Civil society organizations took a prominent early lead in drawing attention to the need to increase access to medicines in the fight against poverty. Dialogue between such organizations and WHO led to a joint WHO-Health Action International project to promote greater openness and better information on medicines prices and availability, as a means of tackling access problems.

The first phase of the project was completed in December 2002. This included development of a methodology for monitoring medicines prices and publication of a manual on how to apply that methodology in individual developing country settings. The methodology can be used to establish whether prices are high or low, availability, price differences between branded medicines and generics, and between sectors, and the elements of price composition. A worksheet enables investigators to measure the affordability of treatment for 9 common conditions.

Field test results and potential impacts

Results from the field tests showed, for example, that in Kenya's private retail sector the median "brand premium" (median price ratio of branded to generic medicines) was "over 5" - meaning that innovator brands cost, on average, over 5 times more than the most-sold generic equivalents. In Brazil, by contrast, the "brand premium" was much lower - close to 0.33. Nevertheless, in Brazil's private sector, as in Kenya, big differences were observed between international prices for individual medicines (the price of brand ciprofloxacin was over 80 times higher than the international reference price. The methodology is also being used in Africa to investigate prices of antimalarials.

Private sector retail prices in 2002 for innovator brand ciprofloxacin, varied widely across 8 countries indicating considerable scope for more effective price regulation

In 2001, innovator brand and generic furosomide prices in relation to the international reference price varied considerably across five countries, indicating scope for improving the affordability of medicines