1. Abstract 213 ICIUM: Antalya, Turkey. November 14-18, 2011

2. BACKGROUND Medicine prices vary significantly across Sub- Saharan African countries Strengthening health insurance programs could improve the availability and affordability of essential medicines Health insurance is intended to reduce the financial burden of purchasing medicines and improve access Many types of national, social, private, and community-based health insurance schemes are emerging 2

3. POLICY IMPLICATIONS Defining an effective, affordable minimum medicine benefits package within a health insurance context is an important step Strengthen transparency through improved record management systems, provider and member education, Mechanisms to integrate local population ownership and joint decision-making, Expanded risk pooling that could mitigate the effects of adverse selection Capacity building for medicines policy decision making is needed to strengthen existing systems Strong government commitment and international donor support is needed to expand medicines coverage through health insurance systems

4. STUDY AIMS No published information exists on: 1.the scope of medicine benefits provided by Sub- Saharan Africa health insurance programs 2.what data these programs have available to monitor performance or evaluate effects of changes in medicines coverage We therefore: -describe health insurance programs in Ghana, Kenya, Nigeria, Tanzania and Uganda, their medicine benefits, and the routine data available to them 4

5. METHODS We developed a survey to: – assess program structure, – characteristics of medicine benefits, – availability of routine data for decision making. Distributed through National Program Officers in WHO AFRO Sampled 82 health insurance programs, 33 (40%) returned completed survey Responses presented in aggregate with no individual program identified. 5

6. Very few health insurance programs cover the poor, the unemployed, and pensioners 6 Total responses: 28

7. Most programs require that inpatient and outpatient medicines be dispensed as generics 7 Total responses: 23 (Blue), 23 (Red)

8. Delays in payment and fraud are a serious problem with medicines benefit Total responses: 17 (Blue), 18 (Red)

9. Programs reported the three most important questions they would like answered Some medicines policy or coverage issues included: – concern about expanding pharmacy budgets and controlling medicines prices, – addressing product selection, cost, and cost-effectiveness of medicines, – combating counterfeit medicines, – implementing specific medicines management approaches, – improving adherence to generic prescribing, – responding to quality concerns of patients and providers about generic medicines, – assessing the effectiveness of newer, costly therapies, and – implementing computerized data management. 9