This section provides metadata for the data reported for this indicator at the national level and at the global level.
- Goal
Goal 3: Ensure healthy lives and promote well-being for all at all ages
- Target
Target 3.b: Support the research and development of vaccines and medicines for the communicable and non‑communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all
- Indicator
Indicator 3.b.3: Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis
- Series
- Related indicators
3.b.1- Proportion of the target population covered by all vaccines included in their national programme
3.b.2- Total net official development assistance to medical research and basic health sectors
3.8.1-Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, new born and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population)
3.8.2-Proportion of population with large household expenditures on health as a share of total household expenditure or income
- Custodian agencies
World Health Organization (WHO)
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Organisation | Not available for this indicator |
World Health Organization (WHO) |
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Contact email address | Not available for this indicator |
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Definition and concepts | Not available for this indicator |
Definition: Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis. The indicator is a multidimensional index reported as a proportion (%) of health facilities that have a defined core set of quality-assured medicines that are available and affordable relative to the total number of surveyed health facilities at national level. Concepts: Indicator 3.b.3 is defined as the “Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis”.This indicator is based on the proportion of facilities (pharmacies, hospitals, clinics,primary care centers, public/private, etc.) where core essential medicines from the identified set are available for purchase and their prices are affordable, compared to the total number of facilities surveyed. There are several core concepts that are used for measuring indicator 3.b.3:
→to define affordability, additional concepts are used:
→to apply a core set of relevant essential medicines defined on a global level to all countries, an additional concept is used:
1)A medicine is available in a facility when it is found in this facility by the interviewer on the day of data collection. Availability is measured as a binary variable with 1=medicine is available and 0=otherwise. 2) A medicine is affordable when no extra daily wages (EDW) are needed for the lowest paid unskilled government sector worker (LPGW wage) to purchase a monthly dose treatment of this medicine after fulfilling basic needs represented by the national poverty line (NPL). Affordability is measured as a ratio of 1) the sum of the NPL and the price per daily dose of treatment of the medicine (DDD), over 2) the LPGW salary. This measures the number of extra daily wages needed to cover the cost of the medicines in the core set and that can vary between 0 and infinity. 2.a) Daily dose of treatment (DDD) is an average maintenance dose per day for a medicine used for its main indication in adults.2 DDDs allow comparisons of medicine use despite differences in strength, quantity or pack size. 2.b) National poverty line (NLP) is the benchmark for estimating poverty indicators that are consistent with the country's specific economic and social circumstances. NPLs reflect local perceptions of the level and composition of consumption or income needed to be non-poor. 2.c) Wage of the lowest paid unskilled government worker (LPGW is a minimum living wage that employees are entitled to receive to ensure overcome of poverty and reduction of inequalities. In other words, affordability of a medicine identifies how many (if any) extra daily wages are needed for an individual who earns the LPGW wage to be able to purchase a medicine. The computed EDW ratio aims to indicate whether the LPGW wage is enough for the individual who earns the lowest possible income to cover 1) the daily expenditures for food and non-food items used to define (relative or absolute) poverty using national standards (NPL) and 2) the daily needs for a medicine (DDD). This ratio then requires transformation into a binary variable where medicine is affordable when zero extra daily wages are required to purchase it and not affordable otherwise. 3)The core set of relevant essential medicines is a list of 32 tracer essential medicines for acute and chronic, communicable and non-communicable diseases in the primary health care setting. This basket of medicines has been selected from the 2017 WHO Model List of Essential Medicines and used in primary health care. By definition, essential medicines are those that satisfy the priority health care needs of the population and are selected for inclusion on the Model List based on due consideration of disease prevalence, evidence of efficacy and safety, and consideration of cost and cost-effectiveness. These medicines are listed in table 1 of Annex 1, where a detailed justification for including each medicine is also provided, as well as online references for the relevant treatment guidelines and sections in the WHO List of Essential Medicines. This list of medicines is intended as a global reference. However, to address regional and country specificities in terms of medicine needs, the medicines in this basket are weighted according to the regional burden of disease. 3.a) The global burden of disease is an assessment of the health of the world's population. More specifically, disease burden provides information on the global and regional estimates of premature mortality, disability and loss of health for causes. The summary measure used to give an indication of the burden of disease is the disability adjusted life years (DALYs), which represent a person’s loss of the equivalent of one year of full health. This metric incorporates years of life lost due to death and years of life lost through living in states of less than full health (or disability). |
Unit of measure | Not available for this indicator |
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Classifications | Not available for this indicator |
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Data sources | Not available for this indicator |
The indicator relies on three data sources that have been used by countries to collect information on medicine prices and availability:
Health Action International Project supported by WHO [HAI/WHO] provides data from national and sub-national surveys that have used the WHO/HAI methodology, Measuring Medicine Prices, Availability and Affordability and Price Components. The database is available at the following link: http://haiweb.org/what-we-do/price-availability-affordability/price-availability-data/ The Service Availability and Readiness Assessment [SARA] is a health facility assessment tool designed to assess and monitor availability and readiness of the services provided in the health sector and to generate evidence to support the planning and managing of a health system. The WHO Medicines Price and Availability Monitoring mobile application [EMP MedMon] can be considered as an updated version of the HAI/WHO tool for collecting data on medicine prices and availability. This data collection tool was created based on the two previously mentioned existing and well-established methodologies. This application is used at facility level to collect information on availability and price of the agreed-upon core basket of medicines. The EMP MedMon is easier to use, faster to conduct and consumes much fewer resources for collecting data. It also allows for a modular approach to defining the basket, which is highly useful and convenient for the purposes of this indicator. In order to compute historical data points prior to 2018, data from HAI/WHO is used. To compute current and future data points, SARA and EMP MedMon are recommended |
Data collection method | Not available for this indicator |
Availability and affordability of medicines WHO obtains SARA survey data on availability and affordability from the countries’ Ministries of Health (MoH). HAI/WHO historical data collected at the facility level is available from HAI by request, as publicly available HAI/WHO data on the HAI website has already aggregated at the country level. The EMP MedMon data on availability and medicine prices is collected in collaboration between WHO and Ministries of Health of the countries. NPLs, LPGW wages, DALYs: National poverty reports consistently provide information on the NPLs in local currency units. The updated and recalculated NPLs are also published by the countries in these poverty reports. The wage of the LPGW is published in the ILOSTAT database. Information regarding the regional burden of diseases (DALYs) is publicly available and published by WHO. |
Data collection calendar | Not available for this indicator |
SARA & HAI/WHO: Data collection activities have often been conducted using funds from international donors. EMP MedMon: Data collection activities have been conducted using funds from international donors, but WHO is currently testing a sustainable regular monitoring mechanism through the integration of similar data collection during government inspection of health facilities or using country-determined sentinel monitoring sites. |
Data release calendar | Not available for this indicator |
Based on historical data points, the first release of the SDG indicator 3.b.3 results is planned for the summer of 2019. Subsequently, updated values will be calculated and published on an annual basis. |
Data providers | Not available for this indicator |
SARA, HAI/WHO, EMP MedMon: Data is collected by the countries’ Ministries of Health (MOH), often with the support of the WHO country office. Data is then validated by MoH-based statisticians and shared with WHO by request. |
Data compilers | Not available for this indicator |
The World Health Organization |
Institutional mandate | Not available for this indicator |
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Rationale | Not available for this indicator |
Measurement and monitoring of access to essential medicines are of high priority for the global development agenda given access is an integral part of the Universal Health Coverage movement and an indispensable element of the delivery of quality health care. Access to medicines is a composite multidimensional concept that is composed of the availability of medicines and the affordability of their prices. Information on these two dimensions has been collected and analysed since the 54th World Health Assembly in 2001, when Member States adopted the WHO Medicines Strategy (resolution WHA54.11). This resolution led to the launch of the joint project on Medicine Prices and Availability by WHO and the international non-governmental organization Health Action International (HAI/WHO), as well as a proposed HAI/WHO methodology for collecting data and measuring components of access to medicines. To this day, this methodology has been widely implemented to produce useful analyses of availability and affordability of medicines, however the two dimensions have been evaluated separately. While the above approach has provided an overview of the countries’ performance and progress on improving the affordability and availability of medicines, it has not allowed evaluation of overall access to medicines. This evaluation is in turn essential as country’s success in ensuring one of the dimensions (e.g. availability) does not necessarily indicate the realization of the other (e.g. affordability) and vice versa. For example, a country may focus its policy efforts on ensuring the availability of a core set of essential medicines in the event of low capacity of local production and/or challenges associated with geographic location. As a result of the proposed policies, medicines may become available but their prices may not be affordable. The opposite situation is also possible, as lowering prices of medicines to increase affordability may be too restrictive for some pharmaceutical producers and lead to a decreased supply. Therefore, given the multidimensionality of access to medicines, it is necessary to evaluate both affordability and availability of medicines at the same time. The proposed methodology for indicator 3.b.3 allows the combination of both dimensions into a single indicator to evaluate the availability and affordability of medicines simultaneously. This methodology also allows for disaggregation so that each dimension can be analysed separately and the main driver of poor performance of the overall index can be properly identified. Monitoring the core set of relevant essential medicines is based on the WHO Model List of Essential Medicines (EML). The 2017 WHO EML contains 433 medications deemed essential for addressing the most important public health needs globally. The current index is computed based on a subset of 32 tracer essential medicines for the treatment, prevention and management of acute and chronic, communicable and non-communicable diseases in a primary health care setting. |
Comments and limitations | Not available for this indicator |
Furthermore, given the data collection occurs at the facility level and does not monitor quantities of any given medicine, an overall analysis of the available medicines compared to the national needs is not possible.
The ex-ante approach is suggested for the purposes of this indicator as it is measured at the facility level. Ex-ante analysis requires identifying a reference person or group of people for the measurement. The lowest paid unskilled government worker is suggested to serve as the reference for this indicator. In other words, if a medicine is identified as being affordable for the individual who receives the LPGW wage, it will most likely be affordable for all other individuals affiliated with that economic group and higher. This obviously does not account for people employed in the unofficial labour market. The proposed methodology is an adjusted HAI/WHO methodology. The HAI/WHO approach suggests computing the affordability of medicine prices as the number of daily wages that are required for the lowest paid unskilled government worker (LPGW) to purchase a daily dose of a medicine (DDD). This approach is straightforward and also refers to the capacity of the reference individual to pay for the medicines. However, no threshold was identified to distinguish the maximum number of daily wages that an individual must spend on a medicine in order to still be able to afford it.
Moreover, there are other SDG indicators, such as 3.8.1 and 3.8.2 that capture coverage of essential health services as well as financial protection from health expenditures net of reimbursement, including expenditures for medicines.
A national regulatory authority (NRA) plays a key role in assuring the quality, safety, and efficacy of medical products until they reach the patient/consumer, as well as ensuring the relevance and accuracy of product information. Hence, stable, well-functioning and integrated regulatory systems are an essential component of a health system and contribute to better public health outcomes. NRA maturity and WHO prequalification of medicines can be considered as a proxy for ensuring that medicines in a country are of assured quality. The NRA maturity level is assessed using the WHO National Regulatory Authority Global Benchmarking Tool (WHO NRA GBT). After the evaluations, countries are assigned one of five levels of maturity, with a score of maturity level three representing the minimum acceptable regulatory capacity and maturity level five representing the highest level of functioning. The importance of transparency and the disclosure of the results of assessments amongst regulators (from ML 3 up) are taken into consideration. However, the information on country-specific NRA maturity level is not currently publicly available and WHO is working to address this limitation through recent discussions on WHO Listed Authorities (WLA).
The proposed methodology takes advantage of recognized standards and data collection methods, proposing a recombination of dimensions to allow measurement of affordability of a core set of relevant essential medicines for communicable and non-communicable diseases. |
Method of computation | Not available for this indicator |
The index is computed as a ratio of the health facilities with available and affordable medicines for primary health care over the total number of the surveyed health facilities: For this indicator, the following variables are considered for a multidimensional understanding of the components of access to medicines:
The index is measured for each facility separately. Then a proportion of facilities that have accessible medicines is computed. The following steps must be taken to compute the index at the facility level:
The next two steps are calculated at the country level across all the surveyed facilities:
Below is a more detailed procedure of the index computation. Step 1: Review and selection of the core basket of medicines for primary health care For some of the disease categories captured by the proposed basket of medicines, a therapeutic category of medicine has been specified (e.g. statins, beta blockers, corticosteroids, etc.) and a specific medicine must be identified for monitoring. For example, beclomethasone is used to treat non-communicable respiratory disease and if it is not supplied in a particular country for some policy or market reason, an alternative corticosteroid inhaler must be included in the analysis. In other cases, more than one medicine should be included in the basket per disease category. This will require a preliminary review of the basket before starting the data collection process. Step 2: Estimate weights for the defined medicines based on regional burden of disease The following points must be considered when computing medicines’ weights:
To estimate the weight for each medicine, the following steps have to be undertaken:
As an example, the weights computed across regions for year 2015 are represented in Annex 2 table 2.1 and 2.2. Step 3: Measure the two dimensions of access to medicine Availability and affordability of medicines must be measured and transformed (when necessary) into the format of a binary variable.
3.1 Compute daily price per dose of treatment for each medicine (price per DDD) in the selected basket of medicines WHO treatment guidelines provide the needed information to compute DDD. DDD of a medicine is defined using the following formula: where:
This ratio varies between “0” and infinity and is measured in local currency units per day [LCU/d]. Information on the number of units per treatment is specified in Annex 3. The price per DDD can be measured in per day or per month. 3.2 Define National poverty line (NPL) and minimum wage of the LPGW for the analysed country National poverty line (NLP): countries periodically recalculate and update their poverty lines based on new survey data and publish this information in their national reports on poverty. To adjust the latest available NPLs to the relevant year of analysis (when needed) information on the Consumer Price Index (CPI) in the analysed country has to be used to account for deflation/inflation. National poverty reports consistently provide information on the NPLs in local currency units but often refer to different recall periods from country to country (NPL can be measured per day, per month or per year). For consistency, NPL has to be adjusted to be measured per day [LCU/d]. The wage of the lowest paid unskilled government worker (LPGW): is estimated and published in the ILOSTAT database. For countries with the latest available data collected in a year different from the year of analysis, LPGW wage is actualised using the CPI conversion factor. ILO provides information on the minimum LPGW wages in local currency units per month. LPGW wage has to be adjusted to be measured per day as well [LCU/d]. The NPL and LPGW wage can be measured in per day or per month. 3.3 Compute extra daily wages (EDW) First, the LPGW wage is compared to the NPL and if it is lower, medicine is considered unaffordable. In this case, only medicines with a price equal to zero will be considered affordable. Next, the affordability is measured via the number of extra daily wages (EDW) that are needed for the LPGW to pay for one-month course of treatment using the formula below. In particular, the number of extra daily wages can be computed using the following formula: 3.4 Transform EDW variable into a binary format Following the definition, medicine is considered to be affordable when the sum of NPL and price of a daily dose of the treatment is equal to or less than the minimum daily wage of the LPGW: Hence, the affordability of medicines is also measured as a binary variable that is coded as “1” when the medicine is affordable and “0” otherwise. When the price of the medicine is 0, there is no need for the above-mentioned computations and the medicine is considered affordable (i.e. “1”). If all medicines in the country are provided free of charge, all medicines are directly marked as affordable and further computation of the index depends on the availability of these medicines. Step 4: Combine the two dimensions on availability and affordability (access to medicines) In this step, the two dimensions of access to medicines (availability and affordability) are combined into a multidimensional index. The construction of a multidimensional index is based on the union identification approach[3] proposed by S. Alkire and G. Robles. The combination of the dimensions of medicines can be built in matrix form: This matrix contains performance for n objects of analysis (specified in rows) in d dimensions (specified in columns). The performance of any object in all dimensions is represented by the d-dimensional vector for all . The performance in any dimension for all objects are represented by the n-dimensional vector for all . Overall, an index should be computed via two main steps: identification and aggregation. An example of how to combine the 2 dimensions can be found in Annex 4. Step 5: Apply weights to the medicine in the basket according to the regional prevalence of the diseases that are cured/treated/controlled by these medicines After identifying the access variable, medicines in the basket have to be weighted according to the prevalence of the disease(s) that these medicines are used to cure/treat/control using the weights identified in step 2 and provided in Annex 2, tables 2.1 and 2.2. This is performed by multiplying the access variable with the medicine weights: Figure 1. Achievement matrix of weighted access to medicine Step 6: Identify whether a facility has a core set of relevant essential medicines available and affordable The following computations must be undertaken in this step: 6.1 Calculate proportion of medicines that are accessible (both available and affordable) in each facility Because medicines are weighted, the proportion is computed as a weighted sum of medicines that are both available and affordable (accessible) in each facility using the following formula: This variable is then transformed into a percentage and varies from 0 to 100. The computed number of accessible medicines accounts for the importance of the analysed medicines in the country. In particular, if a medicine with a higher weight (for example hypertension) is not accessible, the index will be sensitive to this and will demonstrate the lack of access. On the contrary, if a medicine has a low weight (i.e. approaching zero, such as antimalarial medication in a non-endemic country) and is not accessible, the index will not be affected. 6.2 Mark facilities that have 80% or more of available and affordable medicines The computed variable “access” is then transformed into the binary format identifying facilities that have the core basket of essential medicines available and affordable versus facilities that do not. A threshold of 80% is applied in order to transform the “access” variable into a binary format. In particular, at least 80% of all the medicines surveyed in a facility have to be both available and affordable. The transformation is made using the following formula: This threshold is agreed upon and adopted by the WHO Global Action Plan on Non-Communicable Diseases and used as a reference in this proposed methodology. Step 7: Calculate the indicator as the proportion of facilities with accessible medicines in the country The proportion of facilities that have reached the 80% threshold is calculated out of the total number of surveyed facilities in a selected country using the following formula: The computed indicator is a proportion that will then be converted into a percentage between 0-100%. Step 8: Consideration of quality of the accessible medicines in the country using a proxy The country level of medicine regulatory capacity assessed using the WHO NRA GBT is used as a proxy of the quality of the accessible medicines. The countries with a WHO Listed Authority (WLA corresponding to maturity level 3 and above) will be flagged to indicate the assured quality component. 1 DALYs for a disease are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for people living with the health condition or its consequences (DALYs YLL + YLD). That is why DALYs allow “calculating” consequences both from acute diseases (mortality) and from chronic diseases (disability and life with disease). http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html ↑ |
Adjustments | Not available for this indicator |
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Treatment of missing values (i) at country level and (ii) at regional level | Not available for this indicator |
Treatment of missing values has already been partially addressed. In particular, when a medicine is not available, its price cannot be collected. For this reason, missing price values are considered as the medicine not being available and therefore not accessible (access = 0). Observing missing values for availability and affordability simultaneously indicates that these medicines are not provided at all in the surveyed facility. For example, in some countries medicines for in-patient care (mostly in injectable forms) are provided only in hospitals. In this case, the procedure for computing the indicator is the same except that:
When computing regional or global aggregates of indicator 3.b.3, it is possible to accommodate missing values from countries resulting from a lack of data collection for a given country in a given year. In order to calculate a regionally aggregated 3.b.3 indicator, a 5-year period of data collection will be used as a reference to identify the available indicators for all the countries in the region. If during the defined 5-year period, one country of the region does not have even one indicator result, this country will not be included in the regional aggregate. The missing values from the countries can only be imputed when at least one data point exists for the given country in such a 5-year period. |
Regional aggregations | Not available for this indicator |
Regional and global aggregates can be computed using national population size of a country as a proxy for the country weights in the region or globally. This is justified because medicines must be available and affordable for every individual in the population. To compute the regional indicator, the weighted average of the country indicators (using either the actual national indicator when available for the specific year of calculation, or the imputed value that corresponds to the year closest to the year of calculation) is used. |
Methods and guidance available to countries for the compilation of the data at the national level | Not available for this indicator |
The HAI/WHO manual on measuring medicine prices, availability, affordability and price components describes the methodology as well as the guidelines for the data collection procedure and analysis of the availability and affordability of medicines on the facility and national level: http://www.who.int/medicines/areas/access/medicines_prices08/en/ http://www.who.int/healthinfo/systems/SARA_Reference_Manual_Full.pdf http://www.who.int/medicines/areas/policy/monitoring/empmedmon |
Quality management | Not available for this indicator |
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Quality assurance | Not available for this indicator |
Quality control can be performed based on the median availability and median consumer price ratio of selected generic medicines listed on the Global Health Observatory (GHO). The quality of the key components of this indicator (i.e. availability, prices, etc.) can be assured for data collected using any of the three mechanisms listed above when cross-referenced with the GHO values. For future data collection, quality will be based on the analysis of the sample size and the number of medicines captured in the basket. Countries will collect and share data with the WHO Secretariat. WHO will subsequently compute the indicator and return to the countries for validation. By request, WHO will also provide all background materials and training for data collection and indicator computation. |
Quality assessment | Not available for this indicator |
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Data availability: SARA: 21 national surveys are currently available from 2010 to 2017 for a total of 13 countries. Two- and three-year trends are available for six countries; the other seven countries only have one data point. 67% of the SDG basket of relevant essential medicines is covered by such surveys. These data will be used to test quality on the availability dimension only. HAI/WHO: Historical data points are available for 55 countries (28%) of all WHO Member States. The highest number of countries captured by the surveys is in the SEARO region (59%) and the smallest is in EURO region (15%). More than 60% of the medicines from the defined SDG indicator basket are captured in the HAI/WHO historical data surveys. Table 1. Number of countries captured by the surveys across regions
HAI/WHO surveys were conducted more than once in some of the countries for a total of 76 surveys. EMP MedMon: In 2016 the design of the EMP MedMon tool for data collection was finalised. Since then, several pilot surveys have been conducted to test the tool. The first pilot survey was conducted across 19 countries using a basket of medicines that captures around 60% of the one currently proposed. The second pilot used a basket adjusted for the purposes of capturing non-communicable diseases only. These pilots have demonstrated that this tool is flexible and can be easily manipulated to include specialized modules of medicines for future data collection. Time series: Existing data has been historically collected based on available funding. The majority of existing surveys have been collected thus far using the HAI/WHO data collection tool. Most of the existing data points are from 2000 – 2005. Table 2. Number of surveys and % of medicines from the defined basket that are captured by HAI/WHO surveys
The distribution of these 76 surveys across WHO regions is represented in Table 3. Table 3. Number of HAI/WHO surveys across regions Overall 21 SARA surveys were conducted over the period from 2010 to 2017. 17 surveys were conducted between 2010 and 2015 and 4 surveys after 2015. Disaggregation: The proposed indicator will allow for the following disaggregation:
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Sources of discrepancies: Data can be received from three data sources: SARA, HAI/WHO, and the EMP MedMon. These data collection methods demonstrate the following discrepancies:
WHO will use any of these three data sources available for the year of calculation as a compromise between the limitations that these discrepancies pose to the proposed methodology and the need to overcome data availability issues in order to start reporting on this critical indicator. In the unlikely case that data is available through more than one data source for a specific country, WHO will rely on the source with a larger sample size and a higher percentage of medicines from the defined core list captured by the survey. |
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Annex 1: Basket of core set of relevant essential medicines for primary health care and related disease category Table 1. Basket of core set of relevant essential medicines for primary health care * These additional medicines were suggested for monitoring during the consultations with WHO regional advisers and WHO Member States, however they do not represent major burden of disease in countries and cannot be weighted according to the same procedure as the mandatory list. Table 2. Diseases treated with the medicines in the core list
Annex 2. Calculation of weights Weights are region-specific, and the sum of the weights assigned to medicines in the basket is always equal to “1” in a given region. Since some of the medicines are weighted not according to the DALYs but according to the formula in points iii. and iv. above, the weights have to be normalized so that their sum is equal to “1”. WHO regional data on disease burden is computed and published for 5-year intervals (e.g. 2000, 2005, 2010 and 2015 for now). As a result, for data points falling between the reference years for which DALY estimates are available the closest reference year is used to calculate medicines’ weights (either previous or following) (Figure 1). Figure 2.1. Selection of data year for computing medicine weights Two versions of weights are computed: one capturing 32 medicines (excluding optional medicines) and the other capturing 36 medicines (including optional medicines). For countries where the distribution of specific medicines is calculated only in specialized facilities (for example injectable medicines are provided only in hospitals), WHO suggests computing two versions of weights (1 – for pharmacies and other non-tertiary health care facilities based on a shorter list of medicines that exclude the mentioned medicines and 2 – for hospitals that includes the full list of medicines). . Annex 3: Basket of core set of relevant essential medicines for primary health care: number of units and duration per treatment
Annex 4 – Combination of availability and affordability As an example, consider a simplified case of access to a basket of three medicines (Figure 2). In the matrix:
Figure 4.1. Achievement matrix on access to medicine (two dimensions) In this basket the 1st medicine is fully accessible (i.e. it is both available and affordable), the 2nd medicine is partially accessible (i.e. it is available but not affordable), while the 3rd medicine is inaccessible (i.e. it is not available and thus it is not possible to collect information on prices). In this example, the first medicine is accessible and the third medicine is not. However, the second medicine is partially deprived indicating that specific policies applied in the country may be effective for availability of the medicine but not for its affordability. Applying the union identification approach by S. Alkire and G. Robles that treats elements (medicines) in the matrix with partial deprivation as fully deprived, the second medicine is considered not accessible as well (Figure 3). Figure 4.2. Achievement matrix of access to medicine (two dimensions & deprivation of dimensions) At the end of this step, the variable “access” to medicines is generated, combining the 2 dimensions of availability and affordability. This variable remains binary in nature with 1 – medicine is accessible (both available and affordable) and 0 – medicine is not accessible (not available or available but not affordable). |