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Babar ZUD, Dulal S, Dhakal NP, Upadhyaya MK, Trap B. Developing Nepal's medicines pricing policy: evidence synthesis and stakeholders' consultation. J Pharm Policy Pract 2024; 17:2346222. [PMID: 38690551 PMCID: PMC11060005 DOI: 10.1080/20523211.2024.2346222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Objectives The objectives of this paper are to (a) explore stakeholders' opinions regarding Nepal's existing medicines pricing practices/situation and (b) build and present a set of medicines pricing policies for Nepal. Methods A review of the literature and field visits to community retail pharmacies, hospital pharmacies, wholesalers, and distributor outlets in Kathmandu were conducted to assess the medicines pricing situation. Following the literature review, preliminary meetings with stakeholders and field visits were held and a draft interview guide was prepared. Consultative sessions subsequently were undertaken in Kathmandu, Nepal, in January 2023 with representatives from the Department of Drug Administration, Ministry of Health and Population, Association of Pharmaceutical Producers of Nepal, consumer groups, Transparency International, Medicines Importers Association of Nepal/ Pharmaceutical Distributors Association of Nepal, Nepal Chemist and Druggist Association, and Nepal Pharmaceutical Association. Notes were taken during these meetings regarding issues and concerns raised as well as experiences and recommendations for the future, as outlined in the interview guide. Results The stakeholders in general stated that they do not have any objection to price regulation; however, they believe such regulation should be subject to periodic review. Both the importers and the Ministry of Health and Population have the view that an independent body/authority should be charged with regulating the prices of medicines. A set of policy options to be considered for use in Nepal include cost-plus pricing, external price referencing, internal reference pricing, and mark-up regulations. Conclusion Key issues related to pricing were identified and suggest that a set of pricing policies and updated regulations need to be considered to establish changes that are transparent, rational, and acceptable to the related stakeholders. Hence, suggestions made in this paper could be useful to inform a rational and fair pricing structure and to improve access to medicines.
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Affiliation(s)
| | - Santosh Dulal
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kathmandu, Nepal
| | - Narayan Prasad Dhakal
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Upadhyaya
- Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Birna Trap
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kathmandu, Nepal
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Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM, Conneh-Duworko MJ, Tehoungue BZ, Chanza H, Phiri H, Bhattarai B, Dhakal NP, Ojo OA, Afolabi K, Kabuteni TJ, Hailu BG, Moses F, Dlamini-Nqeketo S, Zulu T, Rehnström Loi U. Correction: Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities. Reprod Health 2023; 20:160. [PMID: 37884974 PMCID: PMC10604516 DOI: 10.1186/s12978-023-01691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Amy Grossman
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Ndola Prata
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
- Bixby Center for Population, Health & Sustainability, School of Public Health, University of California, Berkeley, CA, USA
| | - Natalie Williams
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Antonella Lavelanet
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Laurence Läser
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Chilanga Asmani
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Hayfa Elamin
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Leopold Ouedraogo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | | | - Harriet Chanza
- World Health Organization, Malawi Country Office, Lilongwe, Republic of Malawi
| | - Henry Phiri
- Ministry of Health, Lilongwe, Republic of Malawi
| | - Bharat Bhattarai
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Kayode Afolabi
- Reproductive Health, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | | | | | - Francis Moses
- Reproductive Health/Family Planning Programme Manager, Ministry of Health, Freetown, Sierra Leone
| | | | - Thembi Zulu
- National Department of Health, Pretoria, Republic of South Africa
| | - Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
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Grossman A, Prata N, Williams N, Ganatra B, Lavelanet A, Läser L, Asmani C, Elamin H, Ouedraogo L, Rahman MM, Conneh-Duworko MJ, Tehoungue BZ, Chanza H, Phiri H, Bhattarai B, Dhakal NP, Ojo OA, Afolabi K, Kabuteni TJ, Hailu BG, Moses F, Dlamini-Nqeketo S, Zulu T, Rehnström Loi U. Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities. Reprod Health 2023; 20:58. [PMID: 37041543 PMCID: PMC10091522 DOI: 10.1186/s12978-023-01574-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. METHODS Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. RESULTS Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. CONCLUSION Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.
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Affiliation(s)
- Amy Grossman
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Ndola Prata
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
- Bixby Center for Population, Health & Sustainability, School of Public Health, University of California, Berkeley, CA, USA
| | - Natalie Williams
- Venture Strategies for Health & Development/OASIS, Berkeley, CA, USA
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Antonella Lavelanet
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Laurence Läser
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Chilanga Asmani
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Hayfa Elamin
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Leopold Ouedraogo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | | | | - Harriet Chanza
- World Health Organization, Malawi Country Office, Lilongwe, Republic of Malawi
| | - Henry Phiri
- Ministry of Health, Lilongwe, Republic of Malawi
| | - Bharat Bhattarai
- Department of Drug Administration, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Kayode Afolabi
- Reproductive Health, Federal Ministry of Health, Abuja, Federal Republic of Nigeria
| | | | | | - Francis Moses
- Reproductive Health/Family Planning Programme Manager, Ministry of Health, Freetown, Sierra Leone
| | | | - Thembi Zulu
- National Department of Health, Pretoria, Republic of South Africa
| | - Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
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