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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).