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Table 1 Policy/research items * generated by the regional meeting in Cambodia according to the World Health Organization framework for access to medicines and Health System Level **

From: Stakeholders’ perspectives on access-to-medicines policy and research priorities in Latin America and the Caribbean: face-to-face and web-based interviews


WHO Framework for ATM

1. Rational selection and use of medicines

2. Pricing/affordability

3. Reliable health system/health system structure

4. Sustainable financing

I. Individual, household, and community level

1a) Information asymmetry (user knowledge level; communication and language barriers – as for ethnic minorities)

2a) High out-of-pocket payment

3a) Geographical accessibility: physical barriers; distance to facilities; remoteness (combination of physical barriers and infrastructure weakness)

4a) Community financing arrangements

2c) Community participation in medicine delivery arrangements

4b) Role of government subsidies at community level

1b) Health seeking behavior, preference for private care, preference for secondary level of care (bypass primary health care), self-medication

4c) Focal models of subside

3e) Traditional medicine (e.g., unclear distinction between allopathy and non-allopathy)

1c) Beliefs about illness and treatment (traditional practices; demand for injections and branded medicines; prescribers and dispensers perception of quality of drugs)

II. Public and private health service delivery channels

1d) Impact of advertisements on medicines; incentives (or lack of, leading to private or dual practice); medicines becoming a source in financing for health services

2d) Medicine price variation according to geographical location (e.g., urban/rural differences, higher prices in remote areas); price differential between public and private

3b) Distribution systems and supply chains

4d) Health provider payment methods

4e) Health insurance coverage and models

3c) Pharmaceutical services at local level

1e) Staff capacity for rational prescription and use of medicines; training curriculum

3d) Informal markets – substandard quality and counterfeit medicines

3f) Staff and technical capacity: for supply management; with managerial, interpersonal, and information technology (IT) skills; with local language skills

1f) Clinical treatment guidelines, and essential medicines list: development; incentives for implementation; operational mechanisms; standardization (including between private and public sectors)

3g) Responsiveness to patient needs; differential responsiveness between public and private

1g) Incentives for rational use of medicines and for implementation of generic policy

3j) Availability of medicines (especially in public sector)

III. Health sector

1h) Staff deployment

2b) Opportunity costs

3h) Public-private mix: reliance on private sector delivery; public-private partnerships and their role in access to medicines

4f) Government budgets for medicines

2e) Medicine price information system

4g) Reimbursement policies

1i) Pharmacovigilance, information on adverse drug reaction, and other problems related to medicines

2f) Impact of prices on access

4h) Cost containment policies

3i) Central procurement policies vs. decentralization

2g) Policy and regulation for medicines price

3k) Quality assurance

2h) Incentives for implementation of generic policy

3l) Coordination between health policies and medicines policies; referral policy/referral system

1j) Medicine information system (not only price information)/competing with medicines advertisement

3m) Monitoring and evaluation systems; funding for monitoring and evaluation

IV. Beyond the health sector

1k) Intersectoral initiatives (e.g., rational use of medicines in schools – role of Ministry of Education)

2i) Patents and intellectual property issues

3n) Governance and governing: law and regulation enforcement; transparency and accountability

4i) Donor funding; harmonization and alignment; verticalized donor support

2j) Finance policies: taxes, autonomy, privatization; exemption systems

4j) Patents and intellectual property issues

3o) Regional integration and economic cooperation (example: UNASUL, MERCOSUL)

4k) Finance policies: taxes, autonomy, privatization

2k) Trade and economic goals (impact of health sector policies outside the health sector)

4l) Trade and economic goals (impact of health sector policies outside the health sector)

3p) Promotion of research and development – new drugs/neglected diseases.

2l) Budget allocation to health

4m) Budget allocation to health

2m) Medicine production

3q) Medicine production

  1. *Item codes reflect the order in which they appeared in the questionnaire. Here they are presented according to Health System Level.
  2. **Health System Levels according to Bigdeli et al.[12]: I. Individual, household and community; II. Health service delivery; III. Health Sector; IV. Beyond the health sector (Public policies cutting across sectors; and, International and regional level).