MONITORING MEDICINE AVAILABILITY AND PRICES
IN UGANDA
By Denis Kibira
HEPS Uganda
Background
The Ministry of Health, in collaboration with the World Health Organization (WHO) and Health Action International Africa (HAI-Africa) represented by the Coalition for Health Promotion and Social Development (HEPS-Uganda), has since 2006 conducted medicines prices and availability monitoring in 3 sectors (public, mission, private) and four regions of the country.
Objective To monitor the ongoing interventions by the
Ministry of Health within the Health Sector Strategic Plan to increase access to essential medicines to all Ugandans.
The purpose of this activity is:• To understand to what extent medicine prices
contribute to problems of access to medicines in a country
• To Inform policymakers when selecting policy options to improve accessibility of medicines
• To monitor the progress of pharmaceutical policy implementation
• To evaluate the impact of policy or regulatory interventions
Specific objectives:• To Show trends in the availability of essential
medicines• To find out the prices (to consumers) of these
medicines• To assess the affordability of these medicines
METHODOLOGY
• The surveys are conducted using the standardized WHO/HAI Medicine Prices Monitoring Tool[1].
• Forty key (regularly prescribed and dispensed) medicines were selected for price and availability survey.
• The medicines, priced lowest to consumers are considered.
• The survey is carried out in the public, private and mission[2] facilities.
• In the public facilities sections that provide medicines free of charge to patients are chosen and in mission facilities the survey is only carried out in facilities where medicine prices can be disaggregated (i.e. where there are set prices for medicines).
• The data is collected from approx. 100 randomly sampled facilities
• [1] www.haiweb.org/medicineprices• [2] According to this survey, Private sector refers to Private for
Profit and Mission sector refers to Private Not for Profit
FINDINGS
33
57 5652
5963
50
58
74 7478
70
79
67
29
7872
67
7771
75
0
10
20
30
40
50
60
70
80
90
Oct-Dec 06 Apr-Jun 07 Jul-Sep 07 Oct-Dec 07 Jul-Sep 08 Oct-Dec 08 Jul-Sep 09
Period
Perc
enta
ge A
vaila
bilit
y
PUBLIC PRIVATE MISSION
Trends in availability of 40 key medicines across sectors 2006-2009
Since 2006 medicine availability across all sectors has been unpredictable with many fluctuations observed. The public sector has consistently lagged behind
Availability
FINDINGS
54
64
73
60 58 60 57
14
5956
4350
64
44
0
10
20
30
40
50
60
70
80
Oct-Dec 06 Apr-Jun 07 Jul-Sep 07 Oct-Dec 07 Jul-Sep 08 Oct-Dec 08 Jul-Sep 09
Period
Perc
enta
ge A
vaila
bilit
y
Urban Rural
Availability of 40 key medicines across Urban and Rural facilities in Public sector 2006-2009
Availability was consistently higher in urban compared to rural facilities
FINDINGS
81 85 81
9686
75
93
8174
81
64
83 83 87
100 96
8188 86
6370
0
20
40
60
80
100
120
Oct-Dec 06 Apr-Jun 07 Jul-Sep 07 Oct-Dec 07 Jul-Sep 08 Oct-Dec 08 Jul-Sep 09
Period
Per
cent
age
Ava
ilabi
lity
Artemether/Lumefantrine Quinnine Inj Pyrimethamine/Sulphadoxine
Trend in availability of key antimalarial medicines 2006-2009 in public sector
Availability of Artemether /Lumefantrine, the first line Antimalarial remained high in the public sector. Availability of the second line treatment for malaria of Quinine injection has risen by 23% since October- December 2007. However, Pyrimethamine/ Sulphadoxine used for prophylaxis has reduced by 30% since 2006.
FINDINGS
44
3741 40
28
4650
3026
33
4852
4641
22
3733
36
24 25
38
2226 24
21 21 19
33
22 24 2421
31
0
10
20
30
40
50
60
Oct-Dec 06 Apr-Jun 07 Jul-Sep 07 Oct-Dec 07 Jul-Sep 08 Oct-Dec 08 Jul-Sep 09
Period
Perc
enta
ge A
vaila
bilit
y
Nifedipine Glibenclamide Metformin Cimetidine Omeprazole
Availability of medicines for ulcer disease, diabetes and hypertension (with highly growing morbidity) has been poorly handled in public facilities
Trend in availability of 5 key medicines for chronic diseases 2006-2009 in public sector
FINDINGS
3022 20 24
13
2526 26 26 2428 29 31
85 8980
86
96
75
157 8
14 17 16
0
20
40
60
80
100
120
Oct-Dec 06 Apr-Jun 07 Jul-Sep 07 Oct-Dec 07 Jul-Sep 08 Oct-Dec 08 Jul-Sep 09
Period
Per
cent
age
Amoxycillin susp Cotrimoxazole susp ORS Metronidazole susp
Although availability of Oral Rehydration Salts used in management of diarrhoea has continued to be high, other Paediatric formulations continued to be stocked in less than 30 percent of public facilities. This shows that pneumonia and respiratory tract diseases common in children are not adequately catered for.
Trend in availability of 4 key paediatric medicines 2006-2009 in public sector
MEDICINE PRICES
PrivUrban/PrivRural
MisUrban/MisRural
PrivUrban/MisUrban
PrivRural/MisRural
No. of times more expensive 1.00 1.14 1.06 1.11
No. of Pairs Compared 24 31 29 26
Comparison of medicine median price ratios between and within private and mission sectors
•Prices charged to consumers for medicines in Private facilities were comparable across urban and rural facilities (ratio 1:1). In the Mission sector medicines in the urban facilities were 14% more expensive for consumers than in the rural facilities. •A comparison between the Private sector and the Mission sector showed that medicines were 6% more costly in private urban facilities and 11% more costly in private rural facilities.
FINDINGS
816.5
625 625 645.8
458.3
270.8333.3
500 500550
600650
700 700
300200
300 300200 200
330
0100200300400500600700800900
Oct-Dec 06 Apr-Jun 07 Jul-Sep 07 Oct-Dec 07 Jul-Sep 08 Oct-Dec 08 Jul-Sep 09
Period
Am
ount
per
uni
t (U
GX
)
Artemether/Lumefantrine Quinnine Inj Pyrimethamine/Sulphadoxine
Price trends of key antimalarials- Private Sector
The consumer price of Artemether/Lumefantrine (first line antimalarial) has dropped from UGX 816.5 per tablet in Oct-Dec 2006 to UGX 333.3 per tablet in July-September 2009.. Price of an ampoule of 600mg of Quinine injection (the second line antimalarial) increased from UGX 500 to UGX 700 per ampoule over the period.
AFFORDABILITY
0.7 0.7
1.5
11
0.5
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Private Mission
Sector
No
.of
day
s' w
ages
Amoxicillin susp Nifedipine 20mg Glibenclamide 5mg
Affordability relates to the number of days the lowest paid government worker would have to work to pay for one treatment course of an acute condition or one month’s treatment of a chronic condition
Affordability of treatment for diabetes, hypertension and pediatric acute RTI: Private Vs Mission
The daily wage of the lowest paid government worker is at UShs 3,000 (1.714 US$) as per the 2006/07 Government of Uganda salary structure It would require close to 3.2 days wages for treatment in the private and 2.2 days’ wages in mission sector.
CONCLUSION
• Studies conducted indicate that availability and prices of medicines in Uganda are still a major hindrance to access to essential medicines
• The situation is particularly confounded for the 85% of Ugandans living in rural areas
RECOMMENDATIONS
In order to make “free care” policies in the public effective, MoH should:
• Increase funding mechanisms for medicines e.g. thru NHIS
• Improve Procurement and Supply Management (PSM) capacities
• Increase transparency and accountability in PSM
• Explore the complementarities envisaged in the Public-Private Partnerships for Health Policy
• Implement pricing mechanisms for medicines in the private sector to increase affordability