Prices, availability, and affordability of adult medicines in 54 low-income and middle-income countries: evidence based on a secondary analysis

Abstract

Background: Medication shortages are a pressing concern throughout the world. To gain insight into this issue, WHO and Health Action International (HAI) have constructed a validated method to survey medicine prices, availability, and affordability in low-income and middle-income countries. This paper aims to present an updated analysis of medicine affordability, availability, and pricing across 54 countries using the WHO-HAI method, highlighting disparities between public and private sectors.

Methods: A search was conducted using the HAI Essential Medicines Access Database and four electronic databases to locate studies using the WHO-HAI method. A total of 71 surveys were included, spanning 54 countries. Data concerned with availability, affordability, and pricing were extracted and synthesised. Availability was defined as the average percentage of outlets stocking a medicine on the survey day; affordability was defined as the days' wages of the lowest-paid unskilled government worker required for a standard treatment; and prices were defined as the medicine's median price relative to the Management Sciences for Health international reference median price. Results are presented for the 15 most reported medicines that were included in at least 75% of surveys. Results are also presented for four commonly used medicines selected to facilitate comparison with previous secondary analyses.

Findings: The average availability of generic medicines across WHO regions ranged from 37·8% to 68·3% in the public sector and from 42·3% to 77·4% in the private sector. The availability of originator brand medicines in the private sector ranged from 18·0% to 47·6% across these regions. Neither the public nor the private sector in any region met WHO's recommended availability target of 80%. Medicine prices were consistently high across all WHO regions, requiring patients to pay 3·0-11·5 times international reference prices for lowest-priced generic medicines and over 25 times international reference prices for originator products across WHO regions. Treatment of both acute and chronic illnesses remained unaffordable in many regions, requiring patients to pay 0·2-37·0 days' wages to purchase a single course of medicine.

Interpretation: Access to essential medicines remains a global challenge. Medicines consistently display high prices, low affordability, and poor availability. Although there have been some advancements, the overall accessibility of essential medicines remains a substantial global concern. Innovative and targeted strategies are essential to enhance access, requiring a concerted effort from governments, health-care organisations, and international bodies to implement solutions that address both economic and logistical barriers.

Funding: None.