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.

Data Source(s):

Surveys of health care facilities and other medicine outlets using standardized instruments (e.g., WHO /HAI survey)

Purpose:

This indicator can be used to examine access in terms of availability of essential medicines in addition to practices and trends over time in selection and procurement of these medicines.  Moreover, it can serve as a proxy for service quality, as represented by the presence of non-expired stock. Various WHO disease prevention and treatment programs have proposed maintaining lists of medicines in stock for assessment of service availability and readiness. 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).

Issue(s):

This indicator measures availability of essential, non-expired 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, storage, affordability, travel time to medicine outlets, and rational use including appropriate prescribing, dosages, and dispensing practices.

References:

The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening. http://www.hivpolicy.org/Library/HPP000485.pdf