Availability, prices and affordability of UN Commission’s lifesaving medicines for reproductive and maternal health in Uganda

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Abstract

Background

Uganda was one of seven countries in which the United Nations Commission on Life Saving Commodities (UNCoLSC) initiative was implemented starting from 2013. A nationwide survey was conducted in 2015 to determine availability, prices and affordability of essential UNCoLSC maternal and reproductive health (MRH) commodities.

Methods

The survey at health facilities in Uganda was conducted using an adapted version of the standardized methodology co-developed by World Health Organisation (WHO) and Health Action International (HAI). In this study, six maternal and reproductive health commodities, that were part of the UNCoLSC initiative, were studied in the public, private and mission health sectors. Median price ratios were calculated with Management Sciences for Health International Drug Price Indicator prices as reference. Maternal and reproductive health commodity stocks were reviewed from stock cards for their availability for a period of 6 months preceding the survey. Affordability was measured using wages of the lowest paid government worker.

Results

Overall none of the six maternal and reproductive commodities was found in the surveyed health facilities. Public sector had the highest availability (52%), followed by mission sector (36%) and then private sector had the least (30%). Stock outs ranged from 7 to 21 days in public sector; 2 to 23 days in private sector and 3 to 27 days in mission sector. During the survey, maternal health commodities were more available and had less number of stock out days than reproductive health commodities. Median price ratios (MPR) indicated that medicines and commodities were more expensive in Uganda compared to international reference prices. Furthermore, MRH medicines and commodities were more expensive and less affordable in private sector compared to mission sector.

Conclusion

Access to MRH commodities is inadequate in Uganda. Maternal health commodities were more available, cheaper and thus more affordable than reproductive health commodities in the current study. Efforts should be undertaken by the Ministry of Health and stakeholders to improve availability, prices and affordability of MRH commodities in Uganda to ensure that sustainable Development Goals are met.

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Exploring inequalities in access to and use of maternal health services in South Africa

Sheetal Silal, Loveday Penn-Kekana, Bronwyn Harris … (2012)

Background South Africa’s maternal mortality rate (625 deaths/100,000 live births) is high for a middle-income country, although over 90% of pregnant women utilize maternal health services. Alongside HIV/AIDS, barriers to Comprehensive Emergency Obstetric Care currently impede the country’s Millenium Development Goals (MDGs) of reducing child mortality and improving maternal health. While health system barriers to obstetric care have been well documented, “patient-oriented” barriers have been neglected. This article explores affordability, availability and acceptability barriers to obstetric care in South Africa from the perspectives of women who had recently used, or attempted to use, these services. Methods A mixed-method study design combined 1,231 quantitative exit interviews with sixteen qualitative in-depth interviews with women (over 18) in two urban and two rural health sub-districts in South Africa. Between June 2008 and September 2009, information was collected on use of, and access to, obstetric services, and socioeconomic and demographic details. Regression analysis was used to test associations between descriptors of the affordability, availability and acceptability of services, and demographic and socioeconomic predictor variables. Qualitative interviews were coded deductively and inductively using ATLAS ti.6. Quantitative and qualitative data were integrated into an analysis of access to obstetric services and related barriers. Results Access to obstetric services was impeded by affordability, availability and acceptability barriers. These were unequally distributed, with differences between socioeconomic groups and geographic areas being most important. Rural women faced the greatest barriers, including longest travel times, highest costs associated with delivery, and lowest levels of service acceptability, relative to urban residents. Negative provider-patient interactions, including staff inattentiveness, turning away women in early-labour, shouting at patients, and insensitivity towards those who had experienced stillbirths, also inhibited access and compromised quality of care. Conclusions To move towards achieving its MDGs, South Africa cannot just focus on increasing levels of obstetric coverage, but must systematically address the access constraints facing women during pregnancy and delivery. More needs to be done to respond to these “patient-oriented” barriers by improving how and where services are provided, particularly in rural areas and for poor women, as well as altering the attitudes and actions of health care providers.

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Switching from originator brand medicines to generic equivalents in selected developing countries: how much could be saved?

Alexandra Cameron, Aukje Mantel-Teeuwisse, Hubert Leufkens … (2012)

In low- and middle-income countries, patients and reimbursement agencies that purchase medicines in the private sector pay more for originator brands when generic equivalents exist. We estimated the savings that could be obtained from a hypothetical switch in medicine consumption from originator brands to lowest-priced generic equivalents for a selection of medicines in 17 countries. In this cost minimization analysis, the prices of originator brands and their lowest-priced generic equivalents were obtained from facility-based surveys conducted by using a standard methodology. Fourteen medicines most commonly included in the surveys, plus three statins, were included in the analysis. For each medicine, the volume of private sector consumption of the originator brand product was obtained from IMS Health, Inc. Volumes were applied to the median unit prices for both originator brands and their lowest-priced generics to estimate cost savings. Prices were adjusted to 2008 by using consumer price index data and were adjusted for purchasing power parity. For the medicines studied, an average of 9% to 89% could be saved by an individual country from a switch in private sector purchases from originator brands to lowest-priced generics. In public hospitals in China, US $ 370 million could be saved from switching only four medicines, saving an average of 65%. Across individual medicines, average potential savings ranged from 11% for beclometasone inhaler to 73% for ceftriaxone injection. Substantial savings could be achieved by switching private sector purchases from originator brand medicines to lowest-priced generic equivalents. Strategies to promote generic uptake, such as generic substitution by pharmacists and increasing confidence in generics by professionals and the public, should be included in national medicines policies. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries.

Alexandra Cameron, Amit Bansal, Tarun K Dua … (2012)

In low- and middle-income countries (LMICs), a large proportion of people with epilepsy do not receive treatment. An analysis of the availability, price, and affordability of antiepileptic drugs (AEDs) was conducted to evaluate whether these factors contribute to the treatment gap.

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Author and article information

Contributors

Denis Kibira: dkibira@gmail.com , dkibira@heps.or.ug

Freddy Eric Kitutu: freddy.kitutu@kbh.uu.se

Gemma Buckland Merrett: gemma@haiweb.org

Aukje K. Mantel-Teeuwisse: a.k.mantel@uu.nl

Journal

Journal ID (nlm-ta): J Pharm Policy Pract

Journal ID (iso-abbrev): J Pharm Policy Pract

Title: Journal of Pharmaceutical Policy and Practice

Publisher: BioMed Central (London )

ISSN (Electronic): 2052-3211

Publication date (Electronic): 15 November 2017

Publication date PMC-release: 15 November 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 35

Affiliations

[1 ]ISNI 0000000120346234, GRID grid.5477.1, WHO Collaborating Centre for Pharmaceutical Policy and Regulation, , Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, ; Universiteitsweg 99, 3584 CG Utrecht, the Netherlands

[2 ]Coalition for Health Promotion and Social Development (HEPS-Uganda), Plot 351A, Balintuma Road, Namirembe Hill, Kampala, Uganda

[3 ]Makerere University, School of Public Health and Pharmacy Department, College of Health Sciences, PO Box 7072, Kampala, Uganda

[4 ]Uppsala University, Department of Women’s and Children’s Health, International Maternal and Child Health, SE-751 85 Uppsala, Sweden

[5 ]Health Action International, Overtoom 60 (2), 1054 HK Amsterdam, The Netherlands

[6 ]ISNI 0000000120346234, GRID grid.5477.1, WHO Collaborating Centre for Pharmaceutical Policy and Regulation, , Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, ; Universiteitsweg 99, 3584 CG Utrecht, the Netherlands

Article

Publisher ID: 123

DOI: 10.1186/s40545-017-0123-9

PMC ID: 5686951

PubMed ID: 27446591

SO-VID: d046cf7e-0075-498b-8412-ca082bfcfeb3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 July 2017

Date accepted : 12 October 2017

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Availability, prices and affordability of UN Commission’s lifesaving medicines for reproductive and maternal health in Uganda

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Abstract

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Methods

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UN Sustainable Development Goals

Most cited references 24

Exploring inequalities in access to and use of maternal health services in South Africa

Switching from originator brand medicines to generic equivalents in selected developing countries: how much could be saved?

Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries.

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