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literature review: access to medicines used to treat chronic disease in low- and middle-income countries
Differences in the availability of medicines
used for chronic and acute conditions in
Department of Essential Medicines and Pharmaceutical
Utrecht Institute for Pharmaceutical Sciences, Utrecht
• Worldwide, 60 % of deaths are due to noncommunicable
• Developing countries are undergoing an epidemiological
transition from infectious and parasitic diseases to non- communicable diseases
• Of the global deaths due to chronic diseases, 80% occur
• Substantial chronic disease morbidity and mortality can
• Equitable access to essential medicines is a key
component of a comprehensive health system response to the prevention and management of chronic diseases
• Studies have shown that low medicine availability can be
a barrier to access to treatment for these conditions.
To investigate whether differences exist in the availability of medicines used for chronic conditions compared to those used for acute conditions, in developing countries.
• Data on medicine availability obtained from 50 facility-based
surveys conducted in 40 developing countries using WHO/HAI standard methodology.
– Medicines included in WHO/HAI surveys selected for international
• 30 medicines included: 15 most-commonly surveyed
medicines for each of acute conditions and chronic diseases.
– All medicines included in any WHO/HAI survey classified as acute or
– Alternate strengths of the same medicine combined when used for
– Frequency of inclusion of each medicines in the 50 surveys was
calculated to identify the top 15 medicines in each category
• % availability of each medicine was compiled for
both originator brand and generic medicines, in both public and private sectors.
• Data on the availability of originator brands and
generics was also combined on a facility-by-facility basis to determine the overall availability (any product type) of each medicine.
• Mean difference in the availability of the two baskets
of medicines was analysed using unpaired T-test in Stata 8.2®
• Results aggregated by World Bank Country Income
Table 1. Basket of 15 most frequently surveyed medicines for acute conditions and basket
of 15 most frequently surveyed medicines for chronic conditions
% of surveys with
Medicines to treat acute conditions
Ciprofloxacin 250 or 500 mg capsule/tablet
Fluconazole 50, 150 or 200 mg capsule/tablet
Metronidazole 200, 250, 400 or 500 mg capsule/tablet
Sulfadoxine+pyrimethamine 500+25 mg capsule/tablet
Erythromycin 250 or 500 mg capsule/tablet
% of surveys with
Medicines to treat chronic conditions
Hydrochlorothiazide 25 or 50 mg capsule/tablet
Beclometasone inhaler 0.25 or 0.5 mg capsule/tablet
Average availability of medicines used for acute and
chronic conditions for all countries surveyed
Mean % availability,
Mean % availability,
Difference in mean
medicines for acute
Private sector, originator brands (n=39)
* Availability of originator brands in the public sector was 0% in several countries. The resulting skewness of the data prevented the calculation of statistical significance.
Average availability of medicines chronic diseases by
therapeutic class, generics, all countries
Ratio of the availability of medicines for acute conditions to medicines for
chronic conditions in the public sector by World Bank Income Group
a. public sector
b. private sector
Ratio of the availability of medicines for acute conditions to medicines
for chronic conditions in the public sector by WHO region
A: Public sector
B. Private sector
• Availability of acute and chronic medicines both sub-
• Significant differences in public sector availability of
medicines for acute and chronic conditions
• Gaps between acute and chronic not the result of low
patient demand due to lower disease burden or other factors.
• Increased attention to chronic diseases is needed in the
public sector, especially in LICs and LMICs and especially in Africa
• Low public sector availability can be addressed through
improved purchasing and/or distribution efficiency and adequate, equitable, and sustainable financing.
• Schemes to make chronic disease medicines available
in the private sector at subsidised prices
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