Skip to main content

Table 2 Priority policy issues identified by country, region and global stakeholders’ interviews (unranked)

From: Health policy and systems research in access to medicines: a prioritized agenda for low- and middle-income countries

Priority policy issue No. of regions No. of global KII
1. Medicine selection and use   
Generic medicines: perceptions of patients, communities, prescribers and dispensers of low quality and efficacy of generic medicines. Inadequate demand for branded medicines, perceived as superior to generics. 5 15
Clinical practice guidelines, Standard Treatment Guidelines (STG), National Essential Medicines List (NEML): development, implementation, enforcement, standardization of implementation between public and private sector, procedures for addition and deletion to NEML, STG, formularies, generic policies. Impact of these on medicines use and access. 5 15
Health seeking behaviour of patients, households and communities: knowledge and awareness of general public on medicines, patients’ expectations from health services, adherence to prescribed medication and treatment; self-medication. 5 14
Overuse of medicines: inappropriate use of injections, intravenous perfusions, antibiotics. 3 20
Financial and non-financial incentives for providers: impact of incentives on prescribing practices, quality of care and access. Includes issues related to transparency of incentive systems or the impact of removing financial link between patients and providers. 3 20
2. Sustainable financing and affordable prices   
Medicines and health financing arrangements: coverage and reimbursement of medicines under pre-payment and social health insurance schemes, impact on access, out-of-pocket and catastrophic expenditures. Includes resource mobilization for universal coverage of medicines, fragmentation of financing schemes, cost containment policies. 5 18
Resource allocation for health and medicines: government budget for health, funds allocated to health service delivery and medicines. Includes issues related to accountability and disbursement of funds at implementation level, and impact of these on medicine availability and prices. 5 18
Medicine pricing: pricing policies and regulations, and their impact on access, especially mark-up. Includes issues related to transparency, corruption and speculation on medicine prices. 5 18
3. Leadership and governance   
Crosscutting policies outside the health sector affecting health and medicines access: such as finance policies or legal issues, coordination and engagement of stakeholders across sectors, and transparency (e.g., regulation and management of conflicts of interest, regulation of incentives and profits above the health sector). 4 14
Governance over the private sector: mapping private sector health service delivery and assessment of training and support needs, governance over the informal pharmaceutical markets, regulation of unethical promotion practices and impact on access. 4 14
Donors’ agenda, funding type and funding mechanisms; impact on access. 3 18
4. Availability of medicines   
Procurement, supply and stock management: limited capacity for these functions in resource limited settings, including regulatory capacity and enforcement. Includes issues related to regulation and enforcement of generic policy for procurement and supply. 5 9
Medicine availability in the public sector: comparison with availability in the private sector, consequences on health seeking behaviour, medicine use, price and affordability. 4 9
Geographical accessibility: physical barriers, remoteness, geographical distribution of health services; impact on access. 3 9
5. Human resources for health   
Deployment/shortage and training of human resources for health, e.g., in underserved areas; impact on access. 4 20
6. Quality of medicines and quality assurance systems   
Counterfeit medicines: regional and national strategies, inspection and border control. 5 NA*
Substandard medicines: technical capacity for quality assurance in LMICs, e.g., laboratory capacity, minilabs; regulation of quality standards and enforcement capacity. 4 16
7. Medicine information and information systems   
Monitoring and evaluation systems on rational use, price and quality: data collection, flow of information, adequate and timely use by all stakeholders. 3 5
  1. *Global key informants who mentioned the issue of counterfeit often did mention that counterfeit medicines were symptoms of other problems in LMICs. A few specifically recommended exercising caution and not limiting medicine quality to the issue of counterfeits and some said that the issue of substandard medicines was more important.