Column Actions

This indicator is necessary to evaluate both affordability and availability of medicines.

Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis.

The indicator is a multidimensional index reported as a proportion (%) of health facilities that have a defined core set of quality-assured medicines that are available and affordable relative to the total number of surveyed health facilities at the national level.

Ministry of Health (MOH)

Ministry of Health (MOH)

Annual

Percentage (%)

Medicine is available in a facility when it is found in this facility by the interviewer on the day of data collection. Availability is measured as a binary variable with 1 = medicine is available and 0 = otherwise.

A medicine is affordable when no extra daily wages (EDW) are needed for the lowest-paid unskilled government sector worker (LPGW wage) to purchase a monthly dose treatment of this medicine after fulfilling basic needs represented by the national poverty line (NPL). Affordability is measured as a ratio of 1) the sum of the NPL and the price per daily dose of treatment of the medicine (DDD), over 2) the LPGW salary. This measures the number of extra daily wages needed to cover the cost of the medicines in the core set and that can vary between 0 and infinity.

• Daily dose of treatment (DDD) is an average maintenance dose per day for a medicine used for its main indication in adults.2 DDDs allow comparisons of medicine use despite differences in strength, quantity or pack size. 
• National poverty line (NLP) is the benchmark for estimating poverty indicators that are consistent with the country's specific economic and social circumstances. NPLs reflect local perceptions of the level and composition of consumption or income needed to be non-poor.
• Wage of the lowest-paid unskilled government worker (LPGW) is a minimum living wage that employees are entitled to receive to ensure overcome of poverty and reduction of inequalities

Indicator 3.b.3 is defined as the “Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis”. This indicator is based on the proportion of facilities (pharmacies, hospitals, clinics, primary care centres, public/private, etc.) where core essential medicines from the identified set are available for purchase and their prices are affordable, compared to the total number of facilities surveyed. There are several core concepts that are used for measuring indicator 3.b.3: 

1. Availability of medicine
2. Affordability of medicine → to define affordability, additional concepts are used:
   • Daily dose treatment of the medicine
   •  National poverty line
3. Wage of the lowest-paid unskilled government worker

Core set of relevant essential medicines (defined on a global level) → to apply a core set of relevant essential medicines defined on a global level to all countries, an additional concept is used: • global burden of disease

The proposed indicator will allow for the following disaggregation:

1. public/private/mission sectors facilities (managing authority)
2.  geography – rural/urban areas
3. therapeutic group
4.  facility type (pharmacy/hospital)
5. medicine. 

The index is computed as a ratio of the health facilities with available and affordable medicines for primary health care over the total number of the surveyed health facilities:

For this indicator, the following variables are considered for a multidimensional understanding of the components of access to medicines:

•  A core set of relevant essential medicines for primary healthcare
• Regional burden of disease
•  Availability of a medicine
•  Price of a medicine
•  Treatment courses for each medicine (number of units per treatment & duration of treatment)
•  National poverty line and lowest-paid unskilled government worker (LPGW) wage
•  Proxy for quality of the core set of relevant essential medicines.

The index is measured for each facility separately. Then a proportion of facilities that have accessible medicines is computed. The following steps must be taken to compute the index at the facility level:

1. Review and selection of the core basket of medicines for primary health care
2. Estimate weights for the defined medicines based on the regional burden of disease 
3. Measure the two dimensions of the access to medicine a. Availability b. Affordability
4. Combine the two dimensions on availability and affordability (access to medicines) 
5. Apply weights to the medicine in the basket according to the regional prevalence of the diseases that are cured, treated, and controlled by these medicines
6. Identify whether a facility has a core set of relevant essential medicines available and affordable The next two steps are calculated at the country level across all the surveyed facilities:
7. Calculate the indicator as the proportion of facilities with accessible medicines in the country
8. Consideration of the quality of the accessible medicines in the country using a proxy

N/A

Given that the data collection occurs at the facility level and does not monitor quantities of any given medicine, an overall analysis of the available medicines compared to the national needs is not possible.

All the metadata shown above was gathered from the United Nation Statistics Division. The metadata was extracted from https://unstats.un.org/sdgs/metadata/.