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Table 4 Results of ranking exercise

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

Research questions Total score Overall score Top 5 Innovation Impact Equity Lack of research
1. In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on insurance members? 1 1 1 2 1 2 1
2. What are the impacts of different resource allocation mechanisms in fragmented or decentralized health or pharmaceutical systems on access to and use of medicines? 11 11 14 15 14 8 10
3. What are the impacts of different pricing policies and strategies on medicine prices, availability and use? 6 3 8 10 11 3 3
4. What is the impact of different strategies on perception and use of quality assured low-cost generic medicines by key stakeholders including patients, prescribers, dispensers, regulators? 10 10 10 11 10 10 12
5. What is the impact of individual or combined strategies, in particular regulation and economic incentives, in implementing Standard Treatment Guidelines or Essential Medicines list, on appropriate use of medicines in the public and private sector? 15 14 12 16 15 14 15
6. Which innovative strategies targeting individuals, households, communities and systems improve appropriate demand (health seeking behaviour) for access and use of essential medicines? 4 8 4 3 4 5 6
7. What are the best ways of optimizing supply chain management and improving transparency using a systems perspective to improve access to medicines? 16 17 17 12 16 17 16
8. What is the effectiveness and cost-effectiveness of interventions that can be used to detect and reduce supply and demand of counterfeit (fake/falsified) medicines? 13 15 12 9 13 16 9
9. How do we understand and intervene in labour markets for pharmaceuticals to improve the quality of and access to essential medicines? 12 13 16 14 9 13 7
10. What are effective strategies to reduce substandard medicine production, to improve medicine quality and regularly disseminate results? 14 12 11 12 12 15 12
11. How do non-health sector policies (e.g., industry, trade and intellectual property, legal and constitutional, civil service, transport, banking, education, defence, financial systems, customs) influence access to and use of medicines? 5 6 4 4 4 5 4
12. How do policies and other interventions into private markets (such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc.) impact on access to and appropriate use of medicines? 2 2 4 1 3 4 2
13. What are the lessons learned from best practices for public sector management of essential medicine programs to improve access and appropriate use of medicines? 17 15 17 18 17 12 17
14. Based on evidence of impact of inappropriate drug use on burden of disease, drug resistance and systems and household expenditures, how can systems most effectively and sustainably scale up interventions? 9 8 8 4 4 9 10
15. What incentives in a health system optimize prescribing, dispensing and sales practices among the full range of providers (public, private, formal and informal)? 8 4 3 4 4 7 7
16. What are the best practices of donor and NGO behaviour in working with stakeholders, to strengthen capacity of national systems to improve access to and appropriate use of medicines? 18 18 14 17 18 18 18
17. Which innovations effectively improve access (including geographic accessibility, social acceptability, availability, and financial accessibility) of under-served communities to essential medicines, including community engagement strategies? 3 7 7 8 8 1 12
18. How can stakeholders use the information available in the system (e.g., price, availability, quality, utilization, registration, procurement) in a transparent way towards improving access and use of medicines? 7 4 2 4 2 10 4