The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study

Khuluza, Felix; Haefele-Abah, Christine

doi:10.1371/journal.pone.0212125

Cited by 57 publications

(68 citation statements)

References 21 publications

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“…The private sector showed generally higher prices compared to the public sector, and OBs cost more than the LPGs. Similar findings were also seen in studies conducted in other developing countries [32][33][34]. Ball and Tisocki investigated high drug prices in the Philippines by examining the medicine price components [35].…”

Section: Discussionsupporting

confidence: 74%

“…Low availability in the public sector means that patients have to purchase in the private sector, resorting to out-of-pocket spending. Medicines from the private sector are less affordable because of high prices and profit marginalization [32]. In this regard, policies monitoring the availability of essential medicines in the public sector should be considered and implemented.…”

Section: Discussionmentioning

confidence: 99%

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Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines

Lambojon

Chang

Saeed

et al. 2020

IJERPH

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Background: Developing countries, such as the Philippines, started implementing policies to improve access to medicines, which is a vital step toward universal healthcare coverage. This study aimed to evaluate the prices, availability and affordability of prescribed medicines for diabetes, hypercholesterolemia and hypertension with the exemption of 12% value-added tax in the Philippines. Methods: The prices and availability of 50 medicines were collected in August 2019 from 36 public and 42 private medicine outlets in six regions of the Philippines, following a modified methodology developed by the World Health Organization and Health Action International. Availability is reported as the percentage of outlets in which the surveyed medicine was found at the time of visit. Medicine prices are expressed as median unit prices (MUPs) in Philippine Peso. Affordability is calculated based on the number of days’ wages required for the lowest-paid unskilled government worker to purchase a monthly treatment. Results: The mean availability of surveyed medicines was low in both public and private sectors, with 1.3% for originator brands (OBs) and 25.0% for lowest-priced generics (LPGs) in public outlets, and 34.7% and 35.4% in private outlets, respectively. The MUP of medicines were higher in private outlets, and OBs have higher unit price compared to the generic equivalents. Treatments with OBs were unaffordable, except for gliclazide, but the affordability of most LPGs is generally good. Conclusion: Access to medicines in both sectors was affected by low availability. High prices of OBs influenced the affordability of medicines even with tax exemption. A review of policies and regulations should be initiated for a better access to medicines in the Philippines.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines

Lambojon

Chang

Saeed

et al. 2020

IJERPH

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“…A paper including data on the availability of oxytocin and misoprostol in Malawi has recently been published [24]. However, so far there are no data in the scientific literature about the quality of oxytocin and misoprostol in Malawi, and neither on the storage conditions of these medicines, or on health workers' knowledge of storage requirements and of rational use of oxytocics.…”

Section: Introductionmentioning

confidence: 99%

Quality, availability and storage conditions of oxytocin and misoprostol in Malawi

Hagen

Khuluza

Heide

2020

BMC Pregnancy Childbirth

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Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-and middle-income countries (LMICs). Oxytocin and misoprostol are used for the prevention and treatment of PPH. However, both medicines are chemically unstable and sensitive to environmental conditions. Previous studies reported a high prevalence of substandard oxytocin and misoprostol preparations in LMICs. Methods: In randomly selected health facilities of four districts of Malawi, the availability of oxytocin and misoprostol was determined, and the knowledge of health workers on storage requirements and use of oxytocics was assessed. Temperature loggers were used to record the storage temperature of oxytocics. Samples of oxytocin injections and misoprostol tablets were collected from the health facilities and from wholesalers. Oxytocin samples were analysed for identity, assay (= quantity of oxytocin) and for pH value according to United States Pharmacopeia 40. Misoprostol samples were analysed for identity, assay, dissolution and related substances according to the International Pharmacopeia 2017. Results: All visited hospitals and health centers had oxytocin available. At non-refrigerated storage sites, the recorded mean kinetic temperature exceeded the oxytocic's storage temperature stated on the labels in 42% of the sites. At refrigerated storage sites, the required temperature of 2-8°C was exceeded in 33% of the sites. Out of 65 oxytocin samples, 7 (11%) showed moderate deviations from specification, containing 82.2-86.8% of the declared amount of oxytocin. Out of 30 misoprostol samples, 5 (17%) showed extreme deviations, containing only 12.7-30.2% of the declared amount. The extremely substandard misoprostol was reported to the national authorities and to WHO, leading to an immediate recall of the respective brand in Malawi. The UK-based distributor of this brand closed its business shortly thereafter. Conclusion: Availability of oxytocin was excellent in Malawi, and its quality was better than reported in previous studies in other LMICs. However, storage conditions at the health facilities often did not meet the requirements. Extremely substandard misoprostol tablets were found, representing a serious risk to maternal health. This shows the need for continued efforts for quality assurance in medicine procurement and registration, as well as for postmarketing surveillance.

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“…Nevertheless, the implementation of the EM policy is rarely ideal in practice. In recent reports, poor affordability and availability of EMs was found in many developing countries such as Malaysia, Mongolia, Philippines, Vietnam, Malawi, and Pakistan …”

Section: Introductionmentioning

confidence: 99%

“…In recent reports, poor affordability and availability of EMs was found in many developing countries such as Malaysia, Mongolia, Philippines, Vietnam, Malawi, and Pakistan. [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Prices, availability, and affordability of national essential medicines in public primary hospitals: A cross‐sectional survey in poverty‐stricken rural areas in China

et al. 2019

Health Planning & Management

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Summary Introduction This study aimed to determine the prices, availability, and affordability of national essential medicines in public primary hospitals in poverty‐stricken areas of Anhui province, China. Methods A cross‐sectional study was conducted in 143 public primary hospitals in Anhui province, eastern China. Data on access to 44 essential medicines was evaluated using the standardized methodology available in the World Health Organization and Health Action International manual. Results Median price rates show that 46.51% (21 of 44) of the lowest price generics and 100% of the originator brands were more expensive than the international reference price. The median availability of the 44 medicines was 31.47%, and 65.91% (29 of 44) of the medicines had less than 50% availability. The majority of the medicines were affordable as they would cost less than a day's income in sample areas. Suppliers could respond to 88.27% of the procuring orders raised by the 143 hospitals in the study, but this ranged from 43.96% to 99.86%. Conclusions There is poor availability and non‐ideal response rate of medicine delivery in public primary hospitals in poverty‐stricken areas in eastern China. Further implementation of national essential medicine policy needs to focus on improving both availability and distribution efficiency in these areas.

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The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study

Cited by 57 publications

References 21 publications

Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines

Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines

Quality, availability and storage conditions of oxytocin and misoprostol in Malawi

Prices, availability, and affordability of national essential medicines in public primary hospitals: A cross‐sectional survey in poverty‐stricken rural areas in China

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