2nd Edition
"Equitable access to essential medicines is the goal - it is the people's right."
Published by the World Health Organization (WHO) and Health Action International (HAI), this 310-page manual offers a standardised methodology for measuring medicine prices, availability, affordability, and price, thereby facilitating national and international comparisons. It is a refinement of the first edition, published in 2003, in that it now integrates the experience gained through the more than 50 surveys that have since been conducted worldwide. The results have exposed many problems of poor access to medicines; for example: people having to work 15 days or more to afford one month's treatment for a chronic disease; important medicines not being available locally to patients; governments not passing on low procurement prices to their citizens; excessive mark-ups in the private sector; and taxes and duties being applied to essential medicines. "From the evidence that has resulted from use of the WHO/HAI survey tool, medicine affordability and availability issues show no boundaries. Crucially, it is the poor who are really paying the price - both economically and with their health."
In short, the method works as follows: Data are collected on the availability and price of medicines from a sample of medicine outlets in the public, private, and other sectors (e.g. non-governmental organisations, or NGOs) in 6 regions of a country. Data on medicine prices, but not availability, are also collected for government procurement. Fifty medicines are surveyed, including core medicines that allow for global and regional comparisons, and supplementary medicines of local importance. For each medicine, data are collected on the originator brand and the lowest-priced generic equivalent found at each medicine outlet. A second part of the methodology is the price components survey, where the add-on costs that contribute to the final price of medicines are measured by tracking selected medicines through the distribution chain.
In order to unpack and detail this survey method, the manual explores pre-survey planning and preparatory components such as training area supervisors, data collectors, and data entry personnel. Data collection, data entry, and data analysis are outlined in detail. Chapter 9 covers the measurement of price components; Chapter 10 explores international comparisons. The publishers encourage countries and organisations not only to undertake surveys, but also to implement systems for the regular onitoring of medicine prices, availability, and affordability.
As gathering evidence is only a first step in improving access to affordable treatment, the new edition provides more guidance on policy options and lines of action. This discussion begins on page 183 of the resource, and is followed by an examination of the reporting process. In order to solidify the commitment of governments, civil society, international organisations, health professionals, industry, and many others, advocacy and influencing processes are encouraged; guidance is provided in Chapter 13. For instance, the reader may learn how to develop a strategy by: analysing the problem and defining objectives, identifying and understanding those actors to be influenced, building a strong case, identifying allies and like-minded experts, identifying and understanding potential opponents, developing a long-term plan, and taking advantage of strategic opportunities. Communication elements emphasised here include: getting messages out through the media, networking with civil society organisations, and producing materials such as a policy briefing paper and journal articles.
Chapter 14 outlines the rationale behind monitoring medicine prices and availability, and explains how this activity can effectively be undertaken in resource-poor countries.
According to WHO/HAI, their joint Project on Medicine Prices and Availability (which informed the methodology provided in the manual) and the survey teams across the globe have generated an extensive network of advocates, policy-makers, academics, and others who are now focusing world attention on improving medicine affordability and availability. Next steps for WHO/HAI and this network, as outlined in Chapter 15, include:
- undertaking research to inform policy interventions related to medicine pricing, availability, and affordability;
- evaluating policy interventions and expanding the evidence base on effective policies for lowering medicine prices, increasing availability, and improving affordability; and
- implementing and evaluating advocacy strategies aimed at stimulating national, regional, and global action to increase the availability of affordable medicines.
Annexes include: an abridged questionnaire on structures and processes of country pharmaceutical situations; an example of a letter of endorsement; a trainer's guide; an example of a letter of introduction from the survey manager; a checklist for manual check of survey data; a price components interview guide; a price components data collection form; and tools for international comparison of mandatory price reporting (MPR). Along with an updated version of the automated data workbook, a CD-ROM of survey tools, resources, and background materials is included in an effort to ensure that the manual and accompanying software are as user-friendly as possible.
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