World Drug Situation: Differences and Gaps Between Countries Marthe Everard Essential Drugs and Medicines Policy Policy, Access and Rational Use World Health Organization
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World Drug Situation: Differences and Gaps Between Countries
Marthe EverardEssential Drugs and Medicines Policy
Policy, Access and Rational UseWorld Health Organization
WHO - EDM2
Production and Trade
Global drugs production occurs mainly in high income countries (>90% of production since 1985)
Global trade is also dominated by high income importers and exporters; this appears to be increasing:
% of global imports 1980 1999Low income countries 7.2 3.4Middle income 22.9 17.3High income 69.9 79.3
Findings
WHO - EDM3
Production and Trade
Trend of production value (in current US$ millions) in 5
top countries
0
20000
40000
60000
80000
100000
120000
Year
Valu
e
USA Japan Germany France UK
Findings
WHO - EDM4
Access to Essential Drugs
Differences Between Regions
of 60 “very high” access countries:25 are in EURO, 3 in AFRO
of 29 “very low” access countries 22 are in AFRO, 3 in EURO
of individuals without access:15% are in AFRO,38% in India alone
Findings
WHO - EDM5
Access to Essential Drugs
Differences between Countries:
80% of individuals without access are in low income countries against 0.3% of individuals in high income countries
40% of individuals in low income countries have no accessagainst 1% of individuals in high income countries
Access correlates strongly with income levels: Av.No. of people/registered outlet, 1999high income countries 4,800middle income countries 14,400low income countries 27,400
Findings
WHO - EDM6
Access to Essential Drugs
Access to essential drugs correlates closely with other measures of health system performance:
access to health care health outcomes health system responsiveness fairness in health financing
Findings
WHO - EDM7
0 10 20 30 40 50 60 70
South AfricaArgentina
JordanTunisia
ThailandIndonesia
ChinaEgypt
Mali
LithuaniaSloveniaEstoniaPolandCroatia
HungaryCzech Rep.
Bulgaria
NorwayNetherlands
United StatesUK
DenmarkSpain
FranceItaly
GermanyGreece
Pharmaceutical spending, as % of total health spending
Transitional economies(15-30 %)
Developed countries(7 - 30 %)
Developing countries(24 - 66 %)
Findings
Drug expenditure (out-of-pocket)
WHO - EDM8
Health insurance
Countries with health insurance (79)
Findings
WHO - EDM9
Quality assurance
mechanisms in Africa improving - but much more work needed
29%
38%
33%
46%
24%
30%
0%
50%
100%
1986 1998QA mechanisms with QC lab. Some QA mechanisms, no QC lab.No QA mechanisms
Availability of QA mechanisms in 34 African countries
Findings
WHO - EDM10
Quality control
0
20
40
60
80
100
With basic quality elements No basic elements
Low income
Middle income
High income
Findings
WHO - EDM11
National drug policies
NDP implementation plan <5 years (4)
NDP document (49)
Both (35)
Findings
WHO - EDM12
Still to do...
Additional data being collected “Main messages” yet to be distilled
Conclusion
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