Abstract
ObjectiveTo assess the importance of ensuring medicine quality in order to achieve universal health coverage (UHC).MethodsWe developed a systems map connecting medicines quality assurance systems with UHC goals to illustrate the ensuing impact of quality-assured medicines in the implementation of UHC. The association between UHC and medicine quality was further examined in the context of essential medicines in low- and middle-income countries (LMICs) by analyzing data on reported prevalence of substandard and falsified essential medicines and established indicators for UHC. Finally, we examined the health and economic savings of improving antimalarial quality in four countries in sub-Saharan Africa: the Democratic Republic of the Congo (DRC), Nigeria, Uganda, and Zambia.FindingsA systems perspective demonstrates how quality assurance of medicines supports dimensions of UHC. Across 63 LMICs, the reported prevalence of substandard and falsified essential medicines was found to be negatively associated with both an indicator for coverage of essential services (p = 0.05) and with an indicator for government effectiveness (p = 0.04). We estimated that investing in improving the quality of antimalarials by 10% would result in annual savings of $8.3 million in Zambia, $14 million in Uganda, $79 million in two DRC regions, and $598 million in Nigeria, and was more impactful compared to other potential investments we examined. Costs of substandard and falsified antimalarials per malaria case ranged from $7 to $86, while costs per death due to poor-quality antimalarials ranged from $14,000 to $72,000.ConclusionMedicines quality assurance systems play a critical role in reaching UHC goals. By ensuring the quality of essential medicines, they help deliver effective treatments that lead to less illness and result in health care savings that can be reinvested towards UHC.
Highlights
The goal of Universal Health Coverage (UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them [1]
Medicines quality assurance systems play a critical role in reaching UHC goals
By ensuring the quality of essential medicines, they help deliver effective treatments that lead to less illness and result in health care savings that can be reinvested towards UHC
Summary
The goal of Universal Health Coverage (UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them [1]. Sustainable Development Goal 3.8 supports UHC by aiming to achieve “access to safe, effective, quality, and affordable essential medicines and vaccines for all” [2]. Quality health services cannot be delivered without quality-assured medicines. The World Health Organization (WHO) estimates that, on average, 1 in 10 medical products circulating in low- and middle-income countries (LMICs) is substandard or falsified [3]. A recent meta-analysis found that 13.6% (95% CI, 11.0–16.3%) of essential medicines in LMICs were either substandard or falsified [5], with other literature reviews reporting a comparable range [3, 6,7,8]. Despite the growing evidence of the problem, the importance of quality-assured medicines and the challenge of ensuring their quality is rarely discussed in UHC planning
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