MEDICINE PRICES IN UGANDA

MEASURING MEDICINE PRICES Government health facilities can only go to other sources when the
drugs are out of stock from both NMS and JMS. .
One-third of the global population lacks reliable access to needed
medicines. The high price of medicines is a key factor in their Medicines are provided free of charge in public health facilities and
inaccessibility. High prices are particularly burdensome to patients in are charged for in the mission sector.
developing countries where most medicines are paid for out-of-pocket The importation, registration and quality control of medicines is
by individual patients; in Sub Saharan Africa out-of-pocket expenditure regulated by the National Drug Authority (NDA).
constitute 34% of health expenditure (WHO 2002). 2
A household survey carried out in 2002 found that that for a majority
In September 2004, the Ugandan Ministry of Health was supported by of Ugandans, the first consultation when they are sick is done at the
the World Health Organisation (WHO), Health Action International- clinic or hospital in the public health care facilities or private sector.
Africa (HAI-A) and the HAI-A partner in Uganda, Health Promotion for
Social Development (HEPS), to carry out a national survey of The chart below illustrates that in 87% occasions when medicines
medicine prices. The survey was conducted in the public, private and were not obtained that price and/or availability of medicines was a
NGO sectors. Using the WHO/HAI methodology: Medicine Prices: a factor.
new approach to measurement 1 , the Ministry assessed the
Primary reason for not obtaining all of the prescribed medicines
affordability of key medicines, analyzed the prices and availability of a
selected key medicines, and identified price components (taxes, mark- private pharmacy did
ups etc.) of locally produced and imported medicines. The evidence did not believe were
not have all, 2.1%
obtained was used to determine factors contributing to high and needed, 2.1%
other, 5.4%
variable medicine prices and identify strategies and policies to
improve their affordability and availability in all the three sectors. This started to feel better, public pharmacy did
5.3% not have all, 43.6%
is one of a series of papers summarizing the results of medicine price
surveys carried out by countries across Africa and elsewhere in the
world. price was to high,
14.9%
BACKGROUND - UGANDA not enough
Uganda is classified as a low income country by the World Bank with money/unable to
borrow, 26.6%
a per capita GDP of US$271 (2000). Per capita public health
spending was US$12 (MoH statistical annex 2002); per capita public
sector medicines expenditure is estimated at U$1.6 (2004/5) with an
estimated medicines expenditure need of U$3.5 excluding the MEDICINES, AREAS AND SECTORS SURVEYED
pentavalent vaccines and antiretroviral medicines which are mainly The medicines surveyed included a standardized core group of 30
funded by donors. medicines that were surveyed in all countries and a supplementary
group of up to 20 medicines specific to Uganda. The core group was
Since 1972, the number of public, non-governmental and private selected based on global burden of disease, availability of standard
health facilities has increased by 400 percent and the population has formulations and importance. Medicines in the supplementary group
more than doubled. In spite of this, a 1993 inventory of health units were selected because of the importance and/or the frequency of their
found that geographical access to health care is limited to 49 percent use in treating important common health problems in Uganda. Both
of the population, i.e. population living within 5 kilometres (about one medicines on and off patent and on and off the national essential
hour’s walking distance) of a health facility providing both curative and medicines list were represented.
preventive health services (World Bank quoting Ministry of Health).
Rural communities are particularly affected because health facilities In all, 45 medicines were surveyed in 4 regions in Uganda: Kampala
are mostly located in urban centres. There are 12 regional referral District; and Eastern; Northern; and Western regions.
hospitals (which also act as District Hospitals in the areas where they Areas measured in each sector Public Private NGO
are located) and 2 national referral hospitals (Mulago and Butabika). facilities outlets facilities
Mulago and Mbarara Hospitals also act as University Teaching Affordability to patients √ √ √
Hospitals. The public and mission sector provides health care to Procurement price √ √
around 60% and 40% of the population respectively. Price to patients √ √
Currently there are 5 large-scale pharmaceutical manufacturers and 5
small-scale pharmaceutical manufacturers. There are 2939 public
Availability to patients √ √ √
health facilities from which drugs may be dispensed, 215 private
PRESENTATION OF PRICE INFORMATION
pharmacies and 2600 drug shops. Of the private pharmacies, nearly
The WHO/HAI survey methodology presents prices as median price
80% are in the three major towns of Kampala, Jinja and Mbarara.
ratios (MPR). The MPR is the ratio of the local price divided by an
Medicine budgets have been decentralized, with guidelines to protect
international reference price converted into the same currency. As
them at all service delivery levels. However, demand for essential
such, the reference price serves as an external standard for
medicines far exceeds supply, not least because of the rapid increase
evaluating local prices. An MPR of 1 means the local price is
in service utilization following the abolition of cost sharing in 2001.
equivalent to the reference price whereas an MPR of 2 means the
Additional funding and a policy recommendation to dedicate 50% of
local price is twice the reference price. The international reference
the non-wage budget to essential medicine at the lower levels of care
prices used for this survey were taken from the 2003 Management
have not been enough to stem high stock-out rates which compromise
Sciences for Health (MSH) International Drug Price Indicator Guide
the quality of care .
(http://erc.msh.org/). The MSH guide pulls together information from
The majority of the medicines and equipment for government health recent price lists of large, non-profit generic medicine suppliers and
units are obtained from National Medical Stores (NMS). The main thus reflects the prices governments could be expected to pay for
source of funding for drugs is the poverty alleviation funds sent to the medicines. Patient prices can be expected to be higher than the prices
district under primary health care. Only when drugs and equipment paid by governments, but these surcharges should be minimal and
are out of stock, can these units source elsewhere. The missionary relatively consistent across medicines and facilities.
hospitals source their drugs and health supplies from Joint Medical
Stores (JMS) which is also partly supported by the government.

1 http://www.haiweb.org/medicineprices/ 2 Uganda Pharmaceutical Sector Baseline Survey, MoH, 2002

1
INTERPRETATION OF FINDINGS
Where survey findings point to the high cost or poor availability of a Treatment of peptic ulcers requires at least two and a half days salary
few specific medicines, they are named in this paper. However, these for omeprazole or generic ranitidine necessary for a month’s
are unlikely to be isolated incidents. As only around 50 medicines treatment. An additional 5 hours salary would be required to purchase
were included in this survey, a finding of high prices or low availability from the private sector rather than the NGO sector. Whilst medicines
of even 3 or 4 medicines – or 6% to 8% of those studied – could are provided free of charge in the public sector neither medicine was
indicate a greater problem and requires further investigation. widely found despite ranitidine being found at National Medical Stores.
If innovator brand ranitidine was prescribed, recommended,
AFFORDABILITY TO PATIENTS dispensed or sold, 36 days salary would be necessary to purchase a
In this paper, affordability is calculated in terms of the number of days months course – an additional 33 days work.
the lowest paid unskilled government worker would have to work to
pay for one treatment course for an acute condition or one month’s Number of days wages required for 1 month treatment of a peptic ulcer
treatment for a chronic condition. At the time of the survey, the lowest

Number of days wages - lowest paid government worker

40
paid unskilled government worker earned Ugandan Shillings 2,500 36 days
ranitidine
(US$1.31) per day. 38% of Ugandans live under the poverty line. omeprazole
Hence a large proportion of Ugandans are worse off than the lowest 30
paid government worker and consequently the affordability for many
Ugandans will be lower than what is presented for this worker.
20
Overall, medicines were found to be unaffordable to a large proportion
of the population; purchasing treatments for chronic conditions was
found to require many more days’ work than purchasing treatments for 10
acute conditions.
2.4 days 2.4 days 3 days 3 days
The burden is especially great for a family needing treatment for
several conditions at the same time, e.g. using the lowest priced 0
lowest priced generic innovator brand lowest priced generic
generic medicines, it would take at least 6 days’ wages for the lowest
NGO patient price Private sector
paid unskilled government worker to purchase a medicines for a child
with asthma, an adult with hypertension and an adult with a peptic
3
ulcer ; treatment with innovator brand medicines would require 58 The price of medicines is a key aspect of their affordability. In this
days salary for a months treatment – clearly unaffordable in both survey, public procurement prices were assessed as were the prices
cases. The chart below presents the breakdown for each of the charged to patients at public sector facilities, private retail pharmacies,
medicines in innovator and generic forms and non-governmental facilities.

Number of days work needed to buy a months treatment in private

PUBLIC SECTOR PROCUREMENT PRICES
pharmacies in Uganda Public sector procurement prices for the lowest priced generic
60 medicines were found to be 0.71 times the international reference
prices. In other words, Uganda is procuring medicines at 29% less
Number of days wages - lowest paid government worker

total for 1 months adult/peptic ulcer/ranitidine

treatment
= 58 days wages adult/hypertension/atenolol than the published international market prices of non-profit generic
child/astma/salbutamol inhaler medicine suppliers.
36 days
40 Number of times more expensive: public procurement prices
compared to international reference prices
Price (MPR) Innovator Lowest
4
brand priced
5
20 total for 1 months
treatment
generic
16.8 days = 6 days wages No. of medicines included in analysis 2 25
Median MPR 0.49 0.78
th
5.6 days 2 days
3 days 1.2 days 25 percentile 0.28 0.67
th
0 75 percentile 0.71 0..95
Innovator brands Lowest priced generics
n= 45 medicines
It was found that there are significant differences in affordability Two medicines were procured at less than half the international
between medicines within a therapeutic category. The chart below reference price, and one was procured for more than 50% above the
illustrates these differences for six lowest priced generics used for international reference price. Two innovator products were found,
treatment of hypertension – monotherapy – if more than one drug is fluconazole as part of the Diflucan Donation Programme and
used, the numbers shown are additive. Where medicines are available salbutamol inhaler. The prices of these four products are listed in the
in more than one sector, the patient prices are relatively similar; there table below.
being much greater differences between therapeutic choices and/or
antihypertensive class. Number of times more expensive: public procurement prices
compared to international reference prices – lowest priced
Number of days wages required for 1 month treatment of hypertension generics
- lowest priced generics atenolol (generic) 2.51
Number of days wages - lowest paid government worker

10
chloroquine (generic) 0.46
6 0.06
8
fluconazole (innovator)
ketoconazole (generic) 0.35
6 salbutamol inhaler (innovator) 0.92
Two medicines on the essential drugs list were not found at the
4
national medical stores: diclofenac 25mg and nifedipine retard 20mg.
2

0
NGO patient price Private sector

furosemide 40mg daily atenolol 50mg daily

nifedipine retard 20mg twice daily captopril 25mg twice daily
losarten 50mg daily lisinopril 10mg daily

4 Innovator brands are not generally procured for use in the public sector
5 The lowest priced generic equivalent was determined facility-by-facility and was the lowest priced generic equivalent
3 Number of days wages for lowest paid government worker to buy 1 months of medicines. This family has the following product available for sale at each facility included in the survey. In determining public procurement prices, the lowest
medicines requirements each month: 1 salbutamol inhaler for a child with asthma; infection; 30 atenolol tablets 50mg for priced generic at the national medical store or on the national tender document was used.
an adult with hypertension; 60 ranitidine tablets 150mg for 1 adult with peptic ulcer 6 The innovator fluconazole product was valued so as to be able to calculate and charge a handling fee at the National
Medical Stores

2
PUBLIC SECTOR FACILITIES Number of times more expensive: patient prices for medicines at
Medicines are provided free of charge in Uganda.
private retail pharmacies compared to international reference prices
28 of the 45 medicines studied were on the essential drug list of Medicine Lowest Innovator Number of times
Uganda; the median availability of those medicines on the essential priced brand more expensive
drugs list was found to be 55% (n=20 facilities). It should be noted that generic (IB) IB: LPG
from within these 28, some of the medicines would only be expected (LPG)
to be at the referral and district hospital level and not at some of the albendazole 16.1 118.0 7.3
lower level facilities that were surveyed. amoxicillin 1.5 15.2 10.1
Every facility was found to stock both chloroquine and sulphadoxine atenolol 5.6 78.2 14.0
pyrimethamine, and no facility was found to stock salbutamol inhaler, carbamazepine 2.6 19.7 7.6
which was in available at the National Medical Store. fluconazole 200mg 13.0
fluconazole 150mg 13.1
PRIVATE SECTOR PATIENT PRICES glibenclamide 6.38
Out of the 45 medicines surveyed, innovator brand products were
ranitidine 2.6 31.5 12.1
found for 17 of them in private retail pharmacies.
sulfadoxine- 3.4 13.6 4.0
At private retail pharmacies, patient prices for the lowest priced pyrimethamine
generics were found to be 2.6 times the international reference price. n= 20 facilities
The prices charged to patients for the lowest priced generic medicines
ranged from 0.28 times the international reference price for losartan to When comparing the price difference between innovator brand
16.09 times the international reference price for albendazole. medicines and lowest priced generic medicines matched pairs of
medicines where the same medicines were found in both groups,
For innovator brands, patient prices were found to be 13.6 times the innovator brands were found to be 5.2 times more expensive than the
international reference price. The prices charged to patients for the lowest priced generic (n=11 medicines). The table below shows the
innovator brand medicines ranged from 1.68 times the international differential between the price patients at private retail pharmacies are
reference price for artemether to 118 times the international reference charged for the innovator brand and the lowest priced generic
price for albendazole. equivalent for the six medicines with the greatest differences. It can be
Number of times more expensive: patient prices for medicines at seen that some of the innovator brands were widely available (i.e. in 1
private retail pharmacies compared to international reference prices or 5 pharmacies or more, up to 80%) and hence likely to have a
Price (MPR) Innovator Lowest priced noteworthy market-share, despite having a high brand premium to the
brand generic price.
No. of medicines included 11 38 For sulphadoxine-pyrimethamine, the innovator brand was found in
Median MPR 13.6 2.6 80% of pharmacies and was four times more expensive than the
th
25 percentile 7.5 1.7 lowest priced generic; at the time of the survey there were 24 generic
th
75 percentile 25.6 3.6 products being registered in Uganda.
n= 20 facilities; 45 medicines
Patient prices and availability at private retail pharmacies for
Availability at private retail Innovator Lowest priced innovator brands compared to lowest priced generic equivalents
pharmacies brand generic
Median availability 0 80 Number of times more expensive Availability
innovator brand: lowest priced generic Innovator Generic
25th percentile 0 50
75th percentile 15 90 brand
albendazole 7.3 60% 100%
n= 20 facilities; 45 medicines
amoxicillin 10.1 25% 100%
In the private sector, the prices charged for medicines varied from atenolol 14.0 25% 60%
pharmacy to pharmacy. In some cases, the prices varied by many carbamazepine 7.6 20% 80%
multiples. The lowest priced generics medicines with the greatest ranitidine 12.1 20% 80%
variation in price are shown below. sulfadoxine-pyrimethamine 4.0 80% 100%
Medicines with largest variations in patient prices n= 20 facilities
20
7
75%ile The study included all first line HAART medicines. Three of the six
25%ile medicines were found in a single retail pharmacy in Kampala.
15 Median
Price (MPR)

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The following table shows those generic medicines for which patients
at private retail pharmacies are charged at least fifteen times
published international prices for the lowest priced generic and/or
innovator brand. A difference of five times or more between the
international reference price and the price charged to patients makes
these medicines seem particularly expensive than what could be
available or achieved.

7 Highly Active Anti-Retroviral Therapy

3
NON-GOVERNMENTAL SECTOR PROCUREMENT prices for the lowest priced generic and/or innovator brand. A
difference of five times or more between the international reference
PRICES price and the price charged to patients makes these medicines seem
NGO sector procurement prices for the lowest priced generic particularly expensive than what could be available or achieved.
medicines were found to be 0.87 times international reference prices. Number of times more expensive: patient prices for medicines at
In other words, procurement is 13% less than the published NGO facilities compared to international reference prices
international market prices of non-profit generic medicine suppliers.
Medicine Lowest priced generic (MPR)
Number of times more expensive: NGO procurement prices
compared to international reference prices albendazole 12.34
Price (MPR) Innovator Lowest priced atenolol 5.63
brand generic ciprofloxacin 5.76
No. of medicines included 1 29 glibenclamide 6.38
in analysis sulphadoxine=pyrimethamine 6.11
Median MPR 1.04 0.87
th
25 percentile
th
0.73 INTER-SECTORAL COMPARISONS
75 percentile 1.01 The table below compares the prices of lowest priced generics
n= 45 medicines between sectors where the same medicines were found in both
One medicine was procured at less than half the international sectors.
reference price and two were procured for more than 50% above the For lowest priced Were this many Than:
international reference price. one innovator product was found, generics: times more
salbutamol inhaler. These prices of these four products are listed in expensive:
the table below.
Number of times more expensive: NGO procurement prices NGO patient prices NGO procurement
3.2
(n= 27 medicines) prices
compared to international reference prices – lowest priced
generics NGO procurement Public sector
1.2
prices (n= 25 medicines) procurement prices
albendazole (generic) 4.31
atenolol (generic) 1.97
Private retail patient NGO patient prices
omeprazole (generic) 0.25 1.0
prices (n=29 medicines)
salbutamol (innovator brand) 0.74
While NGO sector procurement prices were 20% more than for public
NON-GOVERNMENTAL SECTOR PATIENT PRICES sector procurement prices for lowest priced the NGO sector
In the non-governmental sector, the price charged to patients for procurement price of some medicines was as much as 4.4 times the
lowest priced generics was found to be 2.69 times the international public procurement price; in a number of instances due to JMS
reference price. Patient prices ranged from 0.53 times the stocking blister packaged medicines whereas NMS stocked bulk
international reference price for omeprazole to 12.34 times the containers.
international reference price for albendazole. No innovator brands Number of times more expensive: NGO sector procurement prices
were found. compared to public sector procurement prices (lowest priced
Number of times more expensive: patient prices for medicines at generic)
non-governmental facilities compared to international reference carbamazepine 1.8
prices ceftriaxone 1.5
Price (MPR) Innovator brand Lowest priced chloroquine 2.2
generic cotrimoxazole 1.5
No. of medicines included 0 29 ketoconazole 1.8
Median MPR 2.69 Metformin 0.71 (JMS had lower price)
th
25 percentile 2.07 rifampicin + isoniazid 4.4
th
75 percentile 3.47 Patient prices in the private sector were generally the same as those
n= 20 facilities; 45 medicines in the NGO sector; the table below shows that some were the same
Availability at non- Innovator brand Lowest priced price and some were more expensive in the private sector and some
governmental facilities generic were more expensive in the NGO sector.
Median availability 0 45 Number of medicines where NGO prices were
th
25 percentile 0 15 same as private sector prices 9
th
75 percentile 0 75 less expensive than the private sector prices 9
n= 20 facilities; 45 medicines more expensive than the private sector prices 11
n= 20 facilities; 29 medicines
In non-governmental facilities, the prices patients were charged for
medicines varied from facility to facility for some medicines. Those 69% of medicines were the same or more expensive in NGO facilities
lowest priced generics with the greatest variation in price are shown than in the private sector; 40% were more expensive in the NGO
below. sector. The table below lists those medicines which were more
expensive in the NGO sector than the private sector.
75%ile
Medicines with largest variations in patient prices 25%ile Number of times more expensive in NGO than in private sector
8 Median
amoxicillin 2.0
benzyl penicillin 2.5
6 captopril 1.2
cephalexin 1.1
Price (MPR)

chloroquine 2.2
4 ciprofloxacin 1.8
co-trimoxazole 2.0
co-trimoxazole suspension 1.2
2
furosemide 1.3
metronidazole 1.5
0
sulfadoxine-pyrimethamine 1.8
The table below examines where patient prices are perhaps more
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The following table shows those generic medicines for which patients
at NGO facilities are charged at least five times published international
4
 Number of times mark-up above median mark-up NGO patient
price: NGO procurement price
8 PRICE COMPONENTS
For those items where Number of times Out of Examining the components that make up the price of medicines is an
NGO prices were mark-up greater (number of important step in determining how to reduce their cost. The final price
than median medicines) paid for a medicine whether by the government or a patient reflects
same as private sector 2 9 the manufacturers selling price plus all the intervening price additions.
prices These additions include the cost of importing, distributing and
less expensive than the 6 9 dispensing the medicine.
private sector prices In the private sector for a branded medicine, the import price
more expensive than the 3 11 represents around 48% of the final patient price, with the other major
private sector prices contributors to the final price being the retail mark-up contributing of
The mark-up was greater than the median for the majority of the around 35% of the final price and the importer mark-up contributing
medicines where the NGO prices were already at or below the private 12%.
sector price – perhaps cross-subsidizing other medicine prices or The following two charts present these two situations graphically.
services; prices could be potentially be lower for these items.
For five out the eleven medicines where the NGO patient was more Typical proportions of add-ons of final patient price for an
innovator brand product in the private retail pharmacy
expensive than the private sector price, the mark-ups were below the
median value, perhaps indicating the cross-subsidy mentioned above
and/or that the JMS price was higher than it could be and perhaps
higher than the private sector prices; for each of the five medicines
retail markup, Import price (FOB),
JMS was procuring at between 17% and 127% more than NMS. The 34.9% 48.5%
five medicines are amoxicillin; benzyl penicillin; chloroquine; and
cotrimoxazole tablets and suspension.
Patients need medicines to not only be affordable, but also available.
wholesaler mark-
The table below presents the availability across all sectors for those up, 1.3%
medicines on the national essential drugs list with less than 50%
9 NDA verification,
availability . importer mark-up, clearing charges, 0.4%
11.9% 1.5%
% Availability Public Private NGO
insurance & freight,
sector retail sector 1.5%
facilities pharmaci (n=20)
(n=20) es (n=20)

Amitriptyline 15% 75% 60% RECOMMENDATIONS FROM COUNTRY REPORT AND

Atenolol 10% 60% 40%
Betamethasone Cream 10% 85% 15%
STAKEHOLDER MEETING
A summary of the recommendations is provided below, for a fuller
Captopril 20% 75% 50%
explanation see the full survey report:
Carbamazepine 40% 80% 45% Develop a medicines pricing policy and monitor its implementation;
Cephalexin 0% 50% 20% potential aspects of the policy could include price/margin control and
Co-trimoxazole suspension 15% 80% 40% reference pricing.
Fluconazole 200mg 10 45% 0%
15% Develop mechanisms and approaches to disseminate price
Glibenclamide 25% 85% 60% information to the public on a regular basis.
Metformin 25% 85% 50% Develop a policy on generic prescribing and substitution, for all
Omeprazole 0% 95% 45% sectors
Ranitidine 5% 80% 30% Promote the use of generics to health professional and the public,
Salbutamol inhaler 0% 95% 10% including assurances on quality issues. Civil Society Organizations to
Atenolol, fluconazole 200mg and glibenclamide are medicines which sensitize communities through sensitization and education
were not widely found in the public sector and previously identified in Promote adherence to the national standard treatment guidelines
this paper as being apparently more expensive than what could be
achieved in the private and/or NGO sector; atenolol is also procured at Advocate on price issues as a barrier to access to medicines at the
higher than expected prices by both the public and mission sector national and sub-regional (East African Community) levels
procurement systems. Strengthen the demand driven ordering system in the public sector to
improve availability and efficiency
Strengthen National Medical Store’s management information
Reinforce training in drug quantification at all levels.
Investigate why some essential medicines such as salbutamol inhaler
are found at the National Medical Stores but not available at the lower
level facilities
Explore the possibilities of a pooled procurement system for the two
procurement agencies (JMS and NMS) especially for medicines which
are being purchased at greater than the international reference price
Conduct a specific study on the availability and prices of ARVs in the
three sectors.
Expedite accreditation mechanism thereby ensuring that more private
pharmacies that supply ARVs
Facilitate the fast-track registration by the National Drug Authority of
essential generic medicines where few are registered to encourage
generic competition

8 NGO patient prices are 3.2 times more expensive than NGO procurement prices
9 the low availability in the public sector could be because some of the medicines are only intended to be at referral centres
and not at some of the lower levels of care which were included in the survey

10 innovator brand availability as part of a donation programme

5
ANALYSIS ACKNOWLEDGEMENTS
Below is a further analysis of the findings presented in this paper. The survey was carried out by the Ministry of Health in collaboration
with and funded by the World Health Organisation, Health Action
AFFORDABILITY AND ACCESS TO MEDICINES International-Africa and Health Action International’s partner in
“Out-of-pocket” purchase of most medicines from the private and NGO Uganda, Health Promotion for Social Development (HEPS). Technical
sectors is not affordable to the majority of the population. support in the ministry was provided by the Director General of Health
Consideration of price in the choice of medicines could determine Services, Prof G Omaswa and the Principal Pharmacist, Mr M Oteba.
whether a patient can obtain a medicine for treatment, or not. The Ministry of health also acknowledges the technical support from
Some medicines seem to be at higher prices than others and than the World Health Organization (HQ) provided by the Coordinator Drug
they could be when compared to the international reference price. Action Programme, WHO Department of Technical Cooperation fpr
Essential Drugs and Traditional Medicines in Geneva M, Dr G Forte,
There was marked price variation for some medicines within the Technical Officer at the WHO Regional Office for Africa, Mr. A. Desta
private and NGO sectors - some patients are paying much more than and the consultant for Health Action International Africa, Mr Martin
they would be in other facilities or pharmacies. Auton. Thanks are extended to the WHO Country office team most
Some key medicines which were not widely available at all in the especially the medicines advisor,,Mr Joseph Serutoke.
public sector were are apparently more expensive than need be in the
private and NGO sectors. The Ministry of Health also acknowledges with thanks the input of the
16 data collectors coordinated by Mr Patrick Mubangizi, the survey
It appears that prices in the NGO sectors for some medicines are manager.
perhaps set at a potentially higher otherwise as the final price is the
same or more as the private sector and at the same time are
apparently marked-up more than average from the available JMS FURTHER INFORMATION
procurement price.
Medicines prices in the NGO sector are very similar to medicines For further information, contact: Dr Jean Marie Trapsida, Coordinator
prices in the private retail pharmacy sector; NGO facilities being EDM, WHO Regional Office for Africa, Brazzaville, Republic of Congo,
largely in the rural areas and retail pharmacies being largely in the [email protected]; Dr. Gilles Forte, Coordinator, Department of
urban areas. NGO facilities in the rural areas are therefore offering a Technical Cooperation on Essential Drugs and Traditional Medicine,
service, in terms of price, almost equivalent to the private pharmacies WHO Geneva, [email protected]; Mr Patrick Mubangizi, Regional
in the urban areas despite being subsidized by government. Coordinator, Health Action International (HAI) Africa, PO Box 66054-
00800 Nairobi, Kenya, [email protected]
Drugs shops were not included in the study, which together with the
public and NGO facilities are important suppliers of medicines to
patients in the rural areas; an evaluation of their actual and potential
role in the supply of medicines, including pricing of medicines could be
very informative.
Some key essential medicines including atenolol, fluconazole 200mg
and glibenclamide were not widely found in the public sector and were
apparently more expensive than what could be achieved in the private
and/or NGO sector.
PUBLIC SECTOR
The public sector procurement system is paying more than might be
necessary for a small proportion of medicines.
Some key essential medicines were not widely found in the public
sector; there is room for improvement in the availability of medicines
for the patient in the public sector.
PRIVATE SECTOR
Some branded medicines were widely available and hence were likely
to have noteworthy market share despite having a high brand
premium compared to the generic equivalent
NGO SECTOR
Availability in the NGO sector was generally greater than in the public
sector.
Prices in NGO facilities were similar to that of the private retail
pharmacies.
Most medicines were the same or more expensive in NGO facilities
than in private sector pharmacies;
The NGO sector procurement system is paying more than might be
necessary for a small proportion of medicines.
A small number of medicines were markedly cheaper at the national
medical stores compared to Joint Medical Stores