Journal Article > CommentaryFull Text
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Gerdin M, Clarke M, Allen C, Kayabu B, Summerskill W, et al.
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Journal Article > CommentaryFull Text
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
Kishore SP, Kolappa K, Jarvis JN, Park PH, Belt R, et al.
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
The modern access-to-medicines movement grew largely out of the civil-society reaction to the HIV/AIDS pandemic three decades ago. While the movement was successful with regard to HIV/AIDS medications, the increasingly urgent challenge to address access to medicines for noncommunicable diseases has lagged behind-and, in some cases, has been forgotten. In this article we first ask what causes the access gap with respect to lifesaving essential noncommunicable disease medicines and then what can be done to close the gap. Using the example of the push for access to antiretrovirals for HIV/AIDS patients for comparison, we highlight the problems of inadequate global financing and procurement for noncommunicable disease medications, intellectual property barriers and concerns raised by the pharmaceutical industry, and challenges to building stronger civil-society organizations and a patient and humanitarian response from the bottom up to demand treatment. We provide targeted policy recommendations, specific to the public sector, the private sector, and civil society, with the goal of improving access to noncommunicable disease medications globally.
Journal Article > ResearchFull Text
Trop Med Int Health. 2010 December 1; Volume 15 (Issue 12); DOI:10.1111/j.1365-3156.2010.02649.x
Bemelmans M, van den Akker T, Ford NP, Philips M, Zachariah R, et al.
Trop Med Int Health. 2010 December 1; Volume 15 (Issue 12); DOI:10.1111/j.1365-3156.2010.02649.x
Objective To describe how district-wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi. Method In mid-2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587 455) based on decentralization of care to health centres and community sites and task shifting. Results After delegating HIV testing and counseling to lay counsellors, uptake of testing increased from 1300 tests per month in 2003 to 6500 in 2009. Shifting responsibility for antiretroviral therapy (ART) initiations to non-physician clinicians almost doubled ART enrolment, with a majority of initiations performed in peripheral health centres. By the end 2009, 23 261 people had initiated ART of whom 11 042 received ART care at health-centre level. By the end of 2007, the universal access targets were achieved, with nearly 9000 patients alive and on ART. The average annual cost for achieving these targets was €2.6 per inhabitant/year. Conclusion The Thyolo programme has demonstrated the feasibility of district-wide access to ART in a setting with limited resources for health. Expansion and decentralization of HIV/AIDS service-capacity to the primary care level, combined with task shifting, resulted in increased access to HIV services with good programme outcomes despite staff shortages.
Journal Article > CommentaryAbstract
Int J Drug Policy. 2015 May 18; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Ford NP, Wiktor SZ, Kaplan K, Andrieux-Meyer I, Hill AM, et al.
Int J Drug Policy. 2015 May 18; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Journal Article > ReviewFull Text
Global Health. 2011 October 12; Volume 7 (Issue 39); DOI:10.1186/1744-8603-7-39
Moon S, Jambert E, Childs M, von Schoen-Angerer T
Global Health. 2011 October 12; Volume 7 (Issue 39); DOI:10.1186/1744-8603-7-39
BACKGROUND
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.
DISCUSSION
We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.
SUMMARY To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.
DISCUSSION
We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.
SUMMARY To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
Journal Article > LetterFull Text
Lancet. 2013 March 16; Volume 381 (Issue 9870); 901.; DOI:10.1016/S0140-6736(13)60664-9
Fernandez G, Boulle P
Lancet. 2013 March 16; Volume 381 (Issue 9870); 901.; DOI:10.1016/S0140-6736(13)60664-9
Journal Article > ResearchFull Text
PLOS One. 2019 March 12; Volume 14 (Issue 3); e0212405.; DOI:10.1371/journal.pone.0212405
Hwang B, Shroufi A, Gils T, Steele SJ, Grimsrud A, et al.
PLOS One. 2019 March 12; Volume 14 (Issue 3); e0212405.; DOI:10.1371/journal.pone.0212405
BACKGROUND
HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.
METHODS
We conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.
RESULTS
Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.
INTERPRETATION
There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.
HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.
METHODS
We conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.
RESULTS
Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.
INTERPRETATION
There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.
Journal Article > ReviewAbstract Only
Lancet Oncol. 2018 December 1; Volume 19 (Issue 12); e709-e719.; DOI:10.1016/S1470-2045(18)30658-2
Velazquez Berumen A, Jimenez Moyao G, Rodriguez NM, Ilbawi AM, Migliore A, et al.
Lancet Oncol. 2018 December 1; Volume 19 (Issue 12); e709-e719.; DOI:10.1016/S1470-2045(18)30658-2
Medical devices are indispensable for cancer management across the entire cancer care continuum, yet many existing medical interventions are not equally accessible to the global population, contributing to disparate mortality rates between countries with different income levels. Improved access to priority medical technologies is required to implement universal health coverage and deliver high-quality cancer care. However, the selection of appropriate medical devices at all income and hospital levels has been difficult because of the extremely large number of devices needed for the full spectrum of cancer care; the wide variety of options within the medical device sector, ranging from small inexpensive disposable devices to sophisticated diagnostic imaging and treatment units; and insufficient in-country expertise, in many countries, to prioritise cancer interventions and to determine associated technologies. In this Policy Review, we describe the methods, process, and outcome of a WHO initiative to define a list of priority medical devices for cancer management. The methods, approved by the WHO Guidelines Review Committee, can be used as a model approach for future endeavours to define and select medical devices for disease management. The resulting list provides ready-to-use guidance for the selection of devices to establish, maintain, and operate necessary clinical units within the continuum of care for six cancer types, with the goal of promoting efficient resource allocation and increasing access to priority medical devices, particularly in low-income and middle-income countries.
Journal Article > CommentaryFull Text
Nature. 2022 February 9; Volume 602 (Issue 7896); 207-210.; DOI:10.1038/d41586-022-00324-y
Swaminathan S, Pecoul B, Abdullah H, Christou C, Gray G, et al.
Nature. 2022 February 9; Volume 602 (Issue 7896); 207-210.; DOI:10.1038/d41586-022-00324-y
Journal Article > LetterFull Text
Lancet. 2002 April 13; Volume 359 (Issue 9314); 1351.; DOI:10.1016/S0140-6736(02)08303-4
Ford NP, 't Hoen E
Lancet. 2002 April 13; Volume 359 (Issue 9314); 1351.; DOI:10.1016/S0140-6736(02)08303-4