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Access to Medicines – Does National Drug Policy Matter?

By Solongo Jargalsaikhan


Background:
 National drug policies (NDP) are seen as essential to ensure equitable access to medicines. They are designed to coordinate the complex pharmaceutical sector encompassing selection of medicines, supply, finance, production, regulation, human resources and monitoring systems. This study critically analyzed 37 countries NDP in relation to their medicine accessibility situation in public and private sectors. The analysis aimed to determine whether countries with indicators of robust NDP also have good access to medicines by their populations, suggesting that policy has a positive effect.


Methods: 
The study exploited massive data sets on 37 low- and middle-income countries policy evaluation indicators and medicine prices and availability, which have been collected by World Health Organization and Health Action International since 2003. Using complex methodological steps a NDP index was built using the policy evaluation indicators for analysis. The data were analyzed by statistical software using simple linear regressions to determine the significant models. In the initial analysis, a series of simple regression models for a single national drug policy index were estimated for the indicators of access to medicines. Then, a similar approach was performed to estimate the independent effects of each policy components on access to medicines variables.


Results
:
 Despite the availability of credible data, no systematic relationship was found between NDP and access to medicines, except for its single component. Finance system was a significant predictor in models of generics price in public sector (p=.017) and availability of generics both in public (p=.039) and private sectors (p=.005). Other findings were unexpected, such as: NDP index as a significant predictor for better availability of generics in the private sector (p=.010), and not public. Selection of medicines as a significant contributor to higher availability of originator brand medicines (not generics) in the public sector (p=.003). Production system as a significant predictor of originator brand availability in the public sector (p=.010), suggesting that local production may contribute to production of brand drugs than generics, and thus may be of little values for provision of affordable medicines.

Conclusion: In this study, the first of its kind, models did not reveal systematic or convincing relationship between national drug NDP and access to medicines. In fact, the findings were unexpected where NDP and its components showed more effects on the private sector and originator brand medicines over public sector and generic medicines. This apparent lack of impact of NDP may be due to poor policy implementation, or other externality factors. Policy implementation is a complex phenomenon. The findings and lessons learned from this study recommend further studies to use the context of the entire health system and other externality factors, employing stronger research designs and adapting techniques from the social and political sciences in order to acknowledge the multifaceted problems that governments face in policy processes, especially the complexity of policy implementation.