Summary Uganda Medicine Pricing survey Report – April 2004 by qza17959

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									Hand out for ATM/MeTA meetings in London April 2007                              By HEPS Uganda


                       Uganda Country Working Group;
                  Collaboration of MOH/WHO/HEPS Uganda.

Summary - Uganda Medicine Pricing survey Report – April 2004

Background.

      Medicine pricing and procurement strategies are required to ensure that medicines
       are affordable. Price of medicines is one of the most important obstacles to access
       and needs to be monitored.

      Medicine prices study was carried out in Uganda using an international
       standardized methodology by the Ministry of Health supported, World Health
       Organization and HEPS Uganda supported Health Action International-Africa.

      Data on 45 medicines was collected in 20 public health facilities, 20 private
       pharmacies and 20 NGOs in four geographic and socially economic representative
       regions of Uganda.

      Prices patients pay and availability of medicines was measured, the cost of
       treatment for specified indications calculated and compared to the lowest paid
       government worker and the components of medicine prices identified.

Availability of medicines

      Only 11 of the 45 medicines surveyed were available in the private pharmacies as
       Innovator Brands

      38 of the 45 medicines were available as generics.

Procurement prices

      85% of the medicines at National Medical Stores (NMS) cost less than the
       international reference price,
      72% for Joint Medical Stores (JMS).
      Some medicines, despite being on the Essential Drug List of Uganda (EDLU)
       were not found at either warehouse.
      Generally the prices at NMS were less than JMS.

Medicine prices in the Private and NGO sectors

      The Innovator Brands were 13.6 times more expensive than the international
       reference price and were 5 times more expensive than the prices of their generic
       equivalents.



 Heps Uganda – Making health rights and health responsibilities a reality - heps@utlonline.co.ug   1
Hand out for ATM/MeTA meetings in London April 2007                              By HEPS Uganda


       There was a wide variation of prices for the same medicine within the private
        sector, which was wider for Innovator Brands than generics.
       Only artemether had a greater availability of the Innovator Brand than the
        corresponding lowest price generic.
       The prices of generics were generally lower for the medicines that had a higher
        number of generics registered.

Affordability of medicines

       For a chronic condition, asthma, it could cost the lowest paid government worker1
        an additional 3.6days wages to purchase an Innovator Brand than generic
        salbutamol inhaler in the private pharmacies. (5.6 days for Innovator vs 2days
        for generic ).
       For acute illnesses, such as pneumonia, it would take 4 days wages to buy a
        week’s treatment course of Innovator Brand amoxicillin and 0.6 days (4.8hrs)
        wages to buy the generic equivalent.(4 days for Innovator vs 4.8 hrs for
        generic)
       For common illnesses such as malaria it would take 0.8days (6.4hrs) wages to buy
        a treatment course of Innovator Brand sulfadoxine /pyrimethamine in the private
        pharmacies compared to 0.2days (1.6hrs) wages to buy a generic equivalent.

       It takes 36 days wages to purchase Innovator Brand ranitidine for treatment of
        peptic ulcers compared to 2.4 days (an additional 34 days) wages to buy an
        alternative treatment of generic omeprazole.

       For a monthly treatment of hypertension using a B-blocker, such as atenolol, it
        takes 17days wages to purchase the Innovator Brand atenolol compared to 1day
        wage to purchase a generic equivalent.

Price components and cumulative mark-up

       In the Private pharmacies price almost doubled along the distribution chain from
        importer to wholesaler and then to retailer for Innovator Brand

       Increased almost 4 times for imported generics.

       In the Private pharmacies in Uganda, the mark ups vary, they constitute the
        clearing and handling charges (on average about 3%),

       The importer mark up varied from 10-40%.




1 The lowest government worker earns $1.31 and 38% of the population leave below the national
poverty line 84.9% of the population leave below $1 a day while 96.6% of the population leave
below $2 http://www.worldbank.org/data/wdi2005/pdfs/Table2_5.pdf


 Heps Uganda – Making health rights and health responsibilities a reality - heps@utlonline.co.ug   2
Hand out for ATM/MeTA meetings in London April 2007                              By HEPS Uganda


      The price mark ups varied from 20%-300% from medicine to medicine

      The retail mark up being the highest for all the key medicines that were
       selected.

      In the public sector, the mark-up added to the tender price was 23.3%
      An equivalent of 3.5% was added to cater for the insurance and freight, clearing
       fees, and National Drug Authority verification fees

Regional and International price comparisons

      The medicine price surveys were done in 7 other African countries, Ethiopia,
       Ghana, Kenya, Nigeria, South Africa, Tanzania and Zimbabwe.

      The public sector procurement prices for the 8 countries were lower than the
       international published prices with a median of 0.86 times the international
       published prices.

      In the East Africa region Uganda had the highest public sector procurement prices
       with a median of 0.71 times the international published prices

      Tanzania followed with a median of 0.69 times

      Kenya had the lowest prices with a median of 0.61 times the international
       published prices.

      On the contrary in the private pharmacies, Tanzania had the highest prices in
       East Africa for Innovator Brands of the medicines surveyed with a median of
       18.79 times the international published prices

      Kenya followed with a median of 17.75 times the international price.

      Uganda had the lowest prices with a median of 13.58 times the international price.

      For the lowest price generics in the private pharmacies, Kenya had the highest
       prices in East Africa with a median of 3.33 times the international published
       prices

      Followed by Tanzania with a median price of 2.66 times and

      Uganda with a median price of 2.63 times the international published prices.




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Hand out for ATM/MeTA meetings in London April 2007                              By HEPS Uganda




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