Monitor MEDICINE PRICE - who.int · PNFP Private-not-for-profit (health facility) WHO World Health...

No. 11: July-September 2013

Uganda CoUntry Working groUp

MonitorMEDICINE P R I C E

Ministry of HealtH

World HealtH organisation

HePs Uganda Hai afriCaHealtH action international

With sUpport from

Uganda No. 11 July-September 2013

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UgandaMonitorMEDICINE P R I C E

aBBreViationS anD acronYMSCSO Civil Society OrganizationDANIDA Danish International Development AgencyDHO District Health OfficerDFID Department for International DevelopmentEMHS Essential Medicines and Health SuppliesHAI Health Action InternationalHEPS Coalition for Health Promotion and Social DevelopmentHSSIP Health Sector Strategic and Investment Plan MeTA Medicines Transparency AllianceMoH Ministry of HealthMPR Median Price RatioNGO Non-governmental organizationNPSSP National Pharmaceutical Sector Strategic PlanPFP Private-for-Profit (health facility)PNFP Private-not-for-profit (health facility)WHO World Health Organization

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eXecUtiVe SUMMarYPrice is the most predominant barrier to access to essential medicines.1 Periodic monitoring of medicines is very important in determining if medicines are available and affordable to patients.

In September 2013, MeTA Council of Uganda implemented a Medicine Availability and Price (MAP) survey of 40 essential indicator medicines. The survey was a quantitative process that used the traditional WHO/HAI methodology in 4 geographical regions (Eastern, Central, Western, and Northern) of Uganda across 3 health sectors (Public, Private and Mission) on price and availability.

In total 120 facilities (taking into consideration urban and rural representation) were visited by a team of data collectors comprised of pharmacists/ pharmacy technicians and social scientists having bias in public health practice. The survey was managed by a Survey Manager who is a pharmacist.

Key findings from the survey included:

The overall availability of the surveyed medicines was 68% in the public facilities, •65% in private and 74% in mission facilities.

A relatively bigger proportion of urban-based facilities had medicines available than •rural-based facilities. At 30%, the difference was highest the private sector.

89% of the public and mission facilities had Artemether/Lumefantrine 20/120mg •tablets physically available on the day of the survey compared to 75% of the private facilities.

Medicines for the most common non-communicable diseases (diabetes and hypertension) •were found available in less than 70% of the facilities across the three sectors.

The public facilities had very low availability of paediatric formulations: amoxicillin •suspension (11%), cotrimoxazole syrup (16%) and metronidazole syrup (45%).

Medicine prices were comparable between urban and rural facilities in the private •sector (MPR 1:1).

1 Ellen fm & hoen t (2003): trips, pharmaceutical patents and access to Essential medicines: seattle, doha and Beyond

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Medicines were 12% more expensive in urban than in rural mission facilities (MPR •1:1).

Comparing mission and private sectors, there was no difference in the price of 25 of •the 40 essential medicines surveyed.

In the private and mission sectors, medicines for chronic conditions like asthma, •depression, diabetes, hypertension and ulcers cost more than a day’s wage for the lowest paid government worker in Uganda. However, the following conditions are affordable in both sectors by the lowest paid government worker: RTI (both adult and paediatric), anxiety, arthritis and pain/inflammation.

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No. 11: July-September 2013Table 3: Availability of 40 essential medicines across sectors Oct-Dec 2010

1. introDUction anD BacKGroUnD1.1 IntroductionThe Constitution of the World Health Organisation (1946) recognises access to medicines as a major component of the right to health. Therefore, periodic monitoring of medicine is very important in determining if medicines are available and affordable at the different levels in the distribution chain. One way of addressing the price barrier to access to essential medicines is by improving information flow through multi-stakeholder approaches that pool together diverse expertise. In Uganda, Ministry of Health (MOH), WHO and HAI Africa and its local partner HEPS Uganda through the Country Working Group (CWG) have since 2002 monitored medicine availability and prices. Medicines Transparency Alliance (MeTA) Uganda prioritised this activity in its work plan and funds were provided by the IMS.

1.2 Background

Uganda is among the least developed countries of the world. A big percentage of the population still lives under a dollar a day. Its health statistics are among the worst in the world. An estimated 7% of the population is living with HIV, which has put an extra burden on the country’s already weak public health system.

It is estimated that only one third of the population has access to essential medicines. Price is one of the most predominant barriers to access to medicines. In developing countries, at a national level, the cost of medicines may account for up to 80% of non-salaried health expenditure, and at community level, the majority of people pay out-of-pocket for the medicines they consume. It is clear, therefore, that price is often a determining factor in whether the government can offer treatment to its population for a particular disease, or whether an individual receives a full treatment, an incomplete course, or no medicine at all. Until recently, there has been little information on what government or people paid for medicine.

Data from the various surveys of the CWG have revealed that universal access to medicines has not been achieved and that medicines remain unaffordable for a significant section of the population. The results of these studies guide decisions on a strategy for improving affordability.

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The monitoring system generates regular information on price changes over time, and comparisons between the three sectors (public, private and mission) and four regions of the country. By informing consumers and procurement agencies about current prices and patterns of price changes, these series of surveys are an important complement to efforts to improve access to medicines for Ugandans, especially the poor and vulnerable.

1.3 Objectives of the survey

By gathering and analysing comprehensive data on the prices of selected medicines in the four representative regions of Uganda and across three sectors (Public, Private for profit and private not for profit/NGO/mission), the survey aimed at achieving the following objectives:

To determine the availability of selected medicines in the public, private and mission •sectors;

To compare the prices of selected medicines between the private and mission sectors;•

To determine the affordability of treating key indicator conditions to ordinary Ugandans; •and

To inform policy interventions aimed at improving access to essential medicines in •Uganda

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2. MetHoDoloGY2.1 Design

The survey was conducted using the standard methodology co-developed by WHO and HAI1. The survey used mainly quantitative methods to assess availability and prices of medicines in the public, private and mission sectors (See annex 2 for the survey tool).

2.2 Geographical areas

The survey was conducted in four regions of Uganda (Central, Eastern, Western, and Northern). The four regions were chosen as a realistic representation of the diversity in epidemiological and geographical characteristics of the country.

2.3 Sectors and facilities

The survey was conducted in three sectors: public, private (PFP) and mission (NGO/PNFP). All three contribute a significant proportion of health services in the country. The standard WHO/HAI methodology recommends 30 outlets per sector for a survey to achieve enough data points for analysis.2 The current survey targeted a total 120 facilities disaggregated as follows: 40 outlets per sector (20 rural and 20 urban) and in each region 10 per sector (5 rural and 5 urban).

2.4 Sampling strategy

One hundred and twenty (120) facilities - 40 facilities per sector - were selected for the survey (see annex 1). In each region, the main regional referral hospitals (purposively selected), district hospitals and health centre IVs were selected to represent the public health sector facilities. Five licensed community pharmacies, 3 drug shops and 2 clinics located within 5 km of each of the selected public facilities were purposively selected to represent the private sector.

1 www.haiweb.org/medicineprices2 it is noted that a number of validation studies (in addition to the 9 pilot studies) were done during the original

process of methodology development. the most important validation was on the sampling frame where it was found that sampling more regions, and those in areas greater than one days car travel from the capital, and in each area from more outlets a greater distance from the main hospital produced the same results as using the standard sampling frame. the adequacy of collecting data on just the originator brand and lowest priced generic equivalent was also studied – again it was found there was no significant difference in the results. The volatility of msh prices (used as an external bench-mark) have also been studied and little volatility has been found. a paper on validation has been published, and is cited as madden Jm, meza E, Ewen m, Laing ro, stephens p, ross-degnan d. measuring medicine prices in peru: validation of key aspects of Who/hai survey methodology. rev panamsaludpublica. 010;27 (4):291–9.

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The NGO facilities with similar characteristics to public sector (e.g. mission hospitals of similar size and capacity to the regional, district and sub-district hospitals in the region) were purposively selected.

The list of sites surveyed is attached (Annex 1).

Urban and rural representation was taken into consideration when selecting. Urban areas were considered to be towns with a population of more than 50,000 and rural areas to at least 10 km away from the urban centres.

2.5 Medicines surveyed

The selection of a basket of 40 essential medicines was based on the methodology’s core and supplementary lists. The list was approved by the Pharmacy Division of Ministry of Health – Uganda.

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Table 1: Medicines surveyedNO MeDIcINe STreNGTh DOSaGe fOrM caTeGOry

1 Aciclor 200mg Tablet Antiviral2 Albendazole 200mg Tablet Anthelmintic3 Amitriptyline 25mg Tablet Antidepressant4 Amoxicillin 250mg cap/tab Antibacterial5 Amoxicillin 250mg/5ml Suspension Antibacterial6 Artemether/Lumefantrine 20/120mg Tablet Antimalarial7 Bendrofluazide 5mg Tablet Diuretic8 Betamethasone 1% w/v cream/ointment Anti-inflammatory9 Carbamazepine 200mg Tablet Antiepileptic10 Ceftriaxone 1gm Powder for inj Antibacterial11 Cimetidine 400mg Tablet Anti-ulcer12 Ciprofloxacin 500mg Tablet Antibacterial13 Co-trimoxazole 8/40 mg/ml Suspension Antibacterial14 Co-trimoxazole 400+80 mg Tablet Antibacterial15 Dextrose 5% Injection Parenteral16 Diazepam 5mg Tablet Anxiolytic17 Diclofenac 50mg Tablet Analgesic18 Doxycycline 100mg Capsule Antibacterial19 Erythromycin 250mg Tablet Antibacterial20 Fluconazole 200mg tab /cap Antifungal21 Furosemide 40mg Tablet Diuretic22 Gentamycin 80mg/ml Injection Antibacterial23 Glibenclamide 5mg Tablet Antidiabetic24 Mebendazole 100mg Tablet Anthelmintic25 Metformin 500mg Tablet Antidiabetic26 Methyergometrine 200ug/ml Injection Oxyticic27 Metronidazole 200mg/5ml Suspension Antibacterial28 Metronidazole 200mg Tablet Antibacterial29 Nifedipine retard 20mg Tablet Antihypertensive30 Nystatin 100000iu Pessaries Antifungal31 Omeprazole 20mg Capsule Antiulcer32 Oral Rehydration Salt

(ORS)- Powder Antidiarrhoea

33 Paracetamol 500mg Tablet Analgesic34 Phenytoin 100mg Tablet Antiepileptic35 Prednisolone 500mg Tablet Antiinflammatory36 Pyrimethamine /sulfadoxide 25/500mg Tablet Antimalarial37 Propranolol 40mg Tablet Antihypertensive38 Quinine 300mg/5ml Injection Antimalarial39 Salbutamol 0.1mg(100mcg)/dose Inhaler Antiasthmatic40 Tetracycline 1% eye ointment Antibacterial

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2.6 Personnel

One pharmacist or pharmacy technician and one social scientist with bias in public health, from each of the 4 regions were trained on how to collect data. A pharmacist with bias in public health was recruited as the survey manager, took the responsibility of setting up and conducting the survey, supervising data collectors, analysing the data, and writing the report.

An Expert Advisory Group guided the survey process through supporting the survey manager in setting up and conducting the survey; providing feedback on the survey findings and earlier drafts of this report; informing recommendations on policy options; and promoting the survey and its findings.

Table 2: advisory GroupNaMe TITLe, OrGaNIZaTION1. Mr. Nazeem Mohamed Chief Executive Officer, Kampala Pharmaceutical Industries2. JoanitaLwanyagaNamutebi Head Quality Assurance, Joint Medical Store3.Ms. Rosette Mutambi Executive Director, HEPS Uganda4. Ms. HellenByomire Head Drug Information, National Drug Authority5. Mr. MorriesSeru Principle Pharmacist, Ministry of Health6. Mr. SowediMuyingo CEO, Medical Access Uganda Limited7. Mr. Joseph Mwoga National Professional Officer, WHO Uganda Country Office8. Opio Sam Secretary, Pharmaceutical Society of Uganda9. Fred Kitutu Lecturer School of Pharmacy, Makerere University10. Denis Kibira Coordinator, MeTA Uganda

2.7 Data collection

Prior to data collection, all survey personnel participated in a training/briefing led by the survey manager. Data collectors were provided with introductory letters from Ministry of Health. At the district, data collectors introduced themselves and the purpose of the survey to the District Health Officer (DHO) before proceeding to collect data from the selected facilities.

At the facility, for each medicine, data on prices and availability of the lowest priced product that was physically available on the day of the visit were collected using a standard data collection form. The collected data was delivered to the survey manager at the coordinating office physically or by courier or post. Data collectors retained a copy of their data collection forms in case there was need for further verification. The HEPS Uganda Secretariat in Namirembe, Kampala acted as the central coordinating office to support the logistics for the survey.

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2.8 Data validation, entry, analysis and management

The survey manager checked all the data collection forms for completeness and accuracy. Questionable entries were validated by contacting either the data collectors or the health facility or both. Validation of the data collection was conducted in 10% of the sampled outlets. This was done by calling the outlets using telephones contacts given on the data collection forms.

Data analysis was done using a customised WHO/HAI Excel workbook. Tables, graphs were generated for the report. Availability was determined as a percentage of facilities having a particular medicine on the day of the survey. Median price ratios (MPR) were calculated to compare prices between mission and private facilities. The following conditions were used to gauge affordability of medicines: Diabetes, hypertension, asthma, acute respiratory infection (ARI), peptic ulcers and malaria. The earning of the government’s lowest paid worker was used as a benchmark for affordability assessment.

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3. reSUltS anD DiScUSSion3.1 availability

Table 3 and Figure 1 below show the overall availability of medicines across the three sectors and comparison between rural and urban facilities.

Table 3: Overall availability of medicines in the surveyed facilities Jul-Sep 2013Sector No. facilities surveyed Median availability (%)

PublicOverall 38 68Urban 19 68Rural 19 66

PrivateOverall 40 65Urban 20 85Rural 20 55

MissionOverall 35 74Urban 16 85Rural 15 66

The overall availability of the surveyed medicines was highest in the mission facilities (74%), followed by public (68%)1 and lowest in private facilities (65%). Generally, urban facilities had the highest availability compared to the rural facilities across all sectors.

figure 1: availability in Urban versus rural facilities, Jul-Sept. 2013

1 Compare with an average availability of 87% for 6 tracer medicines ministry of health (2012) reports in the national performance report on medicines management

68

85 85

66

55

666865

74

0

10

20

30

40

50

60

70

80

90

Public Private Mission

Avai

labi

lity

(%)

Sector

Urban

Rural

Overall

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There was a 2% difference in availability between urban and rural facilities in the public sector, 30% difference in the private sector and 19% in the mission sector. The big difference in availability between urban and rural facilities in the private sector can be attributed to the fact that drug shops and clinics are the most common drug outlets in the rural areas in Uganda and in urban areas pharmacies are the most predominant. According to NDA statute1, drug shops are licensed to stock only Class C drugs whereas pharmacies stock all classes of drugs, and this could have affected availability of some medicines.

a) Overall availability of the 40 essential medicines across the three sectors, Jul–Sep 2013

Table 4 below compares overall availability of the 40 essential medicines surveyed across the public, private, and mission sectors.

In the public sector, 45% (18/40) of the medicines were available in more than 75% •the facilities and 35% (14/40) were in less than 50% of the facilities

In the mission sector, 40% (16/40) of the medicines were found in more than 75% of •the facilities surveyed, whereas 12.5% (5/40) were in less than 50%.

In the private sector, 25% (10/40) of the medicines were in more than 75% of the •facilities, whereas 15% (6/40) were in less than 50% of facilities.

1 national drug policy and authority act 1993

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Table 4: Overall availability of 40 essential medicines across sectorMedicine Overall availability (%)

Public sector Private sector Mission SectorAciclor tab 200mg 50 65 74Albendazole tab 200mg 37 30 46Amitriptyline tab 25mg 95 70 83Amoxicillin cap/tab 250mg 84 85 91Amoxicillin susp 250mg/5ml 11 75 74Artemether/Lumefantrine tab 20/120mg 89 75 89Bendrofluazide tab 5mg 71 53 69Betamethasone cream/ointment 1%w/v 32 60 43Carbamazepine tab 200mg 82 65 71Ceftriaxone 1g pwder for inj'n 76 68 83Cimetidine tab 400mg 8 38 34Ciprofloxacin tab 500mg 82 83 94Co-trimoxazolesusp 8/40 mg/ml 16 65 57Co-trimoxazole tab 400+80 mg 89 80 86Dextrose 5% inj 84 58 77Diazepam tab 5mg 95 80 74Diclofenac tab 50mg 58 95 83Doxycycline cap/tab 100mg 76 70 100Erythromycin tab 250mg 63 65 80Fluconazole tab /cap 200mg 32 38 49Furosemide tab 40mg 61 55 66Gentamycin inj 80mg/ml 45 63 80Glibenclamide tab 5mg 55 53 63Mebendazole tab 100mg 76 88 77Metformin tab 500mg 71 63 66Methyergometrineinj 200ug/ml 45 20 51Metronidazole susp 200mg/5ml 45 50 63Metronidazole tab 200mg 92 93 97Nifedipine retard tab 20mg 79 63 74Nystatinpessaries 100000iu 13 68 63Omeprazole cap 20mg 66 85 83Oral Rehydration Salt (ORS) 89 80 89Paracetamol tab 500mg 89 98 100Phenytoin tab 100mg 76 35 57Prednisolone tab 500mg 16 75 74Pyrimethamine /sulfadoxide (SP) tab 25/500mg 79 63 71Propranolol tab 40mg 39 65 69Quinimeinj 300mg/5ml 45 63 74Salbutamol inhaler 0.1mg(100mcg)/dose 11 43 37Tetracycline eye ointment 1% 89 60 69

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b) a comparison of overall availability of selected anti-malarial medicines across the three sectors:

Figure 2 below compares the overall availability of artemether/lumefantrine 20/120mg and Sulfadoxine/Pyrimethamine used for treating uncomplicated malaria and prophylaxis of malaria during pregnancy respectively, across the three health sectors.

figure 2: comparison of overall availability of medicines for malaria across sectors

89

7975

63

89

71

0

10

20

30

40

50

60

70

80

90

100

Artemether/Lumefantrine • Sulphadoxine/Pyrimethamine

Avai

labi

lity

(%)

-malarial medicines

Public

Private

Mission

89% of the public and mission facilities had Artemether/Lumefantrine tablets 20/120mg in stock on the day of the visit compared to 75% of the private facilities.

Sulphadoxine/Pyrimethamine had the highest availability of 79% in the public facilities followed by mission (71%) and lowest in the private at 63%.

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c) a comparison of overall availability of selected anti-diabetic medicines across the three sectors

Figure 3 below compares the overall availability of Glibenclamide 5mg and Metformin 500mg used in management of diabetes, across the three health sectors

figure 3: comparison of overall availability of medicines for diabetes across sectors

45

71

63 63

80

66

0

10

20

30

40

50

60

70

80

90

Glibenclamide 5mg

Avai

labi

lity

(%)

-

Public

Private

Mission

At least 60% of facilities in the public, private and mission sectors had Metformin 500mg in stock on the day of the survey. Glibenclamide 5mg was less available in the public sector (45%), but more available in the mission sector (80%).

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d) a comparison of overall availability of selected anti-hypertensive medicines across the three sectors

Figure 4 below compares the overall availability of Nifedipine 20mg and propranolol used in management of hypertension, across the three health sectors.

fig. 4: comparison of overall availability of medicines for hypertension across sectors

79

39

63 65

7469

0

10

20

30

40

50

60

70

80

90

Nifedipine 20mg Propranolol

Avai

labi

lity

(%)

-hypertensive medicines

Public

Private

Mission

The public sector had the highest availability of Nifedipine 20mg (79%) and lowest availability of propranolol (39%) compared to other sectors.

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e) a comparison of overall availability of selected paediatric formulations across the three sectors

Figure 4 below compares the overall availability of selected medicines formulated for paediatric use across the three health sectors

figure 5: comparison of overall availability of paediatric formulations across sectors

1116

45

75

65

50

74

5763

0

10

20

30

40

50

60

70

80

Amoxicillin susp Cotrimoxazole susp Metronidazole susp

Avai

labi

lity

(%)

Public

Private

Mission

The Public sector had the lowest availability of appropriate paediatric formulations: amoxicillin suspension 125mg/5ml in 11% of facilities, cotrimoxazole syrup 8/40mg in 16% and metronidazole syrup in 45% of public facilities.

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3.2 Medicine prices

Table 5: Comparison of medicine median price ratios between and within private and mission sectors.

PrivUrb/Privrural MisUrb/Misrural PrivUrb/MisUrb Privrural/Misrural

No. of times more expensive 1.00 1.12 1.00 1.00No. of Pairs Compared 37 40 40 37

As shown in table 5 above, the prices charged to consumers for medicines in the private facilities were comparable across urban and rural facilities (ratio 1:1). However, in the mission facilities medicines were 12% more expensive in the urban than rural facilities (ratio 1:1.12).

Medicine prices were comparable between urban private and mission facilities and in rural private and mission facilities (ratio 1:1).

Table 6 below shows the median consumer prices per unit of selected medicines in the private and mission facilities. There was no difference in price of 25 of the medicines between mission and private facilities. A marked 50% and above price difference between prices in the private and mission sectors were noted for Mebendazole 100mg, Diclofenac 50mg , carbamazepine 200mg, Albendazole 200mg, Artmetther/Lumefantrine 20/120mg and Prednisolone tablets.

More information on prices is in annex 2.

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Table 6: Median unit price of the 40 medicines in the private and mission facilities

MedicineMedian unit price (Ushs.)

% price differencePrIVaTe SecTOr

MISSION SecTOr

Aciclor tab 200mg 300.0 300.0 0.0Albendazole tab 200mg 1000.0 500.0 50.0Amitriptyline tab 25mg 100.0 100.0 0.0Amoxicillin cap/tab 250mg 100.0 100.0 0.0Amoxicillin susp 250mg/5ml 30.0 30.0 0.0Artemether/Lumefantrine tab 20/120mg 250.0 125.0 50.0Bendrofluazide tab 5mg 100.0 100.0 0.0Betamethasone cream/ointment 1%w/v 200.0 166.7 16.7Carbamazepine tab 200mg 100.0 150.0 50.0Ceftriaxone 1g pwder for inj'n 3000.0 3250.0 8.3Cimetidine tab 400mg 200.0 200.0 0.0Ciprofloxacin tab 500mg 250.0 250.0 0.0Co-trimoxazolesusp 8/40 mg/ml 30.0 30.0 0.0Co-trimoxazole tab 400+80 mg 100.0 100.0 0.0Dextrose 5% inj 2000.0 2000.0 0.0Diazepam tab 5mg 100.0 100.0 0.0Diclofenac tab 50mg 50.0 80.0 60.0Doxycycline cap/tab 100mg 100.0 100.0 0.0Erythromycin tab 250mg 200.0 200.0 0.0Fluconazole tab /cap 200mg 1000.0 1000.0 0.0Furosemide tab 40mg 100.0 100.0 0.0Gentamycin inj 80mg/ml 800.0 800.0 0.0Glibenclamide tab 5mg 100.0 100.0 0.0Mebendazole tab 100mg 50.0 100.0 100.0Metformin tab 500mg 200.0 150.0 25.0Methyergometrineinj 200ug/ml 2000.0 1100.0 45.0Metronidazole susp 200mg/5ml 27.5 25.0 9.1Metronidazole tab 200mg 50.0 66.7 33.3Nifedipine retard tab 20mg 200.0 200.0 0.0Nystatinpessaries 100000iu 285.7 300.0 5.0Omeprazole cap 20mg 200.0 250.0 25.0Oral Rehydration Salt (ORS) 500.0 500.0 0.0Paracetamol tab 500mg 50.0 50.0 0.0Phenytoin tab 100mg 100.0 100.0 0.0Prednisolone tab 500mg 100.0 50.0 50.0Pyrimethamine /sulfadoxide (SP) tab 25/500mg 500.0 500.0 0.0Propranolol tab 40mg 100.0 100.0 0.0Quinimeinj 300mg/5ml 1000.0 1100.0 10.0Salbutamol inhaler 0.1mg(100mcg)/dose 8000.0 8000.0 0.0Tetracycline eye ointment 1% 571.4 500.0 12.5

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d) affordability

Affordability was calculated as the number of days the lowest paid government worker would have to pay for one treatment course of an acute condition or one month’s treatment of a chronic condition. Treatments less than or equal to one days’ wages are considered affordable. The monthly earning of the lowest paid government worker is UShs. 222,976 (U8L) before tax, and after tax it is Ushs. 156,083. This gives daily wage of about 5200 (2.00 US$) as take home. Table 7 below shows the number of days it would take the lowest paid government worker to pay for treatment of the most common diseases in the private and mission sectors.

Table 7: affordability (Daily wage of lowest paid government worker is Ushs. 5200)

condition Select MedicineTreatment duration (in days)

# of units per treatment

MTP (Ushs.) Days' wages

Private MissionPrivate(MTP/5200)

Mission(MTP/5200)

Adult Malaria

Artemether/Lumefantrine tab 20/120mg 3 24 6000 3000 1.2 0.6

Adult RTI

Amoxicillin cap/tab 250mg 7 42 4200 4200 0.8 0.8Ceftriaxone 1g pwder for inj'n 1 1 3000 3250 0.6 0.6Ciprofloxacin tab 500mg 7 14 3500 3500 0.7 0.7

Anxiety Diazepam tab 5mg 7 7 700 700 0.1 0.1

Arthritis Diclofenac tab 50mg 30 60 3000 4800 0.6 0.9

AsthmaSalbutamol inhaler 0.1mg/dose as need 200 8000 8000 1.5 1.5

Depression Amitriptyline tab 25mg 30 90 9000 9000 1.7 1.7

Diabetes Glibenclamide tab 5mg 30 60 6000 6000 1.2 1.2

HypertensionNifedipine retard tab 20mg 30 30 6000 6000 1.2 1.2

Paediatric RTICo-trimoxazolesusp 8/40 mg/ml 7 70 2100 2100 0.4 0.4

Pain/Inflammation Paracetamol tab 500mg 3 18 900 900 0.2 0.2

Ulcer Omeprazole cap 20mg 30 30 6000 7500 1.2 1.4

In both the private and mission sectors medicines for treatment of chronic conditions like asthma, depression, diabetes, hypertension and ulcers cost more than a day’s wage.

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4. conclUSionThe overall availability of the surveyed medicines was 68% in the public facilities, •65% in private and 74% in mission facilities

More of urban based facilities had medicines available than rural, a big difference of •30% being in the private sector

89% of the public and mission facilities had Artemether/Lumefantrine 20/120mg •tablets physically available on the day of the survey compared to 75% of the private

Medicines for the most common non-communicable diseases (diabetes and hypertension) •were found available in less than 70% of the facilities across the 3 sectors

The public facilities had a very low availability of paediatric formulations: amoxicillin •suspension (11%), cotrimoxazole syrup (16%) and metronidazole syrup (45%)

Medicine prices were comparable between urban and rural facilities in the private •sector (median price ratio). However, medicines were 12% more expensive in urban than rural mission facilities

There was no difference in price of 25 out of the 40 essential medicines surveyed •between mission and private facilities

In the private and mission sector, medicines for chronic conditions like asthma, •depression, diabetes, hypertension and ulcers cost more than a day’s wage for the lowest paid government worker in Uganda. However, the following conditions are affordable in both sectors by the lowest paid government worker: RTI (both adult &paediatric), anxiety, arthritis and pain/inflammation

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referenceSUganda: Health Sector Strategic Investment Plan 2010/11-2014/15•

Madden JM, Meza E, Ewen M, Laing RO, Stephens P, Ross-Degnan D. Measuring •medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology. Rev PanamSaludPublica. 010;27 (4):291–9

MeTA Uganda Work Plan, 2012•

Ministry of Health 2008b.Access to and use of medicines by Households in Uganda, •Report. Kampala, Uganda.

Ministry of Health, 2002.Pharmaceutical Baseline Survey, Report. Kampala, •Uganda.

Ministry of Health, 2008a.Pharmaceutical Situation Assessment, Report. Kampala, •Uganda.

Ministry of Health, 2010. WHO, HAI (HEPS) Medicine Price Monitor Volume 1-8. •Kampala, Uganda.

Ministry of Health.MoH., 2008.Access to and use of medicines by households in •Uganda. Kampala: Ministry of Health.MoH.

World Health Organisation, 2006. Health Financing: A basic guide. WHO; Western •Pacific Region.

www.haiweb.org/medicineprice• s

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UgandaMonitorMEDICINE P R I C Ea

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ef

hosp

ital

3.Ig

anga

hos

pita

l4.

Kam

uli G

ovt

hosp

ital

5.Pa

llisa

ho

spita

l

1.W

aluk

uba

HC

2.

Buw

enge

HC

jin

ja

3. B

udad

iri H

C

Mba

le4.

Bub

ulo

HC

M

bale

5.

Bud

uda

hosp

ital

1.G

ilead

pha

rmac

y 2.

Ran

a m

edic

al c

ente

r 3.

Sky

phar

mac

y M

bale

2 cl

inic

s 3

Dru

g sh

ops

Nor

ther

n1.

St M

ary’

s Hos

pita

l La

corG

ulu

2.PA

G h

ealth

uni

t L

ira

3.A

muc

a di

spen

sary

Li

ra 4

.Nge

eta

hosp

ital

Lira

1.A

mai

hos

pita

l Lira

2.O

pit H

C

3.A

loi H

C L

ira

4. A

liwan

g H

C L

ira

5.A

lany

i HC

Lira

1.G

ulu

regi

onal

Ref

ho

spita

l2.

Lira

regi

onal

Ref

ho

spita

l3.

Am

aka

hosp

ital G

ulu

1.O

gur H

C2.

Am

uc H

C L

ira

3. D

okol

o H

C

4.

Lal

ogi H

C G

ulu

1.Fe

liest

a ph

arm

acy

Lira

2.G

ulu

inde

pend

ant

hosp

ital

3.

Opi

os c

linic

Gul

u

4.K

akan

yero

pha

rmac

y G

ulu

2 cl

inic

s

3

Dru

g sh

ops

Cen

tral

1.N

sam

bya

hosp

ital

2.R

ubag

a ho

spita

l

3.M

engo

hos

tal

4.K

isub

i hos

pita

l

1.N

koko

njer

u ho

spta

l 2.

Muk

ono

Hos

pita

l

3.N

agal

ama

hosp

ital

4.St

.Ste

phen

s dis

pens

ary

Mpe

rerw

e

5.M

akon

ge c

omm

unity

HC

M

ukon

o

1.M

ulag

o ho

spis

tal

2.B

utab

ika

hosp

ital 3

.Ent

ebbe

gr

ade

B h

ospi

tal

4.M

aker

ere

Uni

vers

ity

hosp

ital

1.K

ayun

ga h

ospi

tal

2.K

awol

o ho

spita

l 3

.Muk

ono

HC

4

4.

Gom

be h

ospi

tal

or a

ny H

C 4

1.Fr

osa

phar

mac

y N

akul

abye

2.G

enes

is p

harm

acy

Lu

zira

3.B

ugol

obi

mat

erni

ty

4.C

ase

clin

ic

4.K

adic

clin

ic

2 cl

inic

s

3

Dru

g sh

ops

Wes

tern

1.

Iban

da H

ospi

tal

2.Is

haka

Hos

pita

l3.

Ruh

aro

hosp

ital

4.K

isiz

i Hos

pita

l

1.N

yaki

bale

Hos

pita

l R

ukug

iri2.

Kya

muh

anga

Hos

pita

l B

ushe

nyi

3.R

ushe

re h

ospi

tal

Mba

rara

4.N

yaki

shen

yi H

C4

1.M

bara

ra R

eg H

osp

2.K

itaga

ta H

ospi

tal

Bus

heny

i3.

Itojo

Hos

pita

l4.

Kam

buga

Hos

pita

l R

ukun

giri

1.N

akiv

ule

HC

42.

Isho

ngor

era

HC

43.

Nsh

enge

zi H

C 4

4.B

wiz

ibw

era

1..M

ayan

ja m

emor

ial

2.M

bara

ra C

omm

unity

3.

Mul

tiple

pha

rmac

ist

4.M

uilti

care

pha

rcac

y

2 cl

inic

s 3

Dru

g sh

ops

25

No. 11: July-September 2013a

nnex

2: M

onito

ring

Pri

ces a

nd a

vaila

bilit

y of

Med

icin

es in

Uga

nda:

Dat

a c

olle

ctio

n fo

rm –

aug

ust 2

013

faci

lity

Nam

e:a

ddre

ss o

f fac

ility

:

fac

ility

Tel

epho

ne:

faci

lity

fax:

faci

lity

em

ail:

faci

lity

cod

e:

Type

of h

ealth

faci

lity

(Tic

k):

Pub

lic

Mis

sion

Pri

vate

reg

ion:

Dis

tric

t:Se

ttin

g (T

ick)

:

U

rban

r

ural

Dat

a co

llect

orN

ame

:M

obile

:e

-mai

l:

Dat

e of

dat

a co

llect

ion:

(DD

/MM

/Y

YY

Y)

/

/

INST

rU

cT

ION

S

1.

Faci

lity

info

rmat

ion:

Mak

e su

re th

at y

ou fi

ll al

l cel

ls o

f the

abo

ve ta

ble.

•

If fa

x or

e-m

ail d

on’t

exis

t put

“N

/A”

to in

dica

te n

ot a

vaila

ble

2.

Iden

tifyi

ng p

rodu

cts f

or p

rice

mon

itorin

g:

Iden

tify

prod

ucts

with

•

thee

xact

stre

ngth

and

dos

age

form

for e

ach

med

icin

e lis

ted

that

are

phy

sica

lly a

vaila

ble

for s

ale

or d

ispe

nsin

g on

the

day

of th

e da

ta c

olle

ctio

n

Mak

e su

re th

at y

ou d

o no

t mis

take

nly

incl

ude

prod

ucts

that

are

of d

iffer

ent

•st

reng

ths o

r for

mul

atio

ns (e

.g. s

low

rele

ase

tabl

et in

stea

d of

regu

lar t

able

t; or

nas

al sp

ray

inst

ead

of in

hale

r; or

com

bina

tion

prod

ucts

whi

ch in

clud

e an

othe

r act

ive

ingr

edie

nt)

Do

not w

rite

dow

n pr

ice

info

rmat

ion

if th

e co

rrec

t pro

duct

is

•no

t ph

ysic

ally

ava

ilabl

e in

the

heal

th fa

cilit

y on

the

day

of d

ata

colle

ctio

n. P

ut

“N/A

” un

der p

rodu

ct n

ame

to in

dica

te n

ot a

vaila

ble

3.

Rec

ordi

ng d

ata

for p

rice

mon

itorin

g:Yo

u•

MU

ST w

rite

dow

n th

e pr

oduc

t nam

e (th

at is

trad

e na

me

or b

rand

na

me)

, the

nam

e an

d co

untry

of t

he m

anuf

actu

rer,

actu

al p

ack

size

and

pa

ck p

rice

foun

d fo

r the

pro

duct

with

the

low

est p

rice

Dis

coun

ts:

• R

ecor

d di

scou

nt a

s % a

nd th

e di

scou

nted

pric

e on

ly w

hen

sam

e di

scou

nt is

ava

ilabl

e fo

r al

l pat

ient

s

If m

edic

ines

are

free

to p

atie

nts l

ike

in th

e pu

blic

sect

or fa

cilit

ies,

•re

cord

all

prod

uct d

etai

ls a

nd w

rite

0 in

the

Pack

Pric

e ce

ll

4.

Cal

cula

ting

the

unit

or p

ack

pric

e:Fo

r pro

duct

s whe

re p

ack

pric

e is

giv

en; d

ivid

e th

e pa

ck p

rice

by th

e •

pack

size

foun

d (p

ack

pric

e/pa

ck si

ze) t

o ge

t uni

t pric

e an

d w

rite

it do

wn

up to

four

dec

imal

s (e.

g 0.

1234

) in

the

Uni

t Pric

e ce

ll.

For

pro

duct

s whe

re u

nit p

rice

is g

iven

; mul

tiply

the

unit

pric

e by

the

•pa

ck si

ze fo

und

(uni

t pric

e x

pack

size

) to

get p

ack

pric

e an

d w

rite

it in

the

pack

size

cel

l

If th

e di

scou

nt is

app

lied

for a

ll pa

tient

s, th

en c

alcu

late

the

unit

•pr

ice

from

the

disc

ount

ed p

ack

pric

e on

ly.

5.

fina

l ste

ps:

Plea

se c

heck

that

all

data

is c

orre

ctly

reco

rded

and

dou

ble

chec

k un

it •

pric

e ca

lcul

atio

ns b

efor

e se

ndin

g th

e da

ta c

olle

ctio

n fo

rms t

o th

e Su

rvey

Man

ager

Send

com

plet

ed d

ata

colle

ctio

n fo

rms b

y co

urie

r or h

and

deliv

er

•as

soon

as p

ossi

ble

to: H

EPS-

Uga

nda,

P.O

. Box

242

6, K

ampa

la,

Bal

intu

ma

Roa

d, M

engo

If y

ou h

ave

any

ques

tions

ple

ase

phon

e th

e su

rvey

man

ager

(Gild

oOku

re)

at +

2567

82-9

5933

6 or

e-m

ail t

o od

uffo

rd@

gmai

l.com

26


Med

icin

e nam

e,

dosa

ge fo

rm,

stre

ngth

Prod

uct

of

inte

rest

avai

labl

e?(“

yes”

or

“N/a

”)

Prod

uct n

ame

(bra

nd /

trad

e na

me)

Man

ufac

ture

r, co

untr

y of

m

anuf

actu

re

Pack

siz

e foun

d

Pack

pr

ice

Uni

t pri

ce (4

di

gits

)

Disc

ount

fo

r all?

Yes

%

Disc

ount

ed

pack

pri

cec

omm

ents

and

ob

serv

atio

ns

Aci

clov

ir ta

b 20

0mg

Low

est

pric

ed/ta

b

%

Alb

enda

zole

tab

200m

gLo

wes

t pr

ice

/tab

%

Am

itrip

tylin

e ta

b 25

mg

Low

est

pric

ed/ta

b

%

Am

oxic

illin

cap

25

0mg

Low

est

pric

ed/c

ap

%

Am

oxic

illin

Sus

p 12

5mg/

5ml

Low

est

pric

ed/m

l

%

Arte

met

her/

Lum

efan

trine

tab

20/1

20m

g

Low

est

pric

ed/ta

b

%

Ben

druo

fluaz

ide

tab

5mg

Low

est

pric

ed/ta

b

%

Bet

amet

haso

ne

crea

m/o

intm

ent

1% w

/v

Low

est

pric

ed/g

ram

%

Car

bam

azep

ine

tab

200m

gLo

wes

t pr

iced

/tab

%

Cef

triax

one

1g

pow

der f

or in

jLo

wes

t pr

ice

/via

l

%

Cim

etid

ine

tab

400m

gLo

wes

tpr

iced

/tab

%

Cip

roflo

xaci

n ta

b 50

0mg

Low

est

pric

ed/ta

b

%

27

No. 11: July-September 2013M

edic

ine n

ame,

do

sage

form

, st

reng

th

Prod

uct

of

inte

rest

avai

labl

e?(“

yes”

or

“N/a

”)

Prod

uct n

ame

(bra

nd /

trad

e na

me)

Man

ufac

ture

r, co

untr

y of

m

anuf

actu

re

Pack

siz

e foun

d

Pack

pr

ice

Uni

t pri

ce (4

di

gits

)

Disc

ount

fo

r all?

Yes

%

Disc

ount

ed

pack

pri

cec

omm

ents

and

ob

serv

atio

ns

Cot

rimox

azol

e Su

sp

40/2

00m

g/5m

l

Low

est

pric

ed/m

l

%

Cot

rimox

azol

e ta

b48

0mg

Low

est

pric

ed/ta

b

%

Dex

trose

5%

inj

Low

est

pric

e/b

ottle

%

Dia

zepa

m ta

b 5m

gLo

wes

t pr

iced

/tab

%

Dic

lofe

nac

tab

50m

gLo

wes

t pr

iced

/tab

%

Dox

ycly

clin

e ca

p 10

0mg

Low

est

pric

e/c

ap

%

Eryt

hrom

ycin

tab

250m

gLo

wes

t pr

iced

/tab

%

Fluc

onaz

ole

tab

/ ca

p 20

0mg

Low

est

pric

ed/ c

ap

%

Furo

sem

ide

tab

40m

gLo

wes

t pr

iced

/tab

%

Gen

tam

ycin

inj

80m

g/2m

lLo

wes

t pr

iced

/Am

p

%

Glib

encl

amid

e ta

b 5m

gLo

wes

t pr

iced

/tab

%

Meb

enda

zole

tab

100m

gLo

wes

t pr

iced

/tab

%

28

UgandaMonitorMEDICINE P R I C EM

edic

ine n

ame,

do

sage

form

, st

reng

th

Prod

uct

of

inte

rest

avai

labl

e?(“

yes”

or

“N/a

”)

Prod

uct n

ame

(bra

nd /

trad

e na

me)

Man

ufac

ture

r, co

untr

y of

m

anuf

actu

re

Pack

siz

e foun

d

Pack

pr

ice

Uni

t pri

ce (4

di

gits

)

Disc

ount

fo

r all?

Yes

%

Disc

ount

ed

pack

pri

cec

omm

ents

and

ob

serv

atio

ns

Met

form

in ta

b 50

0mg

Low

est

pric

ed/ta

b

%

Met

hyer

gom

et-

rinei

nj 2

00μg

/ml

/Am

p

%

Met

roni

dazo

le

Susp

200

mg/

5ml

Low

est

pric

ed/m

l

%

Met

roni

dazo

le ta

b 20

0mg

Low

est

pric

e/ta

b

%

Nife

dipi

ne re

tard

ta

b 20

mg

Low

est

pric

ed/ta

b

%

Nys

tatin

pess

arie

s 10

0,00

0 I.U

.Lo

wes

t pr

iced

/tab

%

Om

epra

zole

cap

20

mg

Low

est

pric

ed/c

ap

%

Ora

l Reh

ydra

tion

Salt

(OR

S)Lo

wes

t pr

ice

/sac

h

%

Para

ceta

mol

tab

500m

gLo

wes

t pr

iced

/tab

%

Phen

ytoi

n ta

b 10

0mg

Low

est

pric

ed/ta

b

%

Pred

niso

lone

tab

5m

gLo

wes

t pr

iced

/tab

%

29

No. 11: July-September 2013M

edic

ine n

ame,

do

sage

form

, st

reng

th

Prod

uct

of

inte

rest

avai

labl

e?(“

yes”

or

“N/a

”)

Prod

uct n

ame

(bra

nd /

trad

e na

me)

Man

ufac

ture

r, co

untr

y of

m

anuf

actu

re

Pack

siz

e foun

d

Pack

pr

ice

Uni

t pri

ce (4

di

gits

)

Disc

ount

fo

r all?

Yes

%

Disc

ount

ed

pack

pri

cec

omm

ents

and

ob

serv

atio

ns

Pyrim

etha

min

e/Su

lfado

xine

tab

25/5

00m

g

Low

est

pric

ed/ta

b

%

Prop

rano

lol t

ab

40m

gLo

wes

t pr

iced

/tab

%

Qui

nine

inj

300m

g/2m

lLo

wes

t pr

iced

/Am

p

%

Salb

utam

ol

inha

ler 0

.1m

g/do

se

Low

est

pric

ed/c

an

%

Tetra

cycl

ine

eye

oint

men

t 1%

Low

est

pric

ed/g

ram

%

30


annex 3: availability of the 40 medicines in Urban versus rural facilities across the sectorsMedicine Urban rural

Public Private Mission Public Private Mission

Aciclor tab 200mg 53% 80% 81% 47% 50% 68%

Albendazole tab 200mg 26% 45% 38% 47% 15% 53%

Amitriptyline tab 25mg 100% 95% 94% 89% 45% 74%

Amoxicillin cap/tab 250mg 89% 100% 100% 79% 70% 84%

Amoxicillin susp 250mg/5ml 11% 85% 88% 11% 65% 63%

Artemether/Lumefantrine tab 20/120mg 89% 85% 81% 89% 65% 95%

Bendrofluazide tab 5mg 68% 80% 88% 74% 25% 53%

Betamethasone cream/ointment 1%w/v 16% 65% 44% 47% 55% 42%

Carbamazepine tab 200mg 79% 85% 94% 84% 45% 53%

Ceftriaxone 1g pwder for inj'n 84% 85% 94% 68% 50% 74%

Cimetidine tab 400mg 0% 50% 25% 16% 25% 42%

Ciprofloxacin tab 500mg 84% 95% 100% 79% 70% 89%

Co-trimoxazolesusp 8/40 mg/ml 11% 70% 75% 21% 60% 42%

Co-trimoxazole tab 400+80 mg 84% 80% 81% 95% 80% 89%

Dextrose 5% inj 95% 60% 75% 74% 55% 79%

Diazepam tab 5mg 95% 90% 81% 95% 70% 68%

Diclofenac tab 50mg 68% 90% 88% 47% 100% 79%

Doxycycline cap/tab 100mg 79% 80% 100% 74% 60% 100%

Erythromycin tab 250mg 63% 80% 94% 63% 50% 68%

Fluconazole tab /cap 200mg 26% 65% 56% 37% 10% 42%

Furosemide tab 40mg 47% 85% 75% 74% 25% 58%

Gentamycin inj 80mg/ml 58% 70% 88% 32% 55% 74%

Glibenclamide tab 5mg 58% 85% 75% 53% 20% 53%

Mebendazole tab 100mg 74% 90% 69% 79% 85% 84%

Metformin tab 500mg 79% 90% 88% 63% 35% 47%

Methyergometrineinj 200ug/ml 42% 30% 56% 47% 10% 47%

Metronidazole susp 200mg/5ml 42% 45% 69% 47% 55% 58%

Metronidazole tab 200mg 95% 95% 94% 89% 90% 100%

Nifedipine retard tab 20mg 79% 90% 88% 79% 35% 63%

Nystatinpessaries 100000iu 5% 75% 81% 21% 60% 47%

Omeprazole cap 20mg 74% 85% 94% 58% 85% 74%

Oral Rehydration Salt (ORS) 95% 90% 88% 84% 70% 89%

Paracetamol tab 500mg 100% 95% 100% 79% 100% 100%

Phenytoin tab 100mg 68% 50% 69% 84% 20% 47%

Prednisolone tab 500mg 16% 95% 94% 16% 55% 58%

Pyrimethamine /sulfadoxide (SP) tab 25/500mg 84% 65% 69% 74% 60% 74%

Propranolol tab 40mg 37% 85% 88% 42% 45% 53%

Quinimeinj 300mg/5ml 63% 60% 88% 26% 65% 63%

Salbutamol inhaler 0.1mg(100mcg)/dose 5% 60% 50% 16% 25% 26%

Tetracycline eye ointment 1% 84% 85% 63% 95% 35% 74%

31

No. 11: July-September 2013annex 4: Median unit price of the 40 medicines in the urban versus rural facilities

Medicine Urban rural

Private Mission % price diff. Private Mission % price diff.

Aciclor tab 200mg 300.0 350.0 -16.7 275.0 275.0 0.0

Albendazole tab 200mg 1000.0 700.0 30.0 400.0 #VALUE!

Amitriptyline tab 25mg 100.0 100.0 0.0 100.0 100.0 0.0

Amoxicillin cap/tab 250mg 100.0 100.0 0.0 100.0 100.0 0.0

Amoxicillin susp 250mg/5ml 30.0 27.5 8.3 25.0 30.0 -20.0

Artemether/Lumefantrine tab 20/120mg 250.0 166.7 33.3 208.3 125.0 40.0

Bendrofluazide tab 5mg 100.0 100.0 0.0 150.0 100.0 33.3

Betamethasone cream/ointment 1%w/v 200.0 183.3 8.3 200.0 133.3 33.3

Carbamazepine tab 200mg 100.0 150.0 -50.0 200.0 100.0 50.0

Ceftriaxone 1g pwder for inj'n 2500.0 5000.0 -100.0 3000.0 3000.0 0.0

Cimetidine tab 400mg 200.0 150.0 25.0 200.0 200.0 0.0

Ciprofloxacin tab 500mg 300.0 275.0 8.3 250.0 250.0 0.0

Co-trimoxazolesusp 8/40 mg/ml 30.0 30.0 0.0 30.0 30.0 0.0

Co-trimoxazole tab 400+80 mg 100.0 85.0 15.0 75.0 100.0 -33.3

Dextrose 5% inj 2000.0 2000.0 0.0 2000.0 2000.0 0.0

Diazepam tab 5mg 100.0 100.0 0.0 100.0 100.0 0.0

Diclofenac tab 50mg 50.0 50.0 0.0 50.0 100.0 -100.0

Doxycycline cap/tab 100mg 100.0 125.0 -25.0 100.0 100.0 0.0

Erythromycin tab 250mg 200.0 200.0 0.0 200.0 150.0 25.0

Fluconazole tab /cap 200mg 1000.0 1000.0 0.0 600.0 #VALUE!

Furosemide tab 40mg 100.0 100.0 0.0 50.0 87.5 -75.0

Gentamycin inj 80mg/ml 750.0 800.0 -6.7 800.0 700.0 12.5

Glibenclamide tab 5mg 100.0 100.0 0.0 100.0 100.0 0.0

Mebendazole tab 100mg 50.0 100.0 -100.0 50.0 75.0 -50.0

Metformin tab 500mg 200.0 200.0 0.0 200.0 100.0 50.0

Methyergometrineinj 200ug/ml 2000.0 1350.0 32.5 1000.0 #VALUE!

Metronidazole susp 200mg/5ml 30.0 25.0 16.7 25.0 25.0 0.0

Metronidazole tab 200mg 100.0 100.0 0.0 50.0 50.0 0.0

Nifedipine retard tab 20mg 200.0 200.0 0.0 150.0 150.0 0.0

Nystatinpessaries 100000iu 357.1 292.9 18.0 200.0 300.0 -50.0

Omeprazole cap 20mg 300.0 300.0 0.0 200.0 200.0 0.0

Oral Rehydration Salt (ORS) 500.0 500.0 0.0 500.0 500.0 0.0

Paracetamol tab 500mg 50.0 50.0 0.0 30.0 50.0 -66.7

Phenytoin tab 100mg 100.0 100.0 0.0 75.0 100.0 -33.3

Prednisolone tab 500mg 100.0 70.0 30.0 50.0 50.0 0.0

Pyrimethamine /sulfadoxide (SP) tab 25/500mg

500.0 500.0 0.0 500.0 500.0 0.0

Propranolol tab 40mg 100.0 100.0 0.0 100.0 50.0 50.0

Quinimeinj 300mg/5ml 1000.0 1100.0 -10.0 1200.0 1250.0 -4.2

Salbutamol inhaler 0.1mg(100mcg)/dose 8000.0 8000.0 0.0 8000.0 7500.0 6.3

Tetracycline eye ointment 1% 571.4 857.1 -50.0 428.6 428.6 0.0

32

For more information contact:

HePs-UgandaCoalition for Health Promotion & social development

Plot 351a, Balintuma road, namirembeP.o. Box 2426, Kampala, Uganda

tel: +256-414-270970email: [email protected]: www.heps.or.ug

this work is licensed underhttp://creativecommons.org/licenses/by/3.0/ug/

Monitor MEDICINE PRICE - who.int · PNFP Private-not-for-profit (health facility) WHO World Health...

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