Median consumer price ratio of 14 selected essential medicines in public and private health facilities
The consumer price ratios for 14 essential medicines calculated as the ratio between median unit prices and the median international reference prices for that same product for the year preceding the survey.
The 14 drugs in the global core list of tracer medicines can be found in (WHO 2010; Table 4.1). Non-governmental and community-based facilities providing medicines can also be included in the calculation.
The median international reference prices for the essential medicines (as price per tablet or therapeutic unit) are available through Management Sciences for Health (MSH, 2011). The MSH international reference prices have been selected for comparison as they are widely available, updated frequently, and relatively stable over time.
This indicator is calculated as:
(Median unit price paid by consumers for a specific medicine during previous year / Median international reference price for same medicine during previous year)
This indicator is selected from the list of core indicators in the WHO Health System Strengthening (HSS) Handbook. For more background on the process and criteria used in developing the WHO Handbook of indicators for HSS and for details on this and related indicators, see WHO (2010); USAID (2009); The Global Fund (2009).
National surveys of medicine price and availability ideally are conducted using a standard methodology developed by WHO and Health Action International (HAI). WHO/HAI (2008) protocols recommend collecting data from medicine outlets in six sample geographic or administrative areas of a country (or for large countries – a state or province). Data are collected on the availability and price of the essential 14 medicines from all public, private and other sector outlets that serve as important medicine dispensing points. The full list of 50 survey medicines includes 14 essential medicines in use worldwide, 16 regionally specific medicines and countries are encouraged to collect data on an additional 20 medicines of national importance.
For each medicine, information is collected on the originator brand, the lowest priced generic equivalent found at each medicine outlet, government procurement prices, and any add-on costs that are charged to medicines as they proceed through the supply and distribution chain. In the absence of routine monitoring, a national survey of medicine prices and availability should be conducted every three to five years using the WHO/HAI standard methodology.
Surveys of health care facilities and other medicine outlets using standardized instruments (e.g., WHO /HAI survey)
This indicator can be used to examine access in terms of affordability of essential medicines at the time of survey and to compare trends over time. Essential medicines satisfy priority health care needs of the population and are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage, with assured quality, and at a price that individuals and the community can afford. Access to medicines is included in the Millennium Development Goals under MDG 8 to develop global partnerships for development, specifically Target 8.E to provide access to affordable essential drugs in developing countries. For the purpose of monitoring the MDGs, access has been defined as “having medicines continuously available and affordable at public or private health facilities or medicine outlets that are within one hour’s walk of the population” (United Nations Development Group, 2003). Recent United Nations reports assessing progress towards MDG target 8.E found that low availability, high prices and poor affordability of medicines are key impediments to access to treatment in low- and middle-income countries (UN, 2009).
This indicator measures affordability of essential medicines, but the overall access to, distribution of, and quality of services with medicines can only be measured using a range of indicators that provide data on medicine procurement, availability, storage, travel time to medicine outlets, and rational use including appropriate prescribing, dosages, and dispensing practices (WHO, 2010).
health system strengthening (HSS), commodity
The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening, http://www.hivpolicy.org/Library/HPP000485.pdf
Management Sciences for Health (MSH), 2011, International Drug Price Indicator Guide, Cambridge, MA: MSH. https://www.msh.org/resources/international-drug-price-indicator-guide
USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID. https://www.researchgate.net/publication/274064201_Measuring_the_Impact_of_Health_Systems_Strengthening_A_Review_of_the_Literature
WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
WHO/Health Action International (HAI), 2008, Medicine Prices, Availability, and Price Components, Amsterdam: HAI. http://www.haiweb.org/medicineprices/manual/documents.html
United Nations, 2009, Strengthening the global partnership for development in a time of crisis. MDG gap task force report 2009. New York; UN. http://www.un.org/millenniumgoals/pdf/MDG_Gap_%20Task_Force_%20Report_2009.pdf