E-DRUG: Lancet paper on medicine prices, availability, and affordability in 36 countries (2)
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Dear E-druggers
Yesterday Kirsten Myhr posted the summary of a paper by Alexandra
Cameron et al entitled 'Medicine prices, availability, and affordability
in 36 developing and middle-income countries: a secondary analysis'. The
analysis is based on findings from 45 surveys implemented across the
globe, using a standardised methodology developed by HAI and WHO to
measure medicine prices, availability, affordability and price
components. The paper was published on-line on Monday 1 December in The
Lancet.
This analysis provides firm evidence of the dismal situation people with
illnesses face every day. It's shocking that many important medicines
are so hard to find in government outlets, and so expensive in the
private sector.
What are people to do when the medicine they need is not available in
the health clinic? How can people be expected to pay days or, in some
cases, weeks of their salary each month to buy treatment for a chronic
disease from the private sector?
This leads people to buy partial treatment courses for communicable
diseases like malaria, interrupt what should be continuous treatment for
chronic diseases like diabetes, spiral into debt, or simply (and most
likely) go without treatment.
There are many policy options to improve medicine affordability and
availability - as discussed in the Lancet article. Across the surveys,
in the private sector originator brands cost 260% more than lowest
priced generic equivalents - increasing to 1000% or more in some
countries. Therefore, implementing policies that increase the use of
low-priced quality generics would help significantly. Policies to ensure
competition, incentives for pharmacies to dispense low-priced generics,
and education programmes for the public as well as health professionals
to correct misconceptions about generics are crucial.
In the public sector, governments could also ease the burden on patients
by procuring medicines more efficiently and, where they charge for
medicines, passing on low procurement prices to patients. In the private
sector, margins need to be regulated.
Whatever the sector or country, the higher the manufacturer's selling
price, the higher the patient price. So to improve treatment
affordability, lower prices from manufacturers are needed
These 45 surveys have been conducted since 2001, often by Ministries of
Health. In response to the findings, a few have acted to bring prices
down and improve transparency. For example, Lebanon introduced
regressive margins and lowered the prices of a large number of medicines
on the market, and Tajikistan removed VAT on medicines. But clearly,
much more needs to be done in all countries.
What stops governments from acting on the evidence? Is it lack of
political will or uncertainty about what policies to implement? I
suspect it can be either of these. To help countries, in 2009 HAI, WHO
and a group of international experts will be developing guidance on
pricing policies - what works in different settings, what does not.
The 2008 World Health Report states that nearly 30,000 children die
every day from diseases that could easily have been treated if they had
had access to essential medicines*. All must act to stop this -
medicines have to affordable and available to all who need them.
To access the Lancet article, press releases from HAI and WHO, the
database of survey results and other documents, go to HAI's website:
http://www.haiweb.org/medicineprices/
* Black RE, Morris SS, Bryce J. Where and why are 10 million children
dying every year? Lancet, 2003, 361:2226-2234.
Regards
Margaret Ewen
Coordinator, WHO/HAI Project on Medicine Prices and Availability
HAI Global
Overtoom 60/III
1054 HK Amsterdam
The Netherlands
Tel: +31 20 489 1846 (direct), +31 20 683 3684 (office)
Fax: +31 20685 5002
Email: marg@haiweb.org
Web site: http://www.haiweb.org