1. Availability of children’s medicines in Africa, 2007 Jane Robertson, Gilles Forte, Suzanne Hill

2. Background Resolution WHA60.20: to promote access to essential medicines for children through inclusion, as appropriate, of those medicines in national medicine lists, procurement and reimbursement schemes, and to devise measures to monitor prices. Few data on availability and affordability of children’s medicines Medicines advisors in 14 African countries made the study possible

3. Methods Survey of 17 medicines (20 dosage forms) Noted whether included in national EML, STGs Availability and cost in 12 facilities each country Restricted to capital city, facility selection based on WHO/HAI pricing survey methodology CMS, NGO store, teaching hospital, district hospital, 3 primary health care clinics, 5 private pharmacies Was the product on the shelf on that day? What was the price of the cheapest product available (branded or generic)?

4. Proportions of the 20 survey medicines included in EML, STGs, or in CMS

5. Proportions of the 20 survey medicines available by facility type

6. Observations - availability While medicines often in EML and STGs, only 3/14 countries had >50% available in CMS when surveyed Variability across facilities; availability was generally better in the private sector Variability across countries Reflect problems with supply? Reflect demand for products? Prescriber choices? EML relevant to all facilities?

7. Observations - prices Weakness of this initial study Medicine prices varied considerably between countries Generally prices higher in private sector, although not consistently so – highlights need to understand local supply and pricing mechanisms Comparisons were often limited by provision of free medicines in the public sector

8. Strengths of the study Simple survey methodology; minimise need for training of data collectors Adaptable for use as ongoing monitoring tools to chart improvements as issues affecting availability and affordability are addressed Including local medicine priorities will increase the relevance and usefulness of the surveys

9. Identifies other areas of investigation - why? Supply – poor ordering practices – purchasing options available, adequate financing – ‘diversion’ Demand – perverse incentives (salary and financing structures reward particular behaviours) – industry promotion changes prescribing patterns – perceptions about the “quality” of medicines available (confidence in generics, perceptions of EML medicines) May require qualitative investigation

10. Since 2007 study Better Medicines for Children Project Overview of Methods for Medicines Availability and Pricing Surveys http://www.who.int/childmedicines/progress/ChildMeds_pricing_surveys.pdf Inclusion of more country-specific medicines More settings (urban, peri-urban, rural vs WHO/HAI methods) Extension to include other medicines outlets such as licensed drug shops, dispensing doctors, informal outlets More formal processes for pricing survey component Other issues – Development of medicine lists specific to medicines outlets? – Move towards regular on-going monitoring rather than single survey? – Ensuring complexity does not make the task too difficult or too expensive – Recognise the risk of ‘survey fatigue’

11. Thank you