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Methods 4: Monitoring Pharmaceutical Sector Policies with Facility and Household Surveys
Level II Facility and Household Surveys - Methodology Overview
Harvard Medical School and Harvard Pilgrim Health Care Institute
Independent Consultant, United Kingdom
Facility and Household Surveys - Regional Experience (South America; Caribbean)
National School of Public Health/Oswaldo Cruz Foundation, Brazil
Facility and Households Surveys - Experience in Kenya
See posters 497 & 964
Pharmaceutical Situation Analysis of Mongolia
1Ministry of Health, Mongolia; 2Pharmacy School, Health Sciences University, Mongolia
Problem statement: This is the second assessment of the pharmaceutical sector completed at the end of 2009. Previous study was conducted in 2004.
Objectives: To identify the strengths and the weakness of the policy in the pharmaceutical sector and to produce recommendations for future improvement and possible interventions
Design: The standard questionnaires prepared by WHO were translated into Mongolian and used for the assessment.
Settings: As recommended in the WHO operational package for assessing, monitoring, and evaluating country pharmaceutical situations, the study was conducted in 5 geographical areas and Ulaanbaatar (UB), the capital city.
Study population: According to the WHO guide, large public health facilities (PHF) should be selected. In UB, the largest public hospitals with the closest private drug outlets were selected. The largest warehouse in the region and the closest warehouse to each PHF were selected for the survey. We have selected 30 patients with varying diagnoses seen during the survey period, prospectively in the chosen health facilities.
Results: The percentage availability of key medicines was 80.00 % in PHFs, 86.75% in private pharmacies, and 88.7% in warehouses. Since the last assessment conducted in 2004, several improvements have been observed. The availability of essential medicines (EMs) was 64.52%, ranging from 43.56-91.7% at aimag and soum levels, and 41.58-70.4% in UB. As a result of this survey, the affordability of key EMs was estimated at facility levels as 1.7 days’ wages in the PHF and 1.8 days’ wages in the private facility for adults. The geographical accessibility of facilities was determined by interviewing patients; 6.7% of patients in PHF dispensaries and 3.3% of patients at private drug outlets spent more than 1 hour to travel to the facilities. The quality of medicines is best in private retail pharmacies, as the study team has found no expired medicines during the survey, but is least in wholesaling companies (3.20%). The average presence of expired medicines was 1.96% in 2009, down from 8.32% in 2004. The average number of medicines per prescription at PHF was 2 and 3 in private dispensaries. This finding can be assessed as good because it complies with the requirements of the National Standard on Prescription. The prescribed medicines dispensed or administered to patients at PHF dispensaries was 97.5%. And 81.8% of facilities dispensed more than 75% of prescribed medicines.
Conclusion: This study has shown that the NMP is being successfully implemented in terms of changes and improvements related to structures and mechanisms. Nevertheless, the deficiencies in the implementation of the NMP should be emphasized. Inadequate stock management in health facilities, especially in rural areas, should also be emphasized. The availability of EMs varied at all level.
Funding source: WHO
Access to and Use of Medicines by Households in Armenia: Impact of Current Policy on Reimbursement of Medicines
1National Institute of Health, Armenia; 2Drug Utilization Research Group PO, Armenia
Problem statement: Access to medicines remains a serious challenge in Armenia. To improve the situation, the Government approved a decree covering a policy on reimbursement of medicines, and the Ministry of Health introduced a mechanism for implementation. The impact of this policy is insufficient; however, it has not been studied and evaluated. Because changing the current policy is being considered, previous experience in pharmaceutical reimbursement needs to be assessed.
Objectives: To evaluate access to and use of medicines by households in Armenia as well as to identify the impact of the policy on medicines reimbursement
Design: Policy evaluation, household survey
Setting: The survey was implemented in all 11 regions including Yerevan, the capital of Armenia.
Study population: Members of households who are the main health care decision makers in 864 randomly selected households.
Policy: According to the approved decree, patients from socially vulnerable groups (invalids of first and second groups, children under 7, etc.) are eligible to receive medicines free of charge or with a certain discount; patients with some diseases can receive medicines only for treating this disease (mental diseases, cancer, etc).
Outcome measure(s): The set of indicators was developed using a draft of the WHO household manual. Specific indicators were used to identify the impact of policy on medicines reimbursement as well as to assess issues related to labeling, medicines dispensing, disposal of medicine, and so forth.
Results: Analysis showed that about half of respondents believe that they usually can afford to buy medicines they need. More than 90% of all medicines for treating acute and chronically ill patients were bought out-of-pocket. Patients with certain diseases who are eligible to get pharmaceuticals free of charge according to the Government decree received without payment only 23.0% of medicines used. These were mainly insulin and pharmaceuticals for treating epilepsy. The majority of households having patients with periodical disease and diabetes bought medicines out-of-pocket. For chronically ill patients, 4.8% did not receive any medicine; 67.9% of all prescription medicines, including antibiotics, purchased for chronically ill patients were obtained without prescription; 39.2% of medicines for patients with acute diseases were prescribed by physician; 18.2% were self-administered; 42.7% of all medicines used were from the Armenian Essential Medicines List. The top 3 medicines available at home were paracetamol, tincture of Valeriana, and acetylsalicylic acid.
Conclusions: The current reimbursement policy is poorly implemented and the majority of eligible patients still buy medicines out-of-pocket. Additional study to identify the reasons would be useful. Also, patients from some vulnerable groups, in particular, very poor households cannot purchase the pharmaceuticals they need, but are not eligible for free medicines. Policy recommendations were developed and will be presented to the Ministry of Health.
Funding source(s): None