Evaluating medicine prices, availability and affordability in Bangladesh using World Health Organisation and Health Action International methodology

Wu Zeng,David Tordrup,Shyfuddin Ahmed,Zaheer-Ud-Din Babar,Lombe Kasonde,Aliya Naheed

doi:10.1186/s12913-019-4221-z

Abstract

BackgroundPrevious studies have shown limited availability of medicines in health facilities in Bangladesh. While medicines are dispensed for free in public facilities, they are paid out-of-pocket in private pharmacies. Availability, price and affordability are key concerns for access to medicines in Bangladesh.MethodsThe World Health Organization/Health Action International survey methodology was used to determine price, availability and affordability of 61 lowest price generic (LPG) and originator branded medicines in public facilities, private retail pharmacies and private clinics across 6 regions of Bangladesh. Medicines for non-communicable and infectious diseases, and both on and off the national Essential Medicines List were included. Prices were compared internationally using Median Price Ratio (MPR).ResultsMean LPG (originator brand) availability in the public sector, private retail pharmacies, and private clinics was 37%, 63 (4) percent, and 54 (2) percent, respectively. Medicines for Non-Communicable Diseases (NCD) and essential medicines were significantly less available than infectious disease medicines and non-essential medicines, respectively.Mean LPG (originator brand) MPR was 0.977 in the public sector, 1.700 (3.698) in private retail pharmacies and 1.740 (3.758) in private clinics. Six medicines were expensive by international standards across all sectors.The least affordable treatments in both private sectors were bisoprolol (hypertension), metformin (diabetes) and atorvastatin (hypercholesterolemia).ConclusionAvailability and affordability of NCD medicines are key concerns where the burden of NCD is rising. These findings show improvement from earlier studies, but room for further advances in availability and affordability of NCD medicines in Bangladesh. A small number of medicines are consistently expensive across sectors in Bangladesh, suggesting the need for strategies to address prices for certain medicines.

Highlights

Previous studies have shown limited availability of medicines in health facilities in Bangladesh
For each of 61 medicines included, pricing and availability data were collected from retail pharmacies and private clinics on originator brand and lowest price generic (LPG, locally or internationally produced generic version) medicines
Medicines on the national Essential Medicines List (EML) were marginally less available than non-essential medicines (50.3% vs. 57.0%, p > 0.05), and medicines on the Global Core List were more available than Supplementary List medicines selected for this study (66.6% vs. 46.9%, p < 0.01)

Summary

Introduction

Previous studies have shown limited availability of medicines in health facilities in Bangladesh. Bangladesh, a lower-middle economy in South Asia, has been experiencing a demographic and epidemiological transition with rapid urbanization and a gradual increase in life expectancy [3, 4]. This shifting pattern has increased the demand for medicines, especially for chronic conditions such as diabetes and hypertension [5, 6]. A publicly funded health care system provides consultations at low cost and medicines free of charge to patients, anecdotal and limited published evidence suggests availability of medicines is low [7, 8].

Methods

Results

Discussion

Conclusion