Funding a set of essential medicines for low- and middle-income countries

November 8, 2016, University of California, Los Angeles
Corrina Moucheraud's team looked at the cost of providing a package of about 200 essential medicines, for all people in low- and middle-income countries. Credit: iStock.com/Felipe Caparrós Cruz

As the world moves toward universal health coverage, the question arises: How can governments ensure equitable access to essential medicines in low- and middle-income countries?

A section of The Lancet Commission on Essential Medicines Policies report, released today, finds that funding for a "basket" of these essential medicines may pose a challenge, but not necessarily an insurmountable one, for the global health community. The section, intended to inform decision-making and co-written by Corrina Moucheraud, assistant professor of health policy and management at the UCLA Fielding School of Public Health, provides the first comprehensive model estimating the cost to provide essential medicines for all people in these countries.

"As universal coverage is increasingly recognized as central to the right to health, the global community must figure out how to implement it," Moucheraud said. "Estimates like this one are important to assist policymakers, to mobilize funds and ensure that everyone has access to the medicines they need." 

The commission comprises 21 independent experts from a variety of disciplines to, in part, develop a plan for institutional, regional, national and global policies on essential medicines and other health technologies for the next 20 years.

Moucheraud's section looked at the cost of providing a package of about 200 essential medicines, for all people in low- and middle-income countries.

They used 2015 World Bank income groupings for countries to define "low-income" and "middle-income," including lower-middle and upper-middle income.

The set of medicines was based on the World Health Organization list of essential medicines, and included only those that can be administered in primary and secondary care environments and did not require very specialized tertiary care. Examples of conditions that could be treated with medicines from the model include HIV/AIDS, diabetes, cardiovascular diseases, several major mental health disorders, and respiratory conditions. 

They created a model that enters information about the burden of disease—that is, how many people in low- and middle-income countries are affected by each health condition addressed by a medicine in the set; and coverage estimates that reflected the percentage of people with each condition that would receive pharmaceutical treatment. They used this information to estimate how many people in low- and middle-income countries should receive each medicine. Then they referred to international cost data to calculate the total price tag for the set of medicines.

Moucheraud's team found that it would cost $77 billion to $152 billion each year, depending on the exact set of data entries and assumptions, to ensure access to these medicines for all the people in these countries. This amounts to $13 to $25 per capita annually.

"In 2010, 28 of 31 low-income countries and 13 of 47 middle-income countries spent less than this on pharmaceuticals, which in some cases may include drugs not included in the model, Moucheraud said. "This suggests that there may be room to improve the equity and efficiency of financing to ensure access to these essential medicines to all populations."

The commission suggests these steps to address what it calls a "surmountable challenge" for financing essential medicines:

  • Governments and national health systems must provide adequate financing to ensure the inclusion of essential medicines in benefit packages provided by the public sector and all health insurance schemes. The model by Moucheraud and her team can serve as a starting point to determine financing needs.
  • Governments and national health systems must implement policies that reduce the amount of out-of-pocket spending on medicines. More than half of all spending on medicines in low- and comes from out-of-pocket expenditures.
  • The international community must fulfill its human rights obligations to support governments of low-income countries in financing a basic package of essential medicines for all, if they are unable to do so domestically.
  • Governments and national health systems must invest in the capacity to accurately track expenditures on medicines, especially essential medicines, in both the public and private sectors.

Explore further: Monthly cost of $1-2 per person could ensure access to basic package of 201 essential medicines

Related Stories

Monthly cost of $1-2 per person could ensure access to basic package of 201 essential medicines

November 8, 2016
Strong global and national leadership is needed as lack of access to essential medicines threatens progress towards universal health coverage.

Canada needs essential medicines list to ensure supply

June 13, 2016
Canada needs to create a list of essential medicines to help protect against drug shortages, argues an analysis in CMAJ (Canadian Medical Association Journal)

Study reveals poor levels of use, availability and affordability of vital heart medicines

October 21, 2015
New research published in The Lancet shows that the use of vital life-saving generic (and supposedly inexpensive) medicines for prevention in people with existing heart disease is poor worldwide. In low-income and middle-income ...

World Health Organization policy improves use of medicines

September 16, 2014
In this issue of PLOS Medicine, Kathleen Holloway from WHO and David Henry (University of Toronto, Canada) evaluated data on reported adherence to WHO essential medicines practices and measures of quality use of medicines ...

Asthma medicines a struggle for many countries

October 16, 2013
(Medical Xpress)—The availability, pricing and affordability of three essential asthma medicines varies greatly according to a new study of 52 low-and middle-income countries

Missing out on prescription medicines harms health

December 7, 2015
Two new studies conducted by researchers at the University of Otago show that not being able to afford prescription medicines can harm people's health.

Recommended for you

Junk food diet raises depression risk, researchers find

December 18, 2018
A diet of fast food, cakes and processed meat increases your risk of depression, according to researchers at Manchester Metropolitan University.

Children of problem drinkers more likely to marry someone with a drinking problem: study

December 18, 2018
Children of parents who have alcohol use disorder are more likely to get married under the age of 25, less likely to get married later in life, and more likely to marry a person who has alcohol use disorder themselves, according ...

A co-worker's rudeness can affect your sleep—and your partner's, study finds

December 14, 2018
Rudeness. Sarcastic comments. Demeaning language. Interrupting or talking over someone in a meeting. Workplace incivilities such as these are becoming increasingly common, and a new study from Portland State University and ...

Study shows magnesium optimizes vitamin D status

December 14, 2018
A randomized trial by Vanderbilt-Ingram Cancer Center researchers indicates that magnesium optimizes vitamin D status, raising it in people with deficient levels and lowering it in people with high levels.

A holiday gift to primary care doctors: Proof of their time crunch

December 14, 2018
The average primary care doctor needs to work six more hours a day than they already do, in order to make sure their patients get all the preventive and early-detection care they want and deserve, a new study finds.

Teens get more sleep with later school start time, researchers find

December 12, 2018
When Seattle Public Schools announced that it would reorganize school start times across the district for the fall of 2016, the massive undertaking took more than a year to deploy. Elementary schools started earlier, while ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.