Table 2 Measures for improving access to medicines
From: Access to cardiovascular medicines in low- and middle-income countries: a mini review
Access measure | Interventions to improve access | Wirtz et al. [7] | Ewen et al. [9] | Mendis et al. [12] | Antignac et al. [28] | Acosta et al. [31] | WHO [32] |
|---|---|---|---|---|---|---|---|
Availability | Efficient projections, procurement, transparency, good governance; Improving the selection process for medicines Increase public financing for cardiovascular medicines Strong generic policy: Create incentives in the public and private sectors to make low-price, quality-assured medicines available Public health funding Consideration of Market-related factors (high demand, voluntary withdrawal, a shift in clinical practice, loss of interest in the market and changing the location of production facilities) Improve manufacturing processes Address ethical issues (such as regulatory problems) Consider Supply stage of medicines, market competition, and possible therapeutic substitutes | √ |  |  |  | √ |  |
Affordability | Abolish taxes and duties on essential medicines and control mark-ups Improve market competition (price information, price competition); Pooled procurements in specific contexts may work Scale up insurance programs (prepayment schemes; universal health coverage; social protection) Provide incentives to increase local production with fair pricing | √ |  |  |  |  |  |
Accessibility | Increase operational hours Decrease waiting times Increase perceived quality of care, eg, patient satisfaction surveys to monitor changes and identify gaps and needs | √ |  |  |  |  |  |
Acceptability | Rational use of medicines (National treatment guidelines, EML) Provide Fixed Dose Combination (FDC) medications (polypill) | √ |  |  |  |  |  |
Quality of medicines | Provide incentives to businesses to invest in quality medicines Follow good procurement practices Establish systems to verify authenticity; strengthen regulation Continuous monitoring and public awareness as well as national and international scrutiny as measures against substandard and falsified medicines | √ |  |  | √ |  |  |
Availability and affordability | Accelerated and lower-cost registration procedures for generics Efficient government procurement; Pass on low procurement prices Adequate forecasting, adequate and sustainable financing, efficient distribution system, Removing taxes and tariffs on essential medicines Regulating mark-ups in the supply chain Institute mandatory prescribing by the medicine’s International Nonproprietary Name (INN) Promote generic substitution Incentives for dispensing of lower-priced generics (regressive mark-ups) Promote the use of lower-priced generics to health professionals and the public; quality-assurance, publicly available quality testing Introduce market competition Improving governance and management efficiency Assess local supply options Prioritize the essential medicines drugs budget Purchase low-priced quality generics Provide essential chronic disease medicines through the private sector at public sector procurement prices Therapeutic substitution Direct price negotiations; price transparency; Set generic prices from procurement prices if regulating price Differential pricing (tax exemption for government facilities) Establish a national Essential Medicines List Pooled procurement of government institutions, tendering |  | √ | √ |  |  | √ |