Why healthcare market needs government intervention to improve access to essential medicines and healthcare efficiency: a scoping review from pharmaceutical price regulation perspective

Abstract Objective: This scoping review aims to understand the extent of evidence regarding: 1) access to essential medicines, 2) barriers to access, and 3) interventions to improve access for chronic kidney disease (CKD) and related non-communicable diseases (NCDs). Introduction: Access to essential medicines for treatment of NCDs is lacking in low- and low-middle income countries. In nephrology, access to essential medicines is especially important to reduce risk of CKD progression, as kidney replacement therapy is unavailable or cost-prohibitive in many regions of the world. As part of the International Society of Nephrology Emerging Leaders Program’s mandate to improve health promotion and access to prevention and management of kidney diseases globally, this scoping review serves as an initial step towards designing implementation studies to improve access to essential medicines. Inclusion criteria: Articles of any study design involving populations with chronic kidney disease, cardiovascular disease, hypertension, and/or diabetes will be included. The core concept of essential medicines will encompass access to essential medicines, barriers to access, and interventions to improve access. All geographical regions and all World Bank Income categories will be considered. Methods: Methods for this scoping review are based on the Joanna Briggs Manual for Evidence Synthesis. MEDLINE, EMBASE, Web of Science, CENTRAL will be searched. Included studies will be restricted to English language. Screening of title/abstract of each article and subsequent review of retrieved full-text articles will be performed by one reviewer, followed by a second reviewer checking the excluded lists for accuracy. A data extraction tool will be customized using Covidence software. Data will be summarized narratively, and in tabular and diagrammatic format. Studies assessing barriers to access or interventions to improve access will be categorized by patient-level, provider-level, organization-level, community/regional-level, and national/health policy-level.

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Frontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa

BMC Health Services Research ◽

10.1186/s12913-014-0520-6 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 12

Author(s):

Bvudzai Priscilla Magadzire ◽

Ashwin Budden ◽

Kim Ward ◽

Roger Jeffery ◽

David Sanders

Keyword(s):

South Africa ◽

Health Workers ◽

Essential Medicines ◽

Provider Perceptions ◽

Frontline Health Workers ◽

Access To Essential Medicines ◽

Improve Access

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Strategies to improve the availability of medicines in primary health care in Brazil: findings and implications

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0125 ◽

2021 ◽

Vol 10 (3) ◽

pp. 243-253

Author(s):

Mariana M Barbosa ◽

Renata CRM Nascimento ◽

Marina M Garcia ◽

Francisco A Acurcio ◽

Brian Godman ◽

...

Keyword(s):

Access To Medicines ◽

Study Data ◽

Essential Medicines ◽

Survey Study ◽

Financial Resources ◽

Primary Health ◽

Access To Essential Medicines ◽

Availability Index ◽

Descriptive Survey ◽

Improve Access

Aim: Access to essential medicines is a key component of managing patients in ambulatory care. In 2008, the State of Minas Gerais, Brazil, created the Pharmacy Network of Minas (Rede Farmácia de Minas [RFM]) program to improve access to medicines, increasing availability and restructuring the infrastructures. The aim was to assess the current situation, comparing municipalities with and without RFM. Materials & methods: Descriptive survey study, data collected from 2014 July to May 2015. Availability was verified by stock levels. Results: The drug availability index was 61.0%, higher in municipalities with RFM. Most physicians considered the pharmaceutical services as good/very good. The main reasons for medicines shortage were ‘financial transference problems’, ‘insufficient financial resources’ and ‘budget’. Conclusion: Strategies, such as the RFM can promote improvements in medicine availability.

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Mapping actions to improve access to medicines for mental disorders in low and middle income countries

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796016001165 ◽

2017 ◽

Vol 26 (5) ◽

pp. 481-490 ◽

Cited By ~ 3

Author(s):

C. Barbui ◽

T. Dua ◽

K. Kolappa ◽

B. Saraceno ◽

S. Saxena

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Essential Medicines ◽

World Health ◽

Evidence Based ◽

Appropriate Use ◽

Psychotropic Medicines ◽

Access To Essential Medicines ◽

Evidence Based Guidelines ◽

Improve Access

Aims.In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013–2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.Methods.Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.Results.A 4 × 4 framework mapping actions as a function of the four components of access – selection, availability, affordability and appropriate use – and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.Conclusions.Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.

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