Access to essential medicines is both a basic fundamental right and necessity for everyone, and therefore governments should make a concerted effort to ensure that everyone has access to safe, quality and comparably cost-effective medicines. Thus, according to essential contributions to the above, a study was conducted in Harare Metropolitan Province of Zimbabwe to determine prices, price components, pricing policies, source and availability of essential drugs (their innovator and/or generic equivalents) in both private and public retail sectors. In both the private and public sectors, the availability of the selected essential medicines (low-cost generics) was quite high (>80%).
The median price ratio (MPR) of the cheapest generic medicines revealed that many people's access to essential medicines may still be at risk due to high prices, especially in the private sector (4.52).
PLAGIARISM
LIST OF PUBLICATIONS
Background to and rationale for this study
This epidemiological picture makes access to basic quality, safe and effective pharmaceutical care crucial. According to WHO/HAI (2008), at least 50% of people in poor third world countries in Africa and Asia have limited access to basic pharmaceutical care. Given this observation, Zimbabwe's high unemployment level and economic challenges can significantly complicate access to basic medicines.
Also, the survey will help policy makers to create various safeguards that will ensure that everyone has access to basic health care.
Aim
Comparing prices and policies/practices with international standards enables the researcher to gather evidence, thereby helping policymakers design policies that will improve access to medicine and public health in general. According to the Directorate of Pharmacy Services in the Ministry of Health and Child Care (MHCC), formerly the Ministry of Health and Child Welfare (2011) Zimbabwe not only faces significant shortages of essential medicines but also insufficient pharmaceutical professionals especially in the public sector. Considering both sectors is based on the understanding that the private sector often penetrates the community better than the public sector, so better policies in the private sector have tremendous potential to increase access to essential medicines.
Thus, this cross-sectional study will not only help answer the researcher's research questions but also inform policymakers and other stakeholders about access to medicines.
Objectives
The assessment of prices and various pricing policies in both public and private practices will also enable the nation to harmonize these policies for the betterment of all and further protection to the poor and other vulnerable groups.
Novelty and significance of this study
Overview of this thesis
WHO/HAI, (2008), Measuring medicine prices, availability, affordability and price components, 2nd edition, World Health, Organization and Health Action International. M., (2003), TRIPS, Pharmaceutical Patents and Access to Essential Medicines: Seattle, Doha and Beyond, Economics of AIDS and Access to HIV/AIDS Care. K., (2013), Availability and Affordability of Essential Medicines: A Case Study of the Top Ten Registered Diseases in Builsa District of Ghana, International Journal of Scientific & Technology Research.
Morgan S and Kennedy J., (2010), Availability and Affordability of Prescription Medicines in the United States and Abroad, Issues in International Health Policy, Commonwealth Fund pub.
Disease burden in sub-Saharan Africa: Zimbabwe
Essential medicine concept
In the context of Zimbabwe, NMTPAC (2011) highlights several advantages for using the concept of essential medicines, namely;. As stated in its ZNMP, Zimbabwe, using the concept of essential medicine, has the overall objective of improving the health of the majority of the population of Zimbabwe through the treatment, cure, reduction or prevention of diseases and/or disorders within the available means. of health through procurement of medicines, promotion of local production of basic medicines, management and use (Directorate for Pharmacy Activity, 2011). From the analysis, it is crucial that people have access to specially selected medicines to achieve their health care goals.
The United Nations Development Group (2003) defines access “as the continued availability and affordability of medicines at public or private health facilities or medicine outlets within an hour's walk of people's homes.”
Prices of essential medicines
Availability of essential medicines
Summary
The World Health Organization, (2006), estimated that the counterfeit medicine industry is a multi-million dollar business. Africa is threatened by counterfeit medicines, so due to availability and price issues, many have access to essential medicines which is hindered due to many counterfeit medicines in the pharmaceutical markets in Africa (Fenoff and Wilson, 2009). The World Bank (2016), Data, Country and Lending Groups, http://data.worldbank.org/about/country-and-lending-groups#Sub_Saharan_Africa, cited on 01/03/2016.
Zimbabwe Country Report, (2015), Follow-up to the 2011 Political Declaration on HIV/AIDS: Stepping Up Our Efforts to Eliminate HIV/AIDS, Global AIDS Response Progress Report, Reporting period: January 2014 to December 2014. World Health Organization, ( 2002). ), The selection and use of essential medicines, (The 19th is the current Model List of Essential Medicines prepared by the WHO Expert Committee in April 2015), Technical Report Series No 914. Laing R., (2012), How Does the Evidence-based selection of essential medicines deviates from Health Technology Assessment, Utrecht, EMP/WHO.
Directorate of Pharmacy Services, (2011), National Drug Policy of Zimbabwe, Ministry of Health and Child Care, formerly Ministry of Health and Child Welfare. NMTPAC, (2011), 6th Essential Medicines List and Standard Treatment Guidelines for Zimbabwe, Ministry of Health and Child Care, formerly Ministry of Health and Child Welfare. Murray A., (2015), Understanding the role and use of essential drug lists, IMS Institute for Healthcare Informatics.
United Nations Development Group, (2003), Indicators for Monitoring the Millennium Development Goals, United Nations, New York.
Surveys
Determination of minimum returned sample size for a given population size for continuous and categorical data (Bartlett et al, 2001). NOTE: The margins of error used in the table were 0.03 for continuous data and 0.05 for categorical data. Researchers can use this table if the margin of error shown is appropriate for their study; however, the appropriate sample size must be calculated if these error rates are not appropriate.
Survey methods
The knowledge produced may not generalize to other people or other settings (ie, the findings may be unique to the relatively few people involved in the research study). Provides understanding and description of people's personal experiences of phenomena (ie, the "emic" or insider's perspective). The researcher identifies contextual and determining factors as they relate to the phenomenon of interest.
It can generalize research findings if the data are based on random samples of sufficient size. A researcher may miss a phenomenon that occurs due to a focus on testing a theory or hypothesis rather than generating a theory or hypothesis (called confirmation bias). The researcher can construct a situation that eliminates the confounding influence of many variables, allowing for a more credible assessment of cause-and-effect relationships.
It can have greater credibility with many people in power (e.g. administrators, politicians, people who fund programs). It can be difficult for a single researcher to conduct both qualitative and quantitative research, especially if two or more approaches are expected to be used simultaneously; it may require a research team. Can answer a broader and more complete range of research questions because the researcher is not limited to one method or approach.
Some of the details of mixed research have yet to be fully worked out by research methodologists (eg, problems of paradigm mixing, how to qualitatively analyze quantitative data, how to interpret conflicting results). Qualitative and quantitative research used together produce more complete knowledge needed to inform theory and practice.
Price and availability surveys
Researcher must learn about multiple methods and approaches and understand how to mix them appropriately. A researcher can use the strengths of an additional method to overcome the weaknesses in another method by using both in a research study. Can add insights and understanding that may be missed when using only a single method.
Summary
Median price ratios (MPR) of lowest priced generics (LPG) showed that many still might be having their accesses to essential medicines compromised by high prices particularly in the private sector (with median MPR of 4.52). A few essential medicines were completely absent in the public sector namely; ciprofloxacin, amlodipine, omeprazole, chlorpheniramine, fluconazole, miconazole oral gel and praziquantel. Almost all of the medicines used in theatres were completely absent in the private sector.
Availability of many other selected medicines (low price generics) in the private sector was quite similar (ie mean availability in HD was 80%, CBD 77% and LD 85%). The availability of medicines in general in the public sector was also high with an average availability of 79%. In general, prices in the private sector were higher than those in the public sector (see table 3 below).
The median price ratio (MPR) of 1.5 found in the public sector is close to 1, indicating greater procurement efficiency. Among the few innovative brands found only in the private sector, the median MPR was 8.45, as shown in Table 4 below. The prices of drugs in the private sector ranged from twice (2) to even more than 4 times the prices of the same drugs in the public sector.
Some prices in the private retail sector were even 10 times higher than the International Reference Prices (IRP). Based on informants from the Retail Pharmacists Association (RPA) of Zimbabwe and policy documents (such as the Zimbabwe National Medicines Policy (ZNMP)), Zimbabwe has a free market policy when it comes to the pricing and availability of medicines, especially in the private sector. This fact means that despite the good development in the public sector, high prices in the private sector significantly compromise affordability and thus access to essential medicines for many people.
High prices, especially in the private sector, require more effort to ensure that many people have access to essential medicines.
Sources of medicines
Median price ratios
The private sector had prices that were generally more than three (3) times higher than the prices in the public sector (see figure 5.3. below). With fewer public sector pharmacies in Harare province, many people may still be hampered in their access to quality, safe and effective medicines despite their high availability. Compared to public shops, private pharmacies have a large penetration in the local community, so the higher prices observed in the sector have a significant impact on access to basic medicines.
Median MPR of 1.5 in the public sector underlines significant improvements in public sector procurement, in terms of its efficiency.
Conclusion
General Conclusion
Recommendations and future studies
Proof of submission of article
Ethical clearance
Permission granted by the Pharmacists Council of Zimbabwe
Example of approvals from individual pharmacy outlets
Request for consent letter
Consent form for signing
Assessment of price and availability form
Median price ratios used
Prices and references used in calculations
