WHO and Health Action International (HAI) have developed a standardised
method for surveying medicine prices, availability, aff ordability, and price components in
low-income and middle-income countries. Here, we present a secondary analysis of medicine availability in 45 national and
subnational surveys done using the WHO/HAI methodology.
Data from 45 WHO/HAI surveys in 36 countries were adjusted for inflation or deflation and purchasing
power parity. International reference prices from open international
procurements for generic products were used as comparators. Results are
presented for 15 medicines included in at least 80% of surveys and four
individual medicines. Average public sector availability of generic medicines ranged from 29·4% to
54·4% across WHO regions.
Median government procurement prices for 15 generic medicines were 1·11 times
corresponding international reference prices, although purchasing efficiency ranged from 0·09 to 5·37 times
international reference prices. Low procurement prices did not always translate into low patient prices. Private
sector patients paid 9–25 times international reference prices for lowest-priced
generic products and over 20 times international reference prices for originator
products across WHO regions. Treatments for acute and chronic illness were
largely unaff ordable in many countries.
In the private sector, wholesale mark-ups ranged from 2% to 380%, whereas retail
mark-ups ranged from 10% to 552%. In countries where value added tax was applied to medicines, the amount
charged varied from 4% to 15%.
Overall, public and private sector prices for originator and generic medicines
were substantially higher than would be expected if purchasing and distribution were effi cient and
mark-ups were reasonable. Policy options such as promoting generic medicines and alternative fi nancing mechanisms are
needed to increase availability, reduce prices, and improve affordability.