Global, regional and national availability of essential medicines for children, 2009-2020: a systematic review and meta-analysis

Abstract

Background: Access to essential medicines is a vital component of universal health coverage. The low availability of essential medicines for children (EMC) has led the World Health Organization (WHO) to issue a number of resolutions calling on member states on its improvement. But its global progress has been unclear. We aimed to systematically evaluate the progress of availability of EMC over the past decade across economic regions and countries.

Methods: We searched eight databases from inception to December 2021 and reference lists to identify included studies. Two reviewers independently conducted literature screening, data extraction and quality evaluation. This study was registered with PROSPERO, CRD42022314003.

Results: Overall, 22 cross-sectional studies covering 17 countries, 4 income groups were included. Globally, the average availability rates of EMC were 39.0% (95%CI: 35.5-42.5%) in 2009-2015 and 43.1% (95%CI: 40.1-46.2%) in 2016-2020. Based on the World Bank classification of economic regions, income was not proportional to availability. Nationally, the availability rate of EMC was reasonable and high (> 50%) in only 4 countries, and low or very low for the rest 13 countries. The availability rates of EMC in primary healthcare centers had increased, while that for other levels of hospitals slightly declined. The availability of original medicines decreased while that of generic medicines was stable. All drug categories had not achieved the high availability rate.

Conclusion: The availability rate of EMC was low globally, with slight increase in the last decade. Continuous monitoring and timely reporting of the availability of EMC are also needed to facilitate targets setting and inform relevant policy making.

Keywords: Availability; Children; Essential medicine; Systematic review.

Fig. 1

PRISMA flowchart of study selection

Fig. 2

Availability rates (%) of essential medicines for children from 2009–2015 Note: A, Alimentary Tract And Metabolism; B, Blood And Blood Forming Organs; C, Cardiovascular System; D, Dermatologicals; G, Genito Urinary System And Sex Hormones; H, Systemic Hormonal Preparations, Excl. Sex Hormones And insulin; J, Antiinfectives For Systemic Use; L, Antineoplastic And Immunomodulating Agents; M, Musculo-Skeletal System; N, Nervous System; P, Antiparasitic Products, Insecticides And Repellents; R, Respiratory System; V, Various

Fig. 3

Availability rates (%) of essential medicines for children from 2016–2020 Note: A, Alimentary Tract And Metabolism; B, Blood And Blood Forming Organs; C, Cardiovascular System; D, Dermatologicals; G, Genito Urinary System And Sex Hormones; H, Systemic Hormonal Preparations, Excl. Sex Hormones And insulin; J, Antiinfectives For Systemic Use; L, Antineoplastic And Immunomodulating Agents; M, Musculo-Skeletal System; N, Nervous System; P, Antiparasitic Products, Insecticides And Repellents; R, Respiratory System; V, Various

Fig. 4

Availability rates of essential medicines for children by income, ownership, level of medical institutions, original and generic medicines, 2009 to 2015 and 2016 to 2020 Note: HIC, high-income country; UMC, upper-middle income country; LMC, lower-middle-income country; LIC, low- income country; Private, private medical institutions; Public, public medical institutions; Primary, primary healthcare centers; Hospital, other levels of hospitals except for primary medical institutions; Original, original medicines; Generic, generic medicines

Fig. 5

Changes of availability rates (%) of essential medicines for children over time from 2009–2020 Note: LIC, low- income country; LMC, lower-middle-income country; UMC, upper-middle income country. ¹ Total availability; ² Public sectors; ³ Private sectors; ⁴ Original medicines; ⁵ Generic medicines. The size of the dots indicate the number of surveyed institutions

Fig. 6

Availability rates of essential medicine for children by country, from 2009–2015 (A) and from 2016–2020 (B) Note: The availability rate of medicines was calculated as percentage (%) of the surveyed outlets where the medicines were found on the day of data collection. The values in the bar chart were pooled average availability rates of all surveyed medicines in each country using Stata 15.1.

Fig. 7

Availability of essential medicines for children by ATC, 2009 to 2020 Note: A, Alimentary Tract And Metabolism; B, Blood And Blood Forming Organs; C, Cardiovascular System; D, Dermatologicals; J, Antiinfectives For Systemic Use; L, Antineoplastic And Immunomodulating Agents; M, Musculo-Skeletal System; N, Nervous System; P, Antiparasitic Products, Insecticides And Repellents; R, Respiratory System; V, Various Box limits indicate the range of the central 50% of the data, with a central line marking the median value. Lines extend from each box to capture the range of the remaining data. The black dots represent each specific availability value of ATC.