Monitor MEDICINE P R I C E. No. 11: July-September Uganda No. 11 July-September Uganda Country Working Group.

Transcription

1 No. 11: July-September 2013 Monitor MEDICINE P R I C E Uganda No. 11 July-September 2013 Uganda Country Working Group Ministry of Health World Health organisation HEPS Uganda HAI AFRICA Health Action International with support from

2 Monitor MEDICINE P R I C E Uganda ABBREVIATIONS AND ACRONYMS CSO DANIDA DHO DFID EMHS HAI HEPS HSSIP MeTA MoH MPR NGO NPSSP PFP PNFP WHO Civil Society Organization Danish International Development Agency District Health Officer Department for International Development Essential Medicines and Health Supplies Health Action International Coalition for Health Promotion and Social Development Health Sector Strategic and Investment Plan Medicines Transparency Alliance Ministry of Health Median Price Ratio Non-governmental organization National Pharmaceutical Sector Strategic Plan Private-for-Profit (health facility) Private-not-for-profit (health facility) World Health Organization 2

3 No. 11: July-September 2013 EXECUTIVE SUMMARY Price is the most predominant barrier to access to essential medicines. 1 Periodic monitoring of medicines is very important in determining if medicines are available and affordable to patients. In September 2013, MeTA Council of Uganda implemented a Medicine Availability and Price (MAP) survey of 40 essential indicator medicines. The survey was a quantitative process that used the traditional WHO/HAI methodology in 4 geographical regions (Eastern, Central, Western, and Northern) of Uganda across 3 health sectors (Public, Private and Mission) on price and availability. In total 120 facilities (taking into consideration urban and rural representation) were visited by a team of data collectors comprised of pharmacists/ pharmacy technicians and social scientists having bias in public health practice. The survey was managed by a Survey Manager who is a pharmacist. Key findings from the survey included: The overall availability of the surveyed medicines was 68% in the public facilities, 65% in private and 74% in mission facilities. A relatively bigger proportion of urban-based facilities had medicines available than rural-based facilities. At 30%, the difference was highest the private sector. 89% of the public and mission facilities had Artemether/Lumefantrine 20/120mg tablets physically available on the day of the survey compared to 75% of the private facilities. Medicines for the most common non-communicable diseases (diabetes and hypertension) were found available in less than 70% of the facilities across the three sectors. The public facilities had very low availability of paediatric formulations: amoxicillin suspension (11%), cotrimoxazole syrup (16%) and metronidazole syrup (45%). Medicine prices were comparable between urban and rural facilities in the private sector (MPR 1:1). 1 Ellen FM & Hoen T (2003): TRIPS, Pharmaceutical Patents and Access to Essential Medicines: Seattle, Doha and Beyond 3

4 Monitor MEDICINE P R I C E Uganda Medicines were 12% more expensive in urban than in rural mission facilities (MPR 1:1). Comparing mission and private sectors, there was no difference in the price of 25 of the 40 essential medicines surveyed. In the private and mission sectors, medicines for chronic conditions like asthma, depression, diabetes, hypertension and ulcers cost more than a day s wage for the lowest paid government worker in Uganda. However, the following conditions are affordable in both sectors by the lowest paid government worker: RTI (both adult and paediatric), anxiety, arthritis and pain/inflammation. 4

5 Table 3: No. Availability 11: of 40 essential July-September medicines across sectors Oct-Dec INTRODUCTION AND BACKGROUND 1.1 Introduction The Constitution of the World Health Organisation (1946) recognises access to medicines as a major component of the right to health. Therefore, periodic monitoring of medicine is very important in determining if medicines are available and affordable at the different levels in the distribution chain. One way of addressing the price barrier to access to essential medicines is by improving information flow through multi-stakeholder approaches that pool together diverse expertise. In Uganda, Ministry of Health (MOH), WHO and HAI Africa and its local partner HEPS Uganda through the Country Working Group (CWG) have since 2002 monitored medicine availability and prices. Medicines Transparency Alliance (MeTA) Uganda prioritised this activity in its work plan and funds were provided by the IMS. 1.2 Background Uganda is among the least developed countries of the world. A big percentage of the population still lives under a dollar a day. Its health statistics are among the worst in the world. An estimated 7% of the population is living with HIV, which has put an extra burden on the country s already weak public health system. It is estimated that only one third of the population has access to essential medicines. Price is one of the most predominant barriers to access to medicines. In developing countries, at a national level, the cost of medicines may account for up to 80% of non-salaried health expenditure, and at community level, the majority of people pay out-of-pocket for the medicines they consume. It is clear, therefore, that price is often a determining factor in whether the government can offer treatment to its population for a particular disease, or whether an individual receives a full treatment, an incomplete course, or no medicine at all. Until recently, there has been little information on what government or people paid for medicine. Data from the various surveys of the CWG have revealed that universal access to medicines has not been achieved and that medicines remain unaffordable for a significant section of the population. The results of these studies guide decisions on a strategy for improving affordability. 5

6 Monitor MEDICINE P R I C E Uganda The monitoring system generates regular information on price changes over time, and comparisons between the three sectors (public, private and mission) and four regions of the country. By informing consumers and procurement agencies about current prices and patterns of price changes, these series of surveys are an important complement to efforts to improve access to medicines for Ugandans, especially the poor and vulnerable. 1.3 Objectives of the survey By gathering and analysing comprehensive data on the prices of selected medicines in the four representative regions of Uganda and across three sectors (Public, Private for profit and private not for profit/ngo/mission), the survey aimed at achieving the following objectives: To determine the availability of selected medicines in the public, private and mission sectors; To compare the prices of selected medicines between the private and mission sectors; To determine the affordability of treating key indicator conditions to ordinary Ugandans; and To inform policy interventions aimed at improving access to essential medicines in Uganda 6

7 No. 11: July-September METHODOLOGY 2.1 Design The survey was conducted using the standard methodology co-developed by WHO and HAI 1. The survey used mainly quantitative methods to assess availability and prices of medicines in the public, private and mission sectors (See annex 2 for the survey tool). 2.2 Geographical areas The survey was conducted in four regions of Uganda (Central, Eastern, Western, and Northern). The four regions were chosen as a realistic representation of the diversity in epidemiological and geographical characteristics of the country. 2.3 Sectors and facilities The survey was conducted in three sectors: public, private (PFP) and mission (NGO/PNFP). All three contribute a significant proportion of health services in the country. The standard WHO/ HAI methodology recommends 30 outlets per sector for a survey to achieve enough data points for analysis. 2 The current survey targeted a total 120 facilities disaggregated as follows: 40 outlets per sector (20 rural and 20 urban) and in each region 10 per sector (5 rural and 5 urban). 2.4 Sampling strategy One hundred and twenty (120) facilities - 40 facilities per sector - were selected for the survey (see annex 1). In each region, the main regional referral hospitals (purposively selected), district hospitals and health centre IVs were selected to represent the public health sector facilities. Five licensed community pharmacies, 3 drug shops and 2 clinics located within 5 km of each of the selected public facilities were purposively selected to represent the private sector It is noted that a number of validation studies (in addition to the 9 pilot studies) were done during the original process of methodology development. The most important validation was on the sampling frame where it was found that sampling more regions, and those in areas greater than one days car travel from the capital, and in each area from more outlets a greater distance from the main hospital produced the same results as using the standard sampling frame. The adequacy of collecting data on just the originator brand and lowest generic equivalent was also studied again it was found there was no significant difference in the results. The volatility of MSH prices (used as an external bench-mark) have also been studied and little volatility has been found. A paper on validation has been published, and is cited as Madden JM, Meza E, Ewen M, Laing RO, Stephens P, Ross-Degnan D. Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology. Rev PanamSaludPublica. 010;27 (4):

8 Monitor MEDICINE P R I C E Uganda The NGO facilities with similar characteristics to public sector (e.g. mission hospitals of similar size and capacity to the regional, district and sub-district hospitals in the region) were purposively selected. The list of sites surveyed is attached (Annex 1). Urban and rural representation was taken into consideration when selecting. Urban areas were considered to be towns with a population of more than 50,000 and rural areas to at least 10 km away from the urban centres. 2.5 Medicines surveyed The selection of a basket of 40 essential medicines was based on the methodology s core and supplementary lists. The list was approved by the Pharmacy Division of Ministry of Health Uganda. 8

9 No. 11: July-September 2013 Table 1: Medicines surveyed No Medicine Strength Dosage form Category 1 Aciclor 200mg Tablet Antiviral 2 Albendazole 200mg Tablet Anthelmintic 3 Amitriptyline 25mg Tablet Antidepressant 4 Amoxicillin 250mg cap/tab Antibacterial 5 Amoxicillin 250mg/5ml Suspension Antibacterial 6 Artemether/Lumefantrine 20/120mg Tablet Antimalarial 7 Bendrofluazide 5mg Tablet Diuretic 8 Betamethasone 1% w/v cream/ointment Anti-inflammatory 9 Carbamazepine 200mg Tablet Antiepileptic 10 Ceftriaxone 1gm Powder for inj Antibacterial 11 Cimetidine 400mg Tablet Anti-ulcer 12 Ciprofloxacin 500mg Tablet Antibacterial 13 Co-trimoxazole 8/40 mg/ml Suspension Antibacterial 14 Co-trimoxazole mg Tablet Antibacterial 15 Dextrose 5% Injection Parenteral 16 Diazepam 5mg Tablet Anxiolytic 17 Diclofenac 50mg Tablet Analgesic 18 Doxycycline 100mg Capsule Antibacterial 19 Erythromycin 250mg Tablet Antibacterial 20 Fluconazole 200mg tab /cap Antifungal 21 Furosemide 40mg Tablet Diuretic 22 Gentamycin 80mg/ml Injection Antibacterial 23 Glibenclamide 5mg Tablet Antidiabetic 24 Mebendazole 100mg Tablet Anthelmintic 25 Metformin 500mg Tablet Antidiabetic 26 Methyergometrine 200ug/ml Injection Oxyticic 27 Metronidazole 200mg/5ml Suspension Antibacterial 28 Metronidazole 200mg Tablet Antibacterial 29 Nifedipine retard 20mg Tablet Antihypertensive 30 Nystatin iu Pessaries Antifungal 31 Omeprazole 20mg Capsule Antiulcer 32 Oral Rehydration Salt - Powder Antidiarrhoea (ORS) 33 Paracetamol 500mg Tablet Analgesic 34 Phenytoin 100mg Tablet Antiepileptic 35 Prednisolone 500mg Tablet Antiinflammatory 36 Pyrimethamine /sulfadoxide 25/500mg Tablet Antimalarial 37 Propranolol 40mg Tablet Antihypertensive 38 Quinine 300mg/5ml Injection Antimalarial 39 Salbutamol 0.1mg(100mcg)/dose Inhaler Antiasthmatic 40 Tetracycline 1% eye ointment Antibacterial 9

10 Monitor MEDICINE P R I C E Uganda 2.6 Personnel One pharmacist or pharmacy technician and one social scientist with bias in public health, from each of the 4 regions were trained on how to collect data. A pharmacist with bias in public health was recruited as the survey manager, took the responsibility of setting up and conducting the survey, supervising data collectors, analysing the data, and writing the report. An Expert Advisory Group guided the survey process through supporting the survey manager in setting up and conducting the survey; providing feedback on the survey findings and earlier drafts of this report; informing recommendations on policy options; and promoting the survey and its findings. Table 2: Advisory Group NAME TITLE, ORGANIZATION 1. Mr. Nazeem Mohamed Chief Executive Officer, Kampala Pharmaceutical Industries 2. JoanitaLwanyagaNamutebi Head Quality Assurance, Joint Medical Store 3.Ms. Rosette Mutambi Executive Director, HEPS Uganda 4. Ms. HellenByomire Head Drug Information, National Drug Authority 5. Mr. MorriesSeru Principle Pharmacist, Ministry of Health 6. Mr. SowediMuyingo CEO, Medical Access Uganda Limited 7. Mr. Joseph Mwoga National Professional Officer, WHO Uganda Country Office 8. Opio Sam Secretary, Pharmaceutical Society of Uganda 9. Fred Kitutu Lecturer School of Pharmacy, Makerere University 10. Denis Kibira Coordinator, MeTA Uganda 2.7 Data Collection Prior to data collection, all survey personnel participated in a training/briefing led by the survey manager. Data collectors were provided with introductory letters from Ministry of Health. At the district, data collectors introduced themselves and the purpose of the survey to the District Health Officer (DHO) before proceeding to collect data from the selected facilities. At the facility, for each medicine, data on prices and availability of the lowest product that was physically available on the day of the visit were collected using a standard data collection form. The collected data was delivered to the survey manager at the coordinating office physically or by courier or post. Data collectors retained a copy of their data collection forms in case there was need for further verification. The HEPS Uganda Secretariat in Namirembe, Kampala acted as the central coordinating office to support the logistics for the survey. 10

11 No. 11: July-September Data validation, entry, analysis and management The survey manager checked all the data collection forms for completeness and accuracy. Questionable entries were validated by contacting either the data collectors or the health facility or both. Validation of the data collection was conducted in 10% of the sampled outlets. This was done by calling the outlets using telephones contacts given on the data collection forms. Data analysis was done using a customised WHO/HAI Excel workbook. Tables, graphs were generated for the report. Availability was determined as a percentage of facilities having a particular medicine on the day of the survey. Median price ratios (MPR) were calculated to compare prices between mission and private facilities. The following conditions were used to gauge affordability of medicines: Diabetes, hypertension, asthma, acute respiratory infection (ARI), peptic ulcers and malaria. The earning of the government s lowest paid worker was used as a benchmark for affordability assessment. 11

12 Monitor MEDICINE P R I C E Uganda 3. RESULTS AND DISCUSSION 3.1 Availability Table 3 and Figure 1 below show the overall availability of medicines across the three sectors and comparison between rural and urban facilities. Table 3: Overall availability of medicines in the surveyed facilities Jul-Sep 2013 Public Private Mission Sector No. Facilities surveyed Median Availability (%) Overall Urban Rural Overall Urban Rural Overall Urban Rural The overall availability of the surveyed medicines was highest in the mission facilities (74%), followed by public (68%) 1 and lowest in private facilities (65%). Generally, urban facilities had the highest availability compared to the rural facilities across all sectors. Figure 1: Availability in Urban versus Rural facilities, Jul-Sept Availability ( %) Urban Rural Overall 10 0 Public Private Mission Sector 1 Compare with an average availability of 87% for 6 tracer medicines Ministry of Health (2012) reports in the National Performance Report on Medicines Management 12

13 No. 11: July-September 2013 There was a 2% difference in availability between urban and rural facilities in the public sector, 30% difference in the private sector and 19% in the mission sector. The big difference in availability between urban and rural facilities in the private sector can be attributed to the fact that drug shops and clinics are the most common drug outlets in the rural areas in Uganda and in urban areas pharmacies are the most predominant. According to NDA statute 1, drug shops are licensed to stock only Class C drugs whereas pharmacies stock all classes of drugs, and this could have affected availability of some medicines. a) Overall availability of the 40 essential medicines across the three sectors, Jul Sep 2013 Table 4 below compares overall availability of the 40 essential medicines surveyed across the public, private, and mission sectors. In the public sector, 45% (18/40) of the medicines were available in more than 75% the facilities and 35% (14/40) were in less than 50% of the facilities In the mission sector, 40% (16/40) of the medicines were found in more than 75% of the facilities surveyed, whereas 12.5% (5/40) were in less than 50%. In the private sector, 25% (10/40) of the medicines were in more than 75% of the facilities, whereas 15% (6/40) were in less than 50% of facilities. 1 National Drug Policy and Authority Act

14 Monitor MEDICINE P R I C E Uganda Table 4: Overall availability of 40 essential medicines across sector Medicine Overall availability (%) Public sector Private sector Mission Sector Aciclor tab 200mg Albendazole tab 200mg Amitriptyline tab 25mg Amoxicillin cap/tab 250mg Amoxicillin susp 250mg/5ml Artemether/Lumefantrine tab 20/120mg Bendrofluazide tab 5mg Betamethasone cream/ointment 1%w/v Carbamazepine tab 200mg Ceftriaxone 1g pwder for inj'n Cimetidine tab 400mg Ciprofloxacin tab 500mg Co-trimoxazolesusp 8/40 mg/ml Co-trimoxazole tab mg Dextrose 5% inj Diazepam tab 5mg Diclofenac tab 50mg Doxycycline cap/tab 100mg Erythromycin tab 250mg Fluconazole tab /cap 200mg Furosemide tab 40mg Gentamycin inj 80mg/ml Glibenclamide tab 5mg Mebendazole tab 100mg Metformin tab 500mg Methyergometrineinj 200ug/ml Metronidazole susp 200mg/5ml Metronidazole tab 200mg Nifedipine retard tab 20mg Nystatinpessaries iu Omeprazole cap 20mg Oral Rehydration Salt (ORS) Paracetamol tab 500mg Phenytoin tab 100mg Prednisolone tab 500mg Pyrimethamine /sulfadoxide (SP) tab 25/500mg Propranolol tab 40mg Quinimeinj 300mg/5ml Salbutamol inhaler 0.1mg(100mcg)/dose Tetracycline eye ointment 1%

15 No. 11: July-September 2013 b) A comparison of overall availability of selected anti-malarial medicines across the three sectors: Figure 2 below compares the overall availability of artemether/lumefantrine 20/120mg and Sulfadoxine/Pyrimethamine used for treating uncomplicated malaria and prophylaxis of malaria during pregnancy respectively, across the three health sectors. Figure 2: Comparison of overall availability of medicines for malaria across sectors Availability ( %) Artemether/Lumefantrine Sulphadoxine/Pyrimethamine -malarial medicines Public Private Mission 89% of the public and mission facilities had Artemether/Lumefantrine tablets 20/120mg in stock on the day of the visit compared to 75% of the private facilities. Sulphadoxine/Pyrimethamine had the highest availability of 79% in the public facilities followed by mission (71%) and lowest in the private at 63%. 15

16 Monitor MEDICINE P R I C E Uganda c) A comparison of overall availability of selected anti-diabetic medicines across the three sectors Figure 3 below compares the overall availability of Glibenclamide 5mg and Metformin 500mg used in management of diabetes, across the three health sectors Figure 3: Comparison of overall availability of medicines for diabetes across sectors Availability ( %) Public Private Mission 10 0 Glibenclamide 5mg - At least 60% of facilities in the public, private and mission sectors had Metformin 500mg in stock on the day of the survey. Glibenclamide 5mg was less available in the public sector (45%), but more available in the mission sector (80%). 16

17 No. 11: July-September 2013 d) A comparison of overall availability of selected anti-hypertensive medicines across the three sectors Figure 4 below compares the overall availability of Nifedipine 20mg and propranolol used in management of hypertension, across the three health sectors. Fig. 4: Comparison of overall availability of medicines for hypertension across sectors Availability ( %) Public Private Mission 10 0 Nifedipine 20mg -hypertensive medicines Propranolol The public sector had the highest availability of Nifedipine 20mg (79%) and lowest availability of propranolol (39%) compared to other sectors. 17

18 Monitor MEDICINE P R I C E Uganda e) A comparison of overall availability of selected paediatric formulations across the three sectors Figure 4 below compares the overall availability of selected medicines formulated for paediatric use across the three health sectors Figure 5: Comparison of overall availability of paediatric formulations across sectors Availability ( %) Public Private Mission 0 Amoxicillin susp Cotrimoxazole susp Metronidazole susp The Public sector had the lowest availability of appropriate paediatric formulations: amoxicillin suspension 125mg/5ml in 11% of facilities, cotrimoxazole syrup 8/40mg in 16% and metronidazole syrup in 45% of public facilities. 18

19 No. 11: July-September Medicine prices Table 5: Comparison of medicine median price ratios between and within private and mission sectors. PrivUrb/PrivRural MisUrb/MisRural PrivUrb/MisUrb PrivRural/ MisRural No. of times more expensive No. of Pairs Compared As shown in table 5 above, the prices charged to consumers for medicines in the private facilities were comparable across urban and rural facilities (ratio 1:1). However, in the mission facilities medicines were 12% more expensive in the urban than rural facilities (ratio 1:1.12). Medicine prices were comparable between urban private and mission facilities and in rural private and mission facilities (ratio 1:1). Table 6 below shows the median consumer prices per unit of selected medicines in the private and mission facilities. There was no difference in price of 25 of the medicines between mission and private facilities. A marked 50% and above price difference between prices in the private and mission sectors were noted for Mebendazole 100mg, Diclofenac 50mg, carbamazepine 200mg, Albendazole 200mg, Artmetther/Lumefantrine 20/120mg and Prednisolone tablets. More information on prices is in annex 2. 19

20 Monitor MEDICINE P R I C E Uganda Table 6: Median unit price of the 40 medicines in the private and mission facilities Median unit price (Ushs.) Medicine PRIVATE SECTOR MISSION SECTOR % price difference Aciclor tab 200mg Albendazole tab 200mg Amitriptyline tab 25mg Amoxicillin cap/tab 250mg Amoxicillin susp 250mg/5ml Artemether/Lumefantrine tab 20/120mg Bendrofluazide tab 5mg Betamethasone cream/ointment 1%w/v Carbamazepine tab 200mg Ceftriaxone 1g pwder for inj'n Cimetidine tab 400mg Ciprofloxacin tab 500mg Co-trimoxazolesusp 8/40 mg/ml Co-trimoxazole tab mg Dextrose 5% inj Diazepam tab 5mg Diclofenac tab 50mg Doxycycline cap/tab 100mg Erythromycin tab 250mg Fluconazole tab /cap 200mg Furosemide tab 40mg Gentamycin inj 80mg/ml Glibenclamide tab 5mg Mebendazole tab 100mg Metformin tab 500mg Methyergometrineinj 200ug/ml Metronidazole susp 200mg/5ml Metronidazole tab 200mg Nifedipine retard tab 20mg Nystatinpessaries iu Omeprazole cap 20mg Oral Rehydration Salt (ORS) Paracetamol tab 500mg Phenytoin tab 100mg Prednisolone tab 500mg Pyrimethamine /sulfadoxide (SP) tab 25/500mg Propranolol tab 40mg Quinimeinj 300mg/5ml Salbutamol inhaler 0.1mg(100mcg)/dose Tetracycline eye ointment 1%

21 No. 11: July-September 2013 d) Affordability Affordability was calculated as the number of days the lowest paid government worker would have to pay for one treatment course of an acute condition or one month s treatment of a chronic condition. Treatments less than or equal to one days wages are considered affordable. The monthly earning of the lowest paid government worker is UShs. 222,976 (U8L) before tax, and after tax it is Ushs. 156,083. This gives daily wage of about 5200 (2.00 US$) as take home. Table 7 below shows the number of days it would take the lowest paid government worker to pay for treatment of the most common diseases in the private and mission sectors. Table 7: Affordability (Daily wage of lowest paid government worker is Ushs. 5200) Condition Select Medicine Treatment duration (in days) # of units per treatment MTP (Ushs.) Private Mission Private (MTP/5200) Days' wages Mission (MTP/5200) Adult Malaria Artemether/ Lumefantrine tab 20/120mg Amoxicillin cap/tab 250mg Adult RTI Ceftriaxone 1g pwder for inj'n Ciprofloxacin tab 500mg Anxiety Diazepam tab 5mg Arthritis Diclofenac tab 50mg Salbutamol inhaler Asthma 0.1mg/dose as need Depression Amitriptyline tab 25mg Diabetes Glibenclamide tab 5mg Hypertension Nifedipine retard tab 20mg Paediatric RTI Co-trimoxazolesusp 8/40 mg/ml Pain/ Inflammation Paracetamol tab 500mg Ulcer Omeprazole cap 20mg In both the private and mission sectors medicines for treatment of chronic conditions like asthma, depression, diabetes, hypertension and ulcers cost more than a day s wage. 21

22 Monitor MEDICINE P R I C E Uganda 4. CONCLUSION The overall availability of the surveyed medicines was 68% in the public facilities, 65% in private and 74% in mission facilities More of urban based facilities had medicines available than rural, a big difference of 30% being in the private sector 89% of the public and mission facilities had Artemether/Lumefantrine 20/120mg tablets physically available on the day of the survey compared to 75% of the private Medicines for the most common non-communicable diseases (diabetes and hypertension) were found available in less than 70% of the facilities across the 3 sectors The public facilities had a very low availability of paediatric formulations: amoxicillin suspension (11%), cotrimoxazole syrup (16%) and metronidazole syrup (45%) Medicine prices were comparable between urban and rural facilities in the private sector (median price ratio). However, medicines were 12% more expensive in urban than rural mission facilities There was no difference in price of 25 out of the 40 essential medicines surveyed between mission and private facilities In the private and mission sector, medicines for chronic conditions like asthma, depression, diabetes, hypertension and ulcers cost more than a day s wage for the lowest paid government worker in Uganda. However, the following conditions are affordable in both sectors by the lowest paid government worker: RTI (both adult &paediatric), anxiety, arthritis and pain/inflammation 22

23 No. 11: July-September 2013 References Uganda: Health Sector Strategic Investment Plan 2010/ /15 Madden JM, Meza E, Ewen M, Laing RO, Stephens P, Ross-Degnan D. Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology. Rev PanamSaludPublica. 010;27 (4):291 9 MeTA Uganda Work Plan, 2012 Ministry of Health 2008b.Access to and use of medicines by Households in Uganda, Report. Kampala, Uganda. Ministry of Health, 2002.Pharmaceutical Baseline Survey, Report. Kampala, Uganda. Ministry of Health, 2008a.Pharmaceutical Situation Assessment, Report. Kampala, Uganda. Ministry of Health, WHO, HAI (HEPS) Medicine Price Monitor Volume 1-8. Kampala, Uganda. Ministry of Health.MoH., 2008.Access to and use of medicines by households in Uganda. Kampala: Ministry of Health.MoH. World Health Organisation, Health Financing: A basic guide. WHO; Western Pacific Region. 23

24 Monitor MEDICINE P R I C E Uganda Annex 1: Monitoring Availability and Prices of Medicine in Uganda: List of facilities August, 2013 REGION MISSION (40) PUBLIC (40) PRIVATE (40) urban (20) rural (20) urban (20) rural (20) urban (20) rural (20) Eastern Region 1.Kamuli mission Hospital 2.Islamic University HC Mbale 3.Ahmadiya HC Mbale 4.St- Austin HC Mbale Northern 1.St Mary s Hospital LacorGulu 2.PAG health unit Lira 3.Amuca dispensary Lira 4.Ngeeta hospital Lira 1.Irapa church of God HU Kamuli 2.St Francis Buluba hospital Mayuge 3. Kolonyi health centrembale 1.Amai hospital Lira 2.Opit HC 3.Aloi HC Lira 4. Aliwang HC Lira 5.Alanyi HC Lira 1.Jinja Regional Ref hospital 2.Mbale regional Ref hospital 3.Iganga hospital 4.Kamuli Govt hospital 5.Pallisa hospital 1.Gulu regional Ref hospital 2. Lira regional Ref hospital 3.Amaka hospital Gulu 1.Walukuba HC 2. Buwenge HC jinja 3. Budadiri HC Mbale 4. Bubulo HC Mbale 5. Bududa hospital 1.Ogur HC 2.Amuc HC Lira 3. Dokolo HC 4. Lalogi HC Gulu 1.Gilead pharmacy 2.Rana medical center 3.Sky pharmacy Mbale 1.Feliesta pharmacy Lira 2.Gulu independant hospital 3. Opios clinic Gulu 4.Kakanyero pharmacy Gulu 2 clinics 3 Drug shops 2 clinics 3 Drug shops Central 1.Nsambya hospital 2.Rubaga hospital 3.Mengo hostal 4.Kisubi hospital 1.Nkokonjeru hosptal 2.Mukono Hospital 3.Nagalama hospital 4.St.Stephens dispensary Mpererwe 5.Makonge community HC Mukono 1.Mulago hospistal 2.Butabika hospital 3.Entebbe grade B hospital 4.Makerere University hospital 1.Kayunga hospital 2.Kawolo hospital 3.Mukono HC 4 4. Gombe hospital or any HC 4 1.Frosa pharmacy Nakulabye 2.Genesis pharmacy Luzira 3.Bugolobi maternity 4.Case clinic 4.Kadic clinic 2 clinics 3 Drug shops Western 1.Ibanda Hospital 2.Ishaka Hospital 3.Ruharo hospital 4.Kisizi Hospital 1.Nyakibale Hospital Rukugiri 2.Kyamuhanga Hospital Bushenyi 3.Rushere hospital Mbarara 4.Nyakishenyi HC4 1.Mbarara Reg Hosp 2.Kitagata Hospital Bushenyi 3.Itojo Hospital 4.Kambuga Hospital Rukungiri 1.Nakivule HC 4 2.Ishongorera HC 4 3.Nshengezi HC 4 4.Bwizibwera 1..Mayanja memorial 2.Mbarara Community 3.Multiple pharmacist 4.Muilticare pharcacy 2 clinics 3 Drug shops 24

25 No. 11: July-September 2013 Annex 2: Monitoring Prices and Availability of Medicines in Uganda: Data Collection Form August 2013 Facility Name: Address of facility : Facility Telephone: Facility Fax: Facility Facility Code: Type of health facility (Tick): Public Mission Private Region: District: Setting (Tick): Urban Rural Data collector Name : Mobile: Date of data collection: (DD/MM/ YYYY) / / INSTRUCTIONS 1. Facility information: Make sure that you fill all cells of the above table. If fax or don t exist put N/A to indicate not available 2. Identifying products for price monitoring: Identify products with theexact strength and dosage form for each medicine listed that are physically available for sale or dispensing on the day of the data collection Make sure that you do not mistakenly include products that are of different strengths or formulations (e.g. slow release tablet instead of regular tablet; or nasal spray instead of inhaler; or combination products which include another active ingredient) Do not write down price information if the correct product is not physically available in the health facility on the day of data collection. Put N/A under product name to indicate not available 3. Recording data for price monitoring: You MUST write down the product name (that is trade name or brand name), the name and country of the manufacturer, actual pack size and pack price found for the product with the lowest price Discounts: Record discount as % and the discounted price only when same discount is available for all patients If medicines are free to patients like in the public sector facilities, record all product details and write 0 in the Pack Price cell 4. Calculating the unit or pack price: For products where pack price is given; divide the pack price by the pack size found (pack price/pack size) to get unit price and write it down up to four decimals (e.g ) in the Unit Price cell. For products where unit price is given; multiply the unit price by the pack size found (unit price x pack size) to get pack price and write it in the pack size cell If the discount is applied for all patients, then calculate the unit price from the discounted pack price only. 5. Final steps: Please check that all data is correctly recorded and double check unit price calculations before sending the data collection forms to the Survey Manager Send completed data collection forms by courier or hand deliver as soon as possible to: HEPS-Uganda, P.O. Box 2426, Kampala, Balintuma Road, Mengo If you have any questions please phone the survey manager (GildoOkure) at or to odufford@gmail.com 25

26 Monitor MEDICINE P R I C E Uganda Medicine name, dosage form, strength Aciclovir tab 200mg Albendazole tab 200mg Amitriptyline tab 25mg Amoxicillin cap 250mg Amoxicillin Susp 125mg/5ml Artemether/ Lumefantrine tab 20/120mg Bendruofluazide tab 5mg Betamethasone cream/ointment 1% w/v Carbamazepine tab 200mg Ceftriaxone 1g powder for inj Cimetidine tab 400mg Ciprofloxacin tab 500mg Product of interest price price Available? ( Yes or N/A ) Product name (brand / trade name) Manufacturer, country of manufacture Pack size found Pack price Unit price (4 digits) Discount for all? Yes % /cap % /ml % /gram % /vial % Discounted pack price Comments and observations 26

27 No. 11: July-September 2013 Medicine name, dosage form, strength Cotrimoxazole Susp 40/200mg/5ml Cotrimoxazole tab 480mg Dextrose 5% inj Diazepam tab 5mg Diclofenac tab 50mg Doxyclycline cap 100mg Erythromycin tab 250mg Fluconazole tab / cap 200mg Furosemide tab 40mg Gentamycin inj 80mg/2ml Glibenclamide tab 5mg Mebendazole tab 100mg Product of interest price price Available? ( Yes or N/A ) Product name (brand / trade name) Manufacturer, country of manufacture Pack size found Pack price Unit price (4 digits) Discount for all? Yes % /ml % /bottle % /cap % / cap % /Amp % Discounted pack price Comments and observations 27

28 Monitor MEDICINE P R I C E Uganda Medicine name, dosage form, strength Metformin tab 500mg Methyergometrineinj 200μg/ml Metronidazole Susp 200mg/5ml Metronidazole tab 200mg Nifedipine retard tab 20mg Nystatinpessaries 100,000 I.U. Omeprazole cap 20mg Oral Rehydration Salt (ORS) Paracetamol tab 500mg Phenytoin tab 100mg Prednisolone tab 5mg Product of interest price price Available? ( Yes or N/A ) Product name (brand / trade name) Manufacturer, country of manufacture Pack size found Pack price Unit price (4 digits) Discount for all? Yes % /Amp % /ml % /cap % /sach % Discounted pack price Comments and observations 28

29 No. 11: July-September 2013 Medicine name, dosage form, strength Pyrimethamine/ Sulfadoxine tab 25/500mg Propranolol tab 40mg Quinine inj 300mg/2ml Salbutamol inhaler 0.1mg/ dose Tetracycline eye ointment 1% Product of interest Available? ( Yes or N/A ) Product name (brand / trade name) Manufacturer, country of manufacture Pack size found Pack price Unit price (4 digits) Discount for all? Yes % /Amp % /can % /gram % Discounted pack price Comments and observations 29

30 Monitor MEDICINE P R I C E Uganda Annex 3: Availability of the 40 medicines in Urban versus Rural facilities across the sectors Medicine Urban Rural Public Private Mission Public Private Mission Aciclor tab 200mg 53% 80% 81% 47% 50% 68% Albendazole tab 200mg 26% 45% 38% 47% 15% 53% Amitriptyline tab 25mg 100% 95% 94% 89% 45% 74% Amoxicillin cap/tab 250mg 89% 100% 100% 79% 70% 84% Amoxicillin susp 250mg/5ml 11% 85% 88% 11% 65% 63% Artemether/Lumefantrine tab 20/120mg 89% 85% 81% 89% 65% 95% Bendrofluazide tab 5mg 68% 80% 88% 74% 25% 53% Betamethasone cream/ointment 1%w/v 16% 65% 44% 47% 55% 42% Carbamazepine tab 200mg 79% 85% 94% 84% 45% 53% Ceftriaxone 1g pwder for inj'n 84% 85% 94% 68% 50% 74% Cimetidine tab 400mg 0% 50% 25% 16% 25% 42% Ciprofloxacin tab 500mg 84% 95% 100% 79% 70% 89% Co-trimoxazolesusp 8/40 mg/ml 11% 70% 75% 21% 60% 42% Co-trimoxazole tab mg 84% 80% 81% 95% 80% 89% Dextrose 5% inj 95% 60% 75% 74% 55% 79% Diazepam tab 5mg 95% 90% 81% 95% 70% 68% Diclofenac tab 50mg 68% 90% 88% 47% 100% 79% Doxycycline cap/tab 100mg 79% 80% 100% 74% 60% 100% Erythromycin tab 250mg 63% 80% 94% 63% 50% 68% Fluconazole tab /cap 200mg 26% 65% 56% 37% 10% 42% Furosemide tab 40mg 47% 85% 75% 74% 25% 58% Gentamycin inj 80mg/ml 58% 70% 88% 32% 55% 74% Glibenclamide tab 5mg 58% 85% 75% 53% 20% 53% Mebendazole tab 100mg 74% 90% 69% 79% 85% 84% Metformin tab 500mg 79% 90% 88% 63% 35% 47% Methyergometrineinj 200ug/ml 42% 30% 56% 47% 10% 47% Metronidazole susp 200mg/5ml 42% 45% 69% 47% 55% 58% Metronidazole tab 200mg 95% 95% 94% 89% 90% 100% Nifedipine retard tab 20mg 79% 90% 88% 79% 35% 63% Nystatinpessaries iu 5% 75% 81% 21% 60% 47% Omeprazole cap 20mg 74% 85% 94% 58% 85% 74% Oral Rehydration Salt (ORS) 95% 90% 88% 84% 70% 89% Paracetamol tab 500mg 100% 95% 100% 79% 100% 100% Phenytoin tab 100mg 68% 50% 69% 84% 20% 47% Prednisolone tab 500mg 16% 95% 94% 16% 55% 58% Pyrimethamine /sulfadoxide (SP) tab 25/500mg 84% 65% 69% 74% 60% 74% Propranolol tab 40mg 37% 85% 88% 42% 45% 53% Quinimeinj 300mg/5ml 63% 60% 88% 26% 65% 63% Salbutamol inhaler 0.1mg(100mcg)/dose 5% 60% 50% 16% 25% 26% Tetracycline eye ointment 1% 84% 85% 63% 95% 35% 74% 30

31 No. 11: July-September 2013 Annex 4: Median unit price of the 40 medicines in the urban versus rural facilities Medicine Urban Rural Private Mission % price diff. Private Mission % price diff. Aciclor tab 200mg Albendazole tab 200mg #VALUE! Amitriptyline tab 25mg Amoxicillin cap/tab 250mg Amoxicillin susp 250mg/5ml Artemether/Lumefantrine tab 20/120mg Bendrofluazide tab 5mg Betamethasone cream/ointment 1%w/v Carbamazepine tab 200mg Ceftriaxone 1g pwder for inj'n Cimetidine tab 400mg Ciprofloxacin tab 500mg Co-trimoxazolesusp 8/40 mg/ml Co-trimoxazole tab mg Dextrose 5% inj Diazepam tab 5mg Diclofenac tab 50mg Doxycycline cap/tab 100mg Erythromycin tab 250mg Fluconazole tab /cap 200mg #VALUE! Furosemide tab 40mg Gentamycin inj 80mg/ml Glibenclamide tab 5mg Mebendazole tab 100mg Metformin tab 500mg Methyergometrineinj 200ug/ml #VALUE! Metronidazole susp 200mg/5ml Metronidazole tab 200mg Nifedipine retard tab 20mg Nystatinpessaries iu Omeprazole cap 20mg Oral Rehydration Salt (ORS) Paracetamol tab 500mg Phenytoin tab 100mg Prednisolone tab 500mg Pyrimethamine /sulfadoxide (SP) tab /500mg Propranolol tab 40mg Quinimeinj 300mg/5ml Salbutamol inhaler 0.1mg(100mcg)/dose Tetracycline eye ointment 1%

32 For more information contact: HEPS-Uganda Coalition for Health Promotion & Social Development Plot 351A, Balintuma Road, Namirembe P.O. Box 2426, Kampala, Uganda Tel: Web: This work is licensed under 32