Medicine Price Monitor Uganda No. 8 Jul-Sep 29 Medicine Price Monitor is supported by MEDICINE TRANSPARENCY ALLIANCE And published by UGANDA COUNTRY WORKING GROUP a collaboration of: MINISTRY OF HEALTH WORLD HEALTH ORGANISATION HEPS UGANDA in partnership with HEALTH ACTION INTERNATIONAL HAI AFRICA Goal of the Collaboration Improve equitable and sustainable access to medicines 1. INTRODUCTION The purpose of this activity is: This is the report for the survey conducted for third quarter (July- September) of 29. KEY FINDINGS: OVERALL Compared to the previous quarter (Oct- December 28) there was a decrease in medicine availability in the public sector (by 13%) and private sector ( by 12%). However, there was an increase in the availability in the mission sector (by 4%). Surveys conducted over the past three years have shown the public sector to be the worst performer in terms of availability of essential medicines. Mission sector it was at seventy three percent while it remained low in the private sector Most medicines in Private Sector and Mission facilities can be considered unaffordable live in poverty. 1 Availability of paediatric formulations remains below thirty percent and availability of medicines for chronic diseases was poor. 2. METHODOLOGY 2. survey. The medicines, priced lowest to consumers were considered. The survey was carried out in the public, private and mission facilities. 3 prices for medicines). The data was collected from randomly sampled 93 facilities as shown in Table 1. 1 Uganda Bureau of Statistics: 31% of Ugandans were living on less than US$1 a day in 25/6 (Statistical Abstract 28) 2 www.haiweb.org/medicineprices 3
Table 1: Distribution of facilities that were surveyed Northern Eastern Central Total Public rural 4 4 18 32 Public urban 2 3 4 14 Private rural 2 4 3 4 13 Private urban 4 2 Mission rural 3 2 2 12 Mission urban 4 4 4 4 33 28 3. RESULTS AND DISCUSSION Sector No. of facilities Median availability Overall 32 5% Public Urban 14 57% Rural 18 44% Private Overall 33 67% Urban 2 85% Rural 13 5% Mission Overall 28 75% Urban 16 81% Rural 12 67% Fig 1: Availability in Urban Versus Rural Facilities Percentage Availability 9 8 7 6 5 4 3 2 1 85 81 67 57 5 44 Public Private Mission Sector Urban Rural cilities, the mission sector scores substantially better (23%) than the public sector. Availability in mission sector 2
explore the disparity in availability between urban and rural facilities. MOH should endeavour to increase availability of essential medicines in the Public facilities through forging the people Table 3: Availability of 4 essential medicines across sectors July- September 29 Medicine Percentage Availability Public Private Mission Aciclovir tab 2mg 47% 58% 81% Albendazole tab 2mg 53% 58% 54% Amitriptyline tab 25mg 77% 67% 81% Amoxicillin cap/tab 25mg 6% 91% 1% Amoxicillin susp 25mg/5ml 27% 76% 81% Artemether/Lumefantrine tab 2/12mg 93% 48% 73% 7% 55% 65% Betamethasone cream/ointment 1%w/v 3% 58% 5% Carbamazepine tab 2mg 53% 61% 65% Ceftriaxone 1g pwder for inj'n 5% 64% 81% Cimetidine tab 4mg 2% 67% 46% 5% 88% 1% Co-trimoxazole susp 8/4 mg/ml 33% 67% 62% Co-trimoxazole tab 4+8 mg 83% 94% 88% Dextrose 5% inj 83% 67% 96% Diazepam tab 5mg 27% 73% 92% Diclofenac tab 5mg 33% 82% 81% Doxycycline cap/tab 1mg 63% 85% 92% Erythromycin tab 25mg 43% 79% 96% Fluconazole tab /cap 2mg 6% 48% 73% Furosemide tab 4mg 53% 64% 81% Gentamycin inj 8mg/ml 77% 76% 85% Glibenclamide tab 5mg 43% 61% 69% Mebendazole tab 1mg 3% 85% 96% Metformin tab 5mg 4% 64% 62% Methylergometrine inj 2ug/ml 53% 39% 73% Metronidazole susp 2mg/5ml 17% 79% 5% Metronidazole tab 2mg 6% 94% 14% Nifedipine retard tab 2mg 53% 67% 88% Nystatin pessaries 1iu 13% 76% 77% Omeprazole cap 2mg 33% 79% 73% Oral Rehydration Salt (ORS) 8% 91% 92% Paracetamol tab 5mg 57% 1% 14% Phenytoin tab 1mg 73% 48% 77% Prednisolone tab 5mg 33% 91% 85% Pyrimethamine/Sulfadoxine (SP) tab 25/5mg 7% 64% 62% Propranolol tab 4mg 63% 76% 73% Quinine inj 3mg/5ml 87% 67% 88% Salbutamol inhaler.1mg(1mcg)/dose 3% 48% 54% Tetracycline eye ointment 1% 67% 85% 88% 3
Availability of procured or received by the Ministry of Health. This relationship was however not explored further by the survey. the vital antimalarial medicine from the public and mission sectors may be tantamount to a death sentence. cause of death in children. The continued low availability of anti-diabetic and antihypertensive medicines in Public sector diabetes and hypertension, which have emerged as major chronic diseases in Uganda. The Ministry of Health should use this survey to support the procurement and supply management of essential medicines for these non-communicable diseases. 9 Percentage Availability 8 7 6 5 4 3 2 58 33 29 78 74 74 72 57 56 78 67 52 77 7 59 79 71 63 75 67 5 1 Oct-Dec6 Apr-Jun7 Jul-Sep7 Oct-Dec7 Jul-Sep8 Oct-Dec8 Jul-Sep9 Period PUBLIC PRIVATE MISSION public sector has been the worst performer and in the latest survey (July September 29) showed a decline of 13% from the survey conducted in October- December 28. edicine availability in mission facilities increased Availability of essential medicines in the public sector has remained consistently low whereas essential medicines for the most poor and vulnerable groups 4
Fig 3: Percentage Availability 8 7 6 5 4 3 2 1 73 64 64 59 6 58 6 57 54 56 5 43 44 14 Oct-Dec6 Apr-Jun7 Jul-Sep7 Oct-Dec7 Jul-Sep8 Oct-Dec8 Jul-Sep9 Period Urban Rural there was an increase of 14 percent from the previous quarter. This rise was not explored by the survey. Fig 4: 12 Percentage Availability 1 8 6 4 2 1 81 96 85 74 81 96 88 86 83 64 83 75 63 93 87 7 Oct-Dec6 Apr-Jun7 Jul-Sep7 Oct-Dec7 Jul-Sep8 Oct-Dec8 Jul-Sep9 Artemether/Lumefantrine Quinnine Inj Pyrimethamine/Sulphadoxine maintain adequate management of malaria
Fig 5: 6 Percentage Availability 5 4 3 2 1 44 3 22 37 33 26 22 52 48 46 41 4 36 33 28 26 24 24 25 22 21 21 5 41 38 31 19 Oct-Dec6 Apr-Jun7 Jul-Sep7 Oct-Dec7 Jul-Sep8 Oct-Dec8 Jul-Sep9 Nifedipine Glibenclamide Metformin Cimetidine Omeprazole Fig 6: 12 Percentage 1 8 6 4 2 96 89 85 86 8 75 3 26 26 26 28 29 31 22 24 24 25 2 15 14 17 13 16 7 8 Oct-Dec6 Apr-Jun7 Jul-Sep7 Oct-Dec7 Jul-Sep8 Oct-Dec8 Jul-Sep9 Amoxycillin susp Cotrimoxazole susp ORS Metronidazole susp pneumonia and respiratory tract diseases common in children are not adequately catered for in the public health facilities. MoH should prioritize stocking of pediatric formulations to improve management of diseases in infants and children
PrivUrb/PrivRural MisUrb/MisRural PrivUrb/MisUrb PrivRural/MisRural No.of times more expensive No. of Pairs Compared 1. 1.14 1.6 1.11 24 31 29 26 more costly in private urban facilities and 11% more costly in private rural facilities. Fig 7: 25 2 Amount UGX 15 1 5 Amoxicillin susp Cotrimoxazole susp Metronidazole susp Formulation Private Mission Median consumer prices per unit of selected medicines in Private and Mission facilities 1 1 333.3 28.3 3 3 2 2 4 1 1 1 1 2 2 33 2
9 8 816.5 7 7 7 625 625 645.8 65 6 55 6 5 5 5 458.3 4 333.3 3 3 3 3 27.8 33 2 2 2 2 1 Oct-Dec6 Apr-Jun7 Jul-Sep7 Oct-Dec7 Jul-Sep8 Oct-Dec8 Jul-Sep9 Amount per unit(ugx) Artemether/Lumefantrine Quinnine Inj Pyrimethamine/Sulphadoxine has still not made it affordable to the ordinary person (if unaffordability is than one day the lowest paid Government worker would have to work to pay for treatment). e) No.of days' wages 1.6 1.4 1.2 1.8.6.4.2 1.5 1 1.7.7 Private Mission Amoxicillin susp Nifedipine 2mg Glibenclamide 5mg.5 An illustrative example above is of a child with an acute respiratory tract infection on Amoxicillin family, it would require close to live below a dollar a day would treatment. 4. CONCLUSION partnership to address this important issue. 8
ANNEX I. AVAILABILITY OF MEDICINES IN THE THREE SECTORS Nystatin pessaries 1iu Tetracycline eye ointment 1% Nystatin pessaries 1iu Tetracycline eye ointment 1% Tetracycline eye ointment 1% 9
ANNEX II: AFFORDABILITY: DAILY WAGE OF LOWEST GOVERNMENT WORKER IS USHS 3 Asthma Private Sector NGO Salbutamol inhaler 1 mcg/dose dose as needed 2 Brand Lowest Price 55. 1.8 535. 1.8 Diabetes Private Sector NGO Glibenclamide 5 mg cap/tab 3 6 Brand Lowest Price 3. 1. 15..5 Adult Malaria Private Sector NGO Artemether+lumefantrine 2+12 mg cap/tab 3 24 Brand Lowest Price 7999. 2.7 Hypertension Private Sector NGO Nifedipine 2 mg tab 3 3 Brand Lowest Price 45. 1.5 3. 1. Depression Private Sector NGO Amitriptyline 25 mg cap/tab 3 9 Brand Lowest Price 675. 2.3 45. 1.5 Adult respiratory infection Private Sector NGO 5 mg cap/tab 7 14 Brand Lowest Price 28..9 28..9 Paediatric respiratory infection Private Sector NGO 1
Co-trimoxazole suspension 8+4 mg/ml millilitre 7 7 Brand Lowest Price 15..4 119.5.4 Adult respiratory infection Private Sector NGO Amoxicillin 25mg cap/tab 7 42 Brand Lowest Price 42. 1.4 42. 1.4 Adult respiratory infection Private Sector NGO Ceftriaxone injection 1 g/vial vial 1 1 Brand Lowest Price 3. 1. 3. 1. Anxiety Private Sector NGO Diazepam 5 mg cap/tab 7 7 Brand Lowest Price 28..1 192.5.1 Arthritis Private Sector NGO Diclofenac 5 mg cap/tab 3 6 Brand Lowest Price 3. 1. 3. 1. Private Sector NGO Paracetamol 5 mg cap/tab 3 18 Brand Lowest Price 36..1 36..1 Ulcer Private Sector NGO Omeprazole 2 mg cap/tab 3 3 Brand Lowest Price 6. 2. 6. 2. 11
ANNEX III: MEDIAN PRICES (UG SHS) OF MEDICINES IN THE PRIVATE AND MISSION SECTORS Medicine PRIVATE SECTOR Median Unit Price MISSION SECTOR Aciclor tab 2mg 3. 3. Albendazole tab 2mg 1. 2. Amitriptyline tab 25mg 75. 5. Amoxicillin cap/tab 25mg 1. 1. Amoxicillin susp 25mg/5ml 2. 2. Artemether/Lumefantrine tab 2/12mg 333.33 28.33 5. 5. Betamethasone cream/ointment 1%w/v 1. 1. Carbamazepine tab 2mg 1. 1. Ceftriaxone 1g pwder for inj'n 3. 3. Cimetidine tab 4mg 125. 1. 2. 2. Co-trimoxazole susp 8/4 mg/ml 15. 15.85 Co-trimoxazole tab 4+8 mg 5. 5. Dextrose 5% inj 2. 18. Diazepam tab 5mg 4. 27.5 Diclofenac tab 5mg 5. 5. Doxycycline cap/tab 1mg 1. 1. Erythromycin tab 25mg 1. 1. Fluconazole tab /cap 2mg 1. 85. Furosemide tab 4mg 33.33 2. Gentamycin inj 8mg/ml 5. 7. Glibenclamide tab 5mg 1. 5. Mebendazole tab 1mg 22.5 3. Metformin tab 5mg 15. 1. Methyergometrine inj 2ug/ml 1. 5. Metronidazole susp 2mg/5ml 18.33 15. Metronidazole tab 2mg 33.33 3. Nifedipine retard tab 2mg 15. 1. Nystatin pessaries 1iu 2. 125. Omeprazole cap 2mg 2. 2. Oral Rehydration Salt (ORS) 3. 15. Paracetamol tab 5mg 2. 2. Phenytoin tab 1mg 5. 45. Prednisolone tab 5mg 4. 3. Pyrimethamine /sulfadoxide (SP) tab 25/5mg 33. 2. Propranolol tab 4mg 5. 4. Quinime inj 3mg/5ml 7. 8. Salbutamol inhaler.1mg(1mcg)/dose 27.5 3. Tetracycline eye ointment 1% 2. 286. Acknowledgements UCWG wishes to thank members of the advisory group for their guidance. Advisory Group Members: Martin Oteba Ag. Asst Commissioner, Pharmacy Division, MoH Joseph Mwoga NPO EDM, WHO Uganda Rosette Mutambi (Ms) Executive Director, HEPS Uganda Hellen Ndagije (Mrs) Head Drug Information, National Drug Authority Morries Seru Principal Pharmacist, MoH Frans Bosman Medicines Management Advisor, DANIDA Nazeem Mohamed CEO, Kampala Pharmaceutical Industries/Chairman Uganda Pharmaceutical Manufacturers Association Survey Manager: Denis Kibira Data Collectors: Prima Kazoora Aaron Muhinda Topher Ruyoka Alice Tumwesigye Paul Akankwasa Thomas Obua Joseph Mangusho Mohammed S. Lubega Report Editor: Richard Hasunira 12