Essential medicines, which satisfy the healthcare needs of the majority of a population, can only save lives, reduce suffering and improve health if they are of good quality, safe, available and affordable. Panthihage Ruvini Dabare and colleagues at the University of Sri Jayewardenepura, Sri Lanka, surveyed the availability, price and affordability of essential medicines prescribed to treat NCDs in Sri Lanka [1].

In any given country, essential medicines are selected on the basis of disease prevalence, evidence on efficacy, safety and comparative cost-effectiveness. The availability and affordability of medicines are preconditions for access, defined as having medicines continuously available and affordable at outlets that are within one hour’s walk of every patient’s home [2].

Although there have been previous studies on the availability and affordability of medicines in Sri Lanka, these have been conducted in specific areas. The authors recognized the need for a national survey to determine these factors across the whole country.

They looked at the nationwide availability of selected essential medicines for the treatment of NCDs in public healthcare facilities, and the availability, price and affordability of those medicines in the private sector. All state hospitals have pharmacies off site (called outdoor pharmacies) that provide medicines free of charge.

The NCD burden is increasing in Sri Lanka. Deaths related to circulatory diseases have increased from 3% to 24% in the last 50 years and there is a rise in the number of patients hospitalized for NCDs such as diabetes, hypertensive disease and ischaemic heart disease. The leading causes of deaths in public hospitals in Sri Lanka are cerebrovascular disease, acute myocardial infarction and heart failure. Although cancer is an NCD, cancer medicines were not surveyed as patients are managed in selected hospitals in the country.

The following commonly treated NCDs were included in the survey: cardiovascular diseases, diabetes, asthma and chronic obstructive pulmonary diseases (COPD), peptic ulcers, osteoporosis, diseases of the thyroid, epilepsy, Parkinson’s disease, psychiatric disorders, joint related disorders (osteoarthritis, rheumatoid arthritis) and glaucoma.

Based on the salary of the lowest paid unskilled government worker in Sri Lanka, the authors found that more than 67% of medicines required less than a single day’s wages to purchase a month’s supply. Less than ten days’ wages was required to buy a month’s supply of 14 of the medicines surveyed.

The difference in price between originator brands and the lowest price generics was marked, with originators being over five times and in some cases up to 100 times more expensive. At the same time, the availability of originator brands surveyed was very low. Around two thirds of the registered originator brands were not available where they were surveyed, while many generics were available for particular medicines.

The median prices of surveyed generics in Sri Lanka were compared with their International Reference Prices (IRPs). In many cases the Sri Lankan price was lower than the IRP, suggesting that generics pricing was appropriate in the outlets studied – in private and semi-government pharmacies.

Most of the medicines surveyed in this study were found to be affordable to Sri Lanka’s lowest income earners. There were many generic brands and generics available for most of the medicines in private and semi-government community pharmacies, which in turn has led to increased availability and affordability. The authors call for existing policies and procedures to be strengthened so that demand can be forecast, allowing for timely procurement to ensure a steady and uninterrupted medicines supply to public healthcare facilities.

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References
1.    Dabare PR, Wanigatunge CA, Beneragama BH. A national survey on availability, price and affordability of selected essential medicines for non communicable diseases in Sri Lanka. BMC Public Health. 2014;14:817.
2.    United Nations Publication: Indicators for Monitoring the Millennium Development Goals. United Nations Development Group; 2003.

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