The high costs of medicines have catastrophic effects on poor people. An experts’ assessment of the impact of the cost of medicines on poorer populations indicated that buying common medicines can push poor people further into poverty, reports Sade Oguntola.

In recent years, the international community had prioritised access to essential medicines, which required focusing on the accessibility, availability, quality, and affordability of life-saving medicines and the development of appropriate data and research agendas to measure these components.

The cost of medicines is a major public health issue, especially as the majority of people in developing countries do not have health insurance and medicines freely provided through the public sector are often unavailable.

Although countries have a legal obligation to make essential medicines available to those who need them at an affordable cost, poor people often have to pay for the medicines that they need when they are ill.   

Consequently, where medicine prices are high, people may have to give up treatment or they may go into debt if they decide to buy the necessary medicines.

Although before now determining the degree of affordability of medicines, especially in low- and middle-income countries, is a complex process as the term affordability is vague, a new study quantifying the impoverishing effects of purchasing medicines across 16 countries in the developing world, inclusive of Nigeria, indicated that many poor countries cannot afford common medicines.

The researchers, published in the August 2010 issue of PLoS Medicine, stated that a sizeable proportion (up to 86%) of the population living in low and middle income countries would be pushed to below an income level of $1.25 or $2 a day by paying for four common life-saving medicines.

These were salbutamol inhaler, used to help manage asthma, glibenclamide, a diabetes drug, atenolol, a high blood pressure drug, and amoxicillin, an antibiotic. The prices of these drugs were obtained from facility-based surveys undertaken using a standard measurement methodology.

This selection of drugs covers the treatment/management of three chronic diseases and one acute illness. The emphasis on medicines for chronic disease is justified by the fact that these conditions require ongoing, usually lifelong expenditures, making it more difficult for households to use financing strategies like borrowing and selling assets.

The results of the study show that the high cost of medicines have shattering effects on poor people. In addition, as the treatment of chronic conditions often requires a combination of medicines, the cost of treating and managing a chronic condition such as asthma, diabetes, and cardiovascular disease is likely to be even more unaffordable than what is reported in this study.

According to the results of this analysis, the lowest priced generic versions of each medicine were generally substantially more affordable than originator brand products. For example, in the Philippines, purchasing originator brand atenolol would push an additional 22 per cent of the population below US$1.25 per day compared to 7 per cent if the lowest priced generic equivalent was bought instead.

In Yemen, where seven per cent of people live on less than $1.25 a day, another 22 per cent of the population would fall below the poverty line by purchasing glibenclamide.  However, buying the cheapest generic equivalent would only push another 3 per cent of the population below the poverty line.

In Nigeria, 56 per cent of the population lives on less than $1.25 a day.  If Nigerians were to purchase the branded version of amoxicillin, another 23 per cent would fall below the poverty line.

The researchers take it that medicine is deemed affordable for the proportion of the population that would remain above the poverty line after having purchased it.

As the prevalence rates of hypertension are substantially higher than those of asthma and diabetes, the impoverishing effect, and therefore also the unaffordability, of atenolol is substantially higher than that for the other medicines.

In effect, purchasing essential medicines for both chronic and acute conditions could impoverish large numbers of people, especially if originator brand products are bought.

Professor Oladimeji Oladepo, Dean, Faculty of Public Health, University of Ibadan, Ibadan, Oyo State, linking malaria to poverty declared that currently in Nigeria anybody leaving below the poverty line is unable to afford artmesinin-combination therapy (ACT), the stipulated malaria drug by the Federal government.

“There is low coverage of ACT, the first line recommended drug for treating malaria. Access to it through the public sector is limited and quality of malaria drugs stored by patient medicine vendors, which the majority of the poor patronise, is low.

“The fact that PMVs are not dispensing ACT has to do with its cost. What people demand for when they have malaria is what the PMVs have for sale. This is chloroquine. The average cost of chloroquine is less than N100, unlike the recommended ACT that cost an average of N504.

Dr. Babajide Coker, National Coordinator, National Malaria Control Programme, Abuja, corroborating that the poor do not have access to stipulated malaria medicine, recently in Abuja, declared that evidence from the field support the need for innovative approaches, such as using private distribution systems like the private medicine vendors to supply subsidised medicines for diseases  like malaria.

Given the relatively large share of health care costs for medicines in developing countries, medicine affordability is likely to be an important determinant to access to treatment. Where medicine prices are high, people may have to forego treatment or they may go into debt if they decide to buy the necessary medicines.

Although the purchasing of medicines represents only part of the costs associated with the management of an illness, it is clear that the high cost of medicines have catastrophic effects on poor people.

Consequently, where medicine prices are high, people may have to forego treatment or they may go into debt if they decide to buy the necessary medicines.

In addition, as the treatment of chronic conditions often requires a combination of medicines, the cost of treating and managing a chronic condition such as asthma, diabetes and cardiovascular disease is likely to be even more unaffordable than what was reported in this study.

Therefore concerted action is urgently required to improve medicine affordability and prevent poor populations from being pushed further into poverty.

Such action could include: governments, civil society organisations and others, making access to essential medicines more of a priority and to consider this strategy as an integral part of reducing poverty and the development, implementation, and enforcement of sound national and international price policies.

In addition, there is the need for actively promoting the use of quality assured, low-cost generic drugs; ensuring the availability of essential medicines in the public sector at little or no charge to poor people; establishing health insurance systems with outpatient medicine benefits; encouraging pharmaceutical companies to differentially price medicines that are still subject to patent restrictions.

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