shi
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhe Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Xiao Cheng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Bingchen Lang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yong Tang
- School of Economics, Sichuan University, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Yongmu Jiang
- School of Economics, Sichuan University, Chengdu, China
| | - Imti Choonara
- Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Derby, United Kingdom
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration (NMPA) Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Xu R, Wu L, Liu Y, Ye Y, Mu T, Xu C, Yuan H. Evaluation of the impact of the COVID-19 pandemic on health service utilization in China: A study using auto-regressive integrated moving average model. Front Public Health 2023; 11:1114085. [PMID: 37089481 PMCID: PMC10115989 DOI: 10.3389/fpubh.2023.1114085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/22/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundThe outbreak of COVID-19 in early 2020 presented a major challenge to the healthcare system in China. This study aimed to quantitatively evaluate the impact of COVID-19 on health services utilization in China in 2020.MethodsHealth service-related data for this study were extracted from the China Health Statistical Yearbook. The Auto-Regressive Integrated Moving Average model (ARIMA) was used to forecast the data for the year 2020 based on trends observed between 2010 and 2019. The differences between the actual 2020 values reported in the statistical yearbook and the forecast values from the ARIMA model were used to assess the impact of COVID-19 on health services utilization.ResultsIn 2020, the number of admissions and outpatient visits in China declined by 17.74 and 14.37%, respectively, compared to the ARIMA model’s forecast values. Notably, public hospitals experienced the largest decrease in outpatient visits and admissions, of 18.55 and 19.64%, respectively. Among all departments, the pediatrics department had the greatest decrease in outpatient visits (35.15%). Regarding geographical distribution, Beijing and Heilongjiang were the regions most affected by the decline in outpatient visits (29.96%) and admissions (43.20%) respectively.ConclusionThe study’s findings suggest that during the first year of the COVID-19 pandemic, one in seven outpatient services and one in six admissions were affected in China. Therefore, there is an urgent need to establish a green channel for seeking medical treatment without spatial and institutional barriers during epidemic prevention and control periods.
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Affiliation(s)
- Rixiang Xu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lang Wu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yulian Liu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yaping Ye
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Caiming Xu
- School of Law, Hangzhou City University, Hangzhou, China
- *Correspondence: Caiming Xu, Huiling Yuan,
| | - Huiling Yuan
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Caiming Xu, Huiling Yuan,
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Xu R, Li S, Mu T, Xie X, Xu C, Lv X. Substantial Increase in Accessibility to Essential Anticancer Medicines in Anhui, China: A Longitudinal Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231151783. [PMID: 36722617 PMCID: PMC9893346 DOI: 10.1177/00469580231151783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The study aimed to evaluate the change in accessibility of essential anticancer medicines, from 2015 to 2018 in a pilot province for health care reform in China. Data on access to 23 essential anticancer medicines was obtained from 6 provincial tertiary hospitals. A comprehensive analysis was applied to explore these trends. The total utilization of anticancer medicines had increased by an average of 2.57 times (P < .001) during the study period, of which targeted anticancer medicines had the fastest growth rate of 6.45 times (P < .001). The prices of all targeted medicines and original brands (OBs) were showing a downward trend, with the average change rate of -32% and -28% respectively (both P < .001). In contrast, the price of non-targeted medicines and lowest-price generics (LPG) increased by an average of 98% (P < .001) and 117% (P < .004) respectively. All targeted anticancer medicines were found to be unaffordable under this standard of this study, but the affordability of these medicines is on the rise. The study suggested positive changes in the utilization, price, and affordability of the most essential anticancer medicines. In the future, comprehensive strategies need to be conducted to further increase the affordability of targeted anticancer medicines.
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Affiliation(s)
- Rixiang Xu
- School of Huamanities and Management,
Zhejiang Chinese Medical University, Zhejiang Province, China,School of pharmacy, Anhui Medical
University, Anhui Province, China
| | - Shuting Li
- School of pharmacy, Anhui Medical
University, Anhui Province, China
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese
Medical University, Zhejiang Province, China
| | - Xuefeng Xie
- School of pharmacy, Anhui Medical
University, Anhui Province, China
| | - Caiming Xu
- School of Huamanities and Management,
Zhejiang Chinese Medical University, Zhejiang Province, China,School of Law, Zhejiang University City
College, Zhejiang Province, China
| | - Xiongwen Lv
- School of pharmacy, Anhui Medical
University, Anhui Province, China,Xiongwen Lv, School of Pharmacy, Anhui
Medical University, Hefei 230032 China.
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Wang X, He X, Ren Y, Zhang Z, Cai L, Cao Z, Li X. Evaluating the Price, Availability, and Affordability of Essential Medicines in Primary Healthcare Institutions: A Mixed Longitudinal and Cross-Sectional Study in Jiangsu, China. Front Public Health 2022; 10:860471. [PMID: 35493374 PMCID: PMC9039261 DOI: 10.3389/fpubh.2022.860471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to evaluate the price, availability, and affordability of essential medicines in primary healthcare institutions in Jiangsu Province.MethodsA mixed longitudinal and cross-sectional survey was conducted in primary healthcare institutions in Jiangsu based on the adjusted World Health Organization and Health Action International methodology. 45 essential medicines were collected from 30 primary healthcare institutions in Nanjing from 2016 to 2020. We also collected information on these medicines in 70 primary healthcare institutions across seven cities of Jiangsu in 2021. The availability, price, and affordability were compared with matched sets. Differences of availability between years and cities were further compared using Wilcoxon rank-sum test.ResultsIn Nanjing, the variation was significant of availability during the study period. The MPR was generally decreasing between 2016 and 2020, with the median price ratio (MPR) for lowest-priced generics (LPGs) ranging from 1.20 to 2.53 and originator brands (OBs) substantially above international levels. The median availability of generic medicines increased in 2018 and subsequently stabilized at around 55%, and the availability of originator medicines was low. There were no significant regional differences in prices across the sampled cities in Jiangsu, and the median MPR for LPGs was acceptable (1.23), while the median MPR for OBs was 8.54. The mean availability was different across regions (p < 0.001), being higher in Nanjing (54.67%) and Nantong (56.22%), and lower in northern Jiangsu (about 35%). For LPGs, there was little difference in the proportion of medicines with low availability and high affordability (50.00% for urban residents and 40.48% for rural residents). For OBs, there were more than half of rural residents had low availability and low affordability of medicines (58.82%).ConclusionsIn terms of yearly changes, the prices of essential medicines have considerably decreased, and the availability of LPGs has slightly increased. However, the availability of medicines was found to be poor and there were regional differences in the availability and affordability of medicines among metropolitan and rural areas. Policy interventions targeting external factors associated with health resource allocation are essential and possible strategies include effective and efficient government investment mechanisms on primary healthcare.
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Affiliation(s)
- Xiao Wang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xuan He
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yuqin Ren
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Zhuolin Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Lele Cai
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Zhaoliu Cao
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- School of Pharmacy, Nanjing Medical University, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Xin Li
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Nguyen HTT, Dinh DX, Nguyen TD, Nguyen VM. Availability, prices and affordability of essential medicines: A cross-sectional survey in Hanam province, Vietnam. PLoS One 2021; 16:e0260142. [PMID: 34793554 PMCID: PMC8601520 DOI: 10.1371/journal.pone.0260142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To measure medicines' prices, availability, and affordability in Hanam, Vietnam. METHODS The standardized methodology developed by the World Health Organization (WHO) and Health Action International was used to survey 30 essential medicines (EMs) in 30 public health facilities and 35 private medicine outlets in 2020. The availability of medicine was computed as the percentage of health facilities in which this medicine was found on the data-collection day. International reference prices (IRPs) from Management Sciences for Health (2015) were used to compute Median Price Ratio (MPR). The affordability of treatments for common diseases was computed as the number of days' wages of the lowest-paid unskilled government worker needed to purchase medicines prescribed at a standard dose. Statistic analysis was done using R software version 4.1.1. RESULTS The mean availability of originator brands (OBs) and lowest-priced generics (LPGs) was 0.7%, 63.2% in the public sector, and 13.7%, 47.9% in the private sector, respectively. In private medicine outlets, the mean availability of both OBs and LPGs in urban areas was significantly higher than that in rural areas (p = 0.0013 and 0.0306, respectively). In the public sector, LPGs' prices were nearly equal to their IRPs (median MPRs = 0.95). In the private medicine outlets, OBs were generally sold at 6.24 times their IRPs while this figure for LPGs was 1.65. The affordability of LPGs in both sectors was good for all conditions, with standard treatments costing a day's wage or less. CONCLUSION In both sectors, generic medicines were the predominant product type available. The availability of EMs was fairly high but still lower than WHO's benchmark. A national-scale study should be conducted to provide a comprehensive picture of the availability, prices, and affordability of EMs, thereby helping the government to identify the urgent priorities and improving access to EMs in Vietnam.
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Affiliation(s)
- Huong Thi Thanh Nguyen
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi city, Vietnam
| | - Dai Xuan Dinh
- Department of Pharmaceutical Management and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi city, Vietnam
- * E-mail:
| | - Trung Duc Nguyen
- Pharmacy Department, 108 Military Center Hospital, Hanoi city, Vietnam
| | - Van Minh Nguyen
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi city, Vietnam
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Sisay M, Amare F, Hagos B, Edessa D. Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology. J Pharm Policy Pract 2021; 14:57. [PMID: 34225781 PMCID: PMC8256563 DOI: 10.1186/s40545-021-00339-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 02/04/2023] Open
Abstract
Background Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia. Methods A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen. Results The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings (p < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined. Conclusion Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.
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Affiliation(s)
- Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Bisrat Hagos
- Department of Social Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Tao W, Zeng Z, Dang H, Li P, Chuong L, Yue D, Wen J, Zhao R, Li W, Kominski G. Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China. BMJ Glob Health 2020; 5:e002087. [PMID: 32257401 PMCID: PMC7103842 DOI: 10.1136/bmjgh-2019-002087] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 02/05/2023] Open
Abstract
Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and 'Healthy China 2030', the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.
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Affiliation(s)
- Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Haixia Dang
- Research Center of Tradtional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peiyi Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Linh Chuong
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Dahai Yue
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zhao
- Department of drug policy and evaluation research, China National Health Development Research Center, Beijing, China
| | - Weimin Li
- President's Office, West China Hospital, Sichuan University, Chengdu, China
| | - Gerald Kominski
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
- UCLA Center for Health Policy Research, Los Angeles, California, USA
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