Academic journal article Bulletin of the World Health Organization

Differences in the Availability of Medicines for Chronic and Acute Conditions in the Public and Private Sectors of Developing countries/Differences De Disponibilite Des Medicaments Indiques Dans Les Pathologies Chroniques et Aigues Dans Les Secteurs Public et Prive Des Pays En Voie De developpement/Diferencias En la Disponibilidad De Los Medicamentos Para Enfermedades Cronicas Y Agudas

Academic journal article Bulletin of the World Health Organization

Differences in the Availability of Medicines for Chronic and Acute Conditions in the Public and Private Sectors of Developing countries/Differences De Disponibilite Des Medicaments Indiques Dans Les Pathologies Chroniques et Aigues Dans Les Secteurs Public et Prive Des Pays En Voie De developpement/Diferencias En la Disponibilidad De Los Medicamentos Para Enfermedades Cronicas Y Agudas

Article excerpt

Introduction

Chronic, noncommunicable diseases such as cardiovascular diseases, diabetes and asthma impose a large and growing health burden on developing countries) Chronic diseases are responsible for at least 50% of the deaths that occur in all World Health Organization (WHO) regions except Africa, where they still account for 25% of all deaths. While the proportion of deaths from chronic diseases is largest in high-income countries, in low- and middle-income countries chronic diseases continue to cause 59% and 72% of all deaths, respectively.2 Cardiovascular diseases alone account for 30% of all deaths in the world,2 80% of which occur in low- and middle-income countries. (1) It has been estimated that an additional reduction of 2% annually in deaths from chronic conditions would avert 28 million deaths in low- and middle-income countries between 2005 and 2015? Chronic conditions also cause substantial morbidity in terms of disability-adjusted life years (DALYs), a measure of the potential life lost due to premature mortality and of the productive life lost due to disability. Chronic conditions account for one third of DALYs in low-income countries and for nearly two thirds in middle-income countries.2 In Africa, where chronic disease morbidity is lowest, these conditions still account for 21% of DALYs.

Developing countries undergoing an epidemiological transition from infectious and parasitic diseases to chronic diseases require health systems modifications to address the long-term nature of chronic conditions, in addition to prevention efforts. The WHO Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases recommends addressing management in the context of overall health system strengthening2 Continuous access to essential medicines, with an emphasis on rational selection, affordable prices and sustainable financing, should be a key component of the policy framework.1 Appropriate pharmacological treatment has been shown to significantly reduce morbidity and mortality from chronic conditions,5-~) yet the necessary medicines are not equitably distributed or used as widely as required)

Several studies have found that low drug availability limits access to medicines in low- and middle-income countries.''-~ Cameron et al. investigated the availability of 15 generic medicines used for a range of conditions in 36 developing countries and found it to be 38% and 64% in the public and private sectors, respectively." Studies focused on medicines used to treat chronic conditions have shown similar results. (19-25) However, no studies to date have investigated whether medicines for chronic conditions are less available than medicines in other therapeutic categories. We hypothesized that in countries with weak health systems that have historically focused on infectious diseases, medicines for chronic conditions requiring ongoing management are less available than medicines used to treat acute episodes of illness. This study investigates potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries.

Methods

Data source

Data were obtained from drug price and availability surveys conducted using a standard, validated methodology developed by WHO and Health Action International (HAI). (26-28) In the survey, the availability of 50 medicines was investigated through visits to public and private sector facilities. Data were collected on standard medicines that enable international comparisons and on medicines selected by each country for their importance nationally (e.g. drugs for high-burden diseases). Availability was determined for: (i) the originator brand first authorized worldwide for marketing (normally as a patented product) on the basis of the documentation of its efficacy, safety and quality, according to requirements at the time of authorization; and (ii) generic equivalents intended to be interchangeable with the originator brand product. …

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