Average availability of 14 selected essential medicines in public and private health facilities

 

The average percent of public and private medicine outlets in sample areas where a selection of the 14 essential medicines are found on the day of the survey. The medicines should be present and not expired on the day of visit (or during a specified reference period, e.g., last month or last 3 months). The 14 drugs in the global core list of tracer medicines can be found in (WHO 2010; Table 4.1).  Non-governmental and community-based facilities providing medicines can also be included in the calculation.   

A closely related indicator Percent of facilities that have all tracer medicines and commodities in stock on the day of visit (and last three months) includes additional medicines plus commodities and vaccines. This indicator uses a composite index of 61 essential medicines, commodities, and vaccines and is available in (WHO, 2010; Chapter 4 Annex). For additional information on assessing and tracking commodities, see the database section on Commodity Security and Logistics.

This indicator is calculated as an average of percentages from sample areas:

(The number of facilities with all 14 essential medicines in stock (present and not expired) on the day of visit / Total number of facilities surveyed in sample area) x 100

This indicator is selected from the list of core indicators in the WHO Health System Strengthening (HSS) Handbook. For more background on the process and criteria used in developing the WHO Handbook of indicators for HSS and for details on this and related indicators, see  WHO (2010); USAID (2009); and The Global Fund (2009).


 

National surveys of medicine price and availability ideally are conducted using a standard methodology developed by WHO and Health Action International (HAI).  WHO/HAI (2008) protocols recommend collecting data from medicine outlets in six sample geographic or administrative areas of a country (or for large countries - a state or province). Data are collected on the availability and price of the essential 14 medicines from all public, private, and other sector outlets that serve as important medicine dispensing points. The full list of 50 survey medicines includes 14 essential medicines in use worldwide, 16 regionally specific medicines and countries are encouraged to collect data on an additional 20 medicines of national importance. 

For each medicine, information is collected on the originator brand, the lowest priced generic equivalent found at each medicine outlet, government procurement prices, and any add-on costs that are charged to medicines as they proceed through the supply and distribution chain. In the absence of routine monitoring, a national survey of medicine prices and availability should be conducted every three to five years using the WHO/HAI standard methodology.


Surveys of health care facilities and other medicine outlets using standardized instruments (e.g., WHO /HAI survey)


This indicator can be used to examine access in terms of availability of essential medicines in addition to practices and trends over time in selection and procurement of these medicines.  Moreover, it can serve as a proxy for service quality, as represented by the presence of non-expired stock. Various WHO disease prevention and treatment programs have proposed maintaining lists of medicines in stock for assessment of service availability and readiness. Essential medicines satisfy priority health care needs of the population and are intended to be available within the context of functioning health systems at all times, in adequate amounts, in the appropriate dosage, with assured quality, and at a price that individuals and the community can afford. Access to medicines is included in the Millennium Development Goals under MDG 8 to develop global partnerships for development,  specifically Target 8.E to provide access to affordable essential drugs in developing countries. For the purpose of monitoring the MDGs, access has been defined as “having medicines continuously available and affordable at public or private health facilities or medicine outlets that are within one hour’s walk of the population” (United Nations Development Group, 2003). Recent United Nations reports assessing progress towards MDG target 8.E found that low availability, high prices and poor affordability of medicines are key impediments to access to treatment in low- and middle-income countries (UN, 2009).


This indicator measures availability of essential, non-expired medicines, but the overall access to, distribution of, and quality of services with medicines can only be measured using a range of indicators that provide data on medicine procurement, storage, affordability, travel time to medicine outlets, and rational use including appropriate prescribing, dosages, and dispensing practices.


health system strengthening (HSS), quality, commodity

 

The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening. http://www.hivpolicy.org/Library/HPP000485.pdf

USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID.  https://www.k4health.org/sites/default/files/measuring%20reform%20hss.pdf

WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

WHO/Health Action International (HAI), 2008, Medicine Prices, Availability, and Price Components, Amsterdam: HAI. http://www.haiweb.org/medicineprices/manual/documents.html

United Nations, 2009, Strengthening the global partnership for development in a time of crisis. MDG gap task force report 2009. New York; UN. http://www.un.org/millenniumgoals/pdf/MDG_Gap_%20Task_Force_%20Report_2009.pdf

United Nations Development Group, 2003, Indicators for monitoring the Millennium Development Goals, New York, United Nations. http://www.armstat.am/file/doc/99465263.pdf

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