Price, availability and affordability of antineoplastic medicines in Harare’s public and private institutions: implications for access.
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Date
2020
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Abstract
Background: Antineoplastic medicines are increasingly becoming more vital in many public
health setups. There has been significant progress made in terms of newer molecules since the
advent of chemotherapy. Despite the importance of antineoplastic medicines and advent of
these molecules, there are still issues of limited availability and affordability in Zimbabwe.
Currently the country has no government initiated policies on pricing and accessibility of
antineoplastic medicines in public and private institutions, placing health care consumers at
risk. A study was therefore designed to assess the price, availability and affordability of
antineoplastic medicines in Harare Province, Zimbabwe.
Methods: The study was based on the standardised method recommended by the World Health
Organisation (WHO) and Health Action International (HAI). A data collection form-based
cross-sectional survey was conducted in public and private medicine outlets. A total of 153
facilities were surveyed. The facilities consisted of three (3) public institutions and one hundred
and fifty (150) private pharmacies in Harare and surrounding towns. The percentage
availability, median price ratio using International Reference Prices, mark-ups, price and
affordability of antineoplastic medicines were determined. Affordability was determined by
using the wage of the lowest paid government worker which was USD296 per month.
Median price ratios were calculated for twenty-two (22) of the antineoplastic medicines that
were imported into the country from the import records at the Medicines Control Authority and
also appearing on the medicines register for private pharmacies and seven (7) medicines for
the public hospital pharmacies. The WHO’s International Reference Prices were used for
calculation of median price ratios. Range, mode and average mark-up percentages for the
antineoplastic medicines were also determined. Availability and price in the public sector was
compared to availability in the private sector. Affordability was calculated as the out-of-pocket
day’s wages to buy a monthly cycle of the antineoplastic medicine.
Results: The percentage availability of the antineoplastic medicines at the government
institutions was 25%, whilst the percentage availability of the antineoplastic medicines in the
private sector ranged from 1% to 42.7%. Fifty percent of the twenty-two (22) medicines in the
private sector had a median price ratio of lower than 4. The median price ratio in the private
sector ranged from 0.60 to 11. Median price ratios were calculated for seven (7) medicines in
the public sector. The median price ratio in the public sector ranged from 0.73 to 2.25. Eleven
(11) of the medicines in the private sector were affordable with ten (10) days wage and below.
Eight of the medicines were slightly affordable with wage days more than 10 days wage but
less than 20 days wage. Wage days in private sector ranged from 1 day to 490 days.
Affordability of the medicines in the public sector ranged from 1 to 10 days wage. Average
percentage mark-up was 51.3% in the private sector and 34% in the public sector for the
medicines that were available.
Conclusion: Medicines were generally more available in the private sector than in the public
sector. The government needs to continue supporting the National Pharmaceutical Company’s
procurement of antineoplastic medicines. Generally medicines were more affordable in the
public sector than in the private sector. The high percentage mark-ups calculated in the private
sector compared to the public sector are as a result of the overhead expenses in private
pharmacies which have to be borne from the actual sales of the medicines unlike in the public
sector were the services are subsidised by the government. The low availability of
antineoplastic medicines coupled with a very high unemployment rate means there is a huge
burden on accessibility of antineoplastic medicines in Harare. Most patients cannot afford
antineoplastic medicines which can result in increased mortality. There is a need to subsidise
the medicines to improve accessibility. This will reduce the out-of-pocket expenses made by
patients. There is a need to also ensure that medical insurance in Zimbabwe allow all
pharmacies to retail antineoplastic medicines instead of the selective incorporation of
pharmacies into their health insurance schemes. The calculated median price ratios range
showed that the prices of the medicines are varied and there is need to have medicine
procurement and pricing policies that minimise the median price ratio to lower than 5 for all
antineoplastic medicines.
Description
Masters Degree. University of KwaZulu-Natal, Durban.