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Medicine Availability, Prices and Medicine Availability, Prices and Affordability Affordability

inin West Bengal, IndiaWest Bengal, India

(2004)(2004)

DALIA DEYDALIA DEY

CUTS & CDMUCUTS & CDMU

22

indicates surveyed districts

Geographic Regions SurveyedGeographic Regions Surveyed

Population of West Bengal: 80 millionSource: 2001 Census Report

33

Survey Details Survey Details

Sectors SurveyedSectors Surveyed Public SectorPublic Sector Private retail sectorPrivate retail sector

Products Selected (Core & Supplementary)Products Selected (Core & Supplementary) Originator BrandOriginator Brand Most sold genericsMost sold generics Lowest priced genericsLowest priced generics

AnalysedAnalysed PricesPrices AvailabilityAvailability AffordabilityAffordability

44

Daily salary of lowest paid unskilled Daily salary of lowest paid unskilled government workergovernment worker = INR 131.73 = INR 131.73 ($2.86US)($2.86US)

Estimated proportion of population on Estimated proportion of population on less than this salaryless than this salary11 = 79.9% live on less = 79.9% live on less than $2US per day.than $2US per day.

1 Source = WB Development Report, 2004

Affordability BaselineAffordability Baseline

55

Public Sector Procurement Prices Public Sector Procurement Prices (measured as Median Price Ratios)(measured as Median Price Ratios)Public Sector Procurement Prices Public Sector Procurement Prices

(measured as Median Price Ratios)(measured as Median Price Ratios)

----

----

----

----

IBIB

0.090.09 MPR for OmeprazoleMPR for Omeprazole

0.160.16 MPR for CeftriaxoneMPR for Ceftriaxone

0.930.93 MPR for AmoxicillinMPR for Amoxicillin

0.750.75Median MPR for all 32 Median MPR for all 32 medicinesmedicines

LPGLPG

---- 1.441.44 MPR for DoxycyclineMPR for Doxycycline

66

Availability: Availability: Public vs. Private Retail SectorsPublic vs. Private Retail SectorsMedian Median

Availability (%)Availability (%)Public Public SectorSector

Private Private Retail Retail SectorSector

IBIB LPGLPG IBIB LPGLPG

AciclovirAciclovir ---- 0.0%0.0% 68.6%68.6% 31.4%31.4%

AmoxicillinAmoxicillin ---- 96.2%96.2% 5.7%5.7% 94.3%94.3%

Ceftriaxone InjCeftriaxone Inj ---- 19.2%19.2% 0.0%0.0% 85.7%85.7%

Salbutamol InhSalbutamol Inh ---- 0.0%0.0% 60.0%60.0% 85.7%85.7%

PhenytoinPhenytoin ---- 0.0%0.0% 0.0%0.0% 91.4%91.4%

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Median Price Ratios in the Private Retail Median Price Ratios in the Private Retail Pharmacy SectorPharmacy Sector

Median Price Ratios in the Private Retail Median Price Ratios in the Private Retail Pharmacy SectorPharmacy Sector

0 5 10 15 20

Doxycycline

Atenolol

Diazepam

Ciprofloxacin

All Medicines (32)

MPR

Lowest Priced Generic Originator Brand

88

Affordability in the Private Retail Affordability in the Private Retail Pharmacy SectorPharmacy Sector

0 0.2 0.4 0.6 0.8 1

Hypertension(Atenolol)

Antibacterial(Doxycycline)

Peptic ulcer(Ranitidine)

Days Wages

Lowest Priced Generic Originator Brand

99

Availability and Affordability of Lowest Price Generics – Availability and Affordability of Lowest Price Generics – Acute and Chronic ConditionsAcute and Chronic Conditions

0.10.1

1.31.3

0.50.5

0.30.3

0.30.3

Affordability Affordability in Private in Private

Sector Sector (# days (# days work for unskilled work for unskilled

government worker)government worker)

1 / 26 1 / 26 (3.8%)(3.8%)

Co-trimoxazole Co-trimoxazole suspensionsuspension

Pediatric ARIPediatric ARI

25 / 26 25 / 26 (96.2%)(96.2%)

AmoxicillinAmoxicillinAdult ARIAdult ARI

4 / 26 4 / 26 (15.4%)(15.4%)

AtenololAtenololHypertensioHypertensionn

0 / 260 / 26HydrochloroHydrochloro-thiazide-thiazide

HypertensioHypertensionn

1 / 26 1 / 26 (3.8%)(3.8%)

GlibenclamiGlibenclamidede

DiabetesDiabetes

Availability Availability in Public in Public SectorSector(no. of facilities out (no. of facilities out

of 26 surveyed)of 26 surveyed)

MedicineMedicineConditionCondition

1010

Conclusions - 1Conclusions - 1

1.1. Availability situation in the public sector is far from Availability situation in the public sector is far from satisfactory, with 19 of the 32 medicines (59.4%) satisfactory, with 19 of the 32 medicines (59.4%) not not being availablebeing available

2.2. Procurement in the public sector is quite efficient with Procurement in the public sector is quite efficient with the median MPR (in comparison with MSH 2003 the median MPR (in comparison with MSH 2003 median prices) for all medicines being 0.75median prices) for all medicines being 0.75

3. 3. Availability is better in the private retail sector, with Availability is better in the private retail sector, with the median availability of all the 32 medicines being the median availability of all the 32 medicines being 77.1% for generic products77.1% for generic products

1111

Conclusions - 2Conclusions - 2

4. The median MPR of generics (2.17 for all 32 4. The median MPR of generics (2.17 for all 32 medicines) in the private sector indicate that medicines) in the private sector indicate that medicines are costlier than the international medicines are costlier than the international reference pricesreference prices

5. Most standard treatments are likely to be affordable to 5. Most standard treatments are likely to be affordable to individuals who draw at least the minimum daily individuals who draw at least the minimum daily wageswages

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Policy ImplicationsPolicy Implications

With the government committed to providing universal With the government committed to providing universal access to essential medicines, serious investigation access to essential medicines, serious investigation is needed into the causes of the is needed into the causes of the low availabilitylow availability in the in the public sector.public sector.

Government of West Bengal should Government of West Bengal should establish a establish a monitoring authority to continuously monitor prices, monitoring authority to continuously monitor prices, availability and affordability of medicines, with availability and affordability of medicines, with transparent publicationtransparent publication to their citizens, and to their citizens, and act act when prices are high, availability low and treatment when prices are high, availability low and treatment affordability poor.affordability poor.

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Policy AdvocacyPolicy Advocacy The medicine pricing survey report The medicine pricing survey report “Medicine “Medicine

Prices and Affordability in West Bengal” was Prices and Affordability in West Bengal” was released by Dr. Jayashree Mitra, Director of released by Dr. Jayashree Mitra, Director of Medical Education, Government of West Bengal Medical Education, Government of West Bengal on October 1, 2005. on October 1, 2005.

The report has already been shared with the The report has already been shared with the Department of Health and Family Welfare, Department of Health and Family Welfare, Government of West Bengal and tried to draw their Government of West Bengal and tried to draw their attention on the concerns.attention on the concerns.

CUTS is going to hold an advocacy workshop CUTS is going to hold an advocacy workshop involving relevant state government officials to take involving relevant state government officials to take action to improve medicine availability.action to improve medicine availability.

Both national and local newspapers highlighted the Both national and local newspapers highlighted the abysmal availability situation of medicines in the abysmal availability situation of medicines in the public sector and insisted that the state government public sector and insisted that the state government should find out the exact reason and improve the should find out the exact reason and improve the system.system.

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Press Coverage SurveyPress Coverage Survey

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Thank youThank you