SDG: Access to Medicine Indicator · SDG-IAEG reports the revision to the indicator Major revision...

HIS/EMP | Communications Planning

SDG: Access to Medicine Indicator

Health Systems and Innovations

Department of Essential Medicines and Health Products (EMP)

and

Department of Health Systems Governance and Financing (HGF)

1 3 July 2017 WHO/HIS/EMP


Support the research and development of vaccines

and medicines for the communicable and

noncommunicable disease that primarily affect developing

countries, provide access to affordable essential

medicines and vaccines, in accordance with the Doha

declaration on the TRIPS agreement and public health

which affirms the right of developing countries to use to the

full the provisions in the agreement on trade-related

aspects of intellectual property rights regarding flexibilities

to protect public health, and, in particular, provide access

to medicines for all.

SDG TARGET 3.B



3.b.3: Proportion of health facilities that have a

core set of relevant essential medicines available

and affordable on a sustainable basis (Tier III)

Current Indicator

→ MDG Indicator:

Proportion of the population with access to affordable essential

drugs on a sustainable basis



Requirements for an effective SDG

Indicator:

• Be clear and measurable

• Responsiveness to change (to show progress)

• Indicator should allow disaggregation

Technical Requirements:

• 50% of countries of all regions should have data available

• Country ownership of the data

• Country consultation and approval are required for the

indicator to commence reporting

• Ideally one number per country



An ideal SDG Indicator would address

all the following:



Traditional Data Collection Sources:

• Disease Tracking Registries

• National Health Accounts

• Global Health Statistics

• OECD Data / Euro Stat



3.b.3 Proportion of health facilities that have a core set of

relevant essential medicines available and affordable on a

sustainable basis

Tier I: indicator is conceptually clear, established methodology and

standards are available and data are regularly produced by countries;

Tier II: indicator is conceptually clear, established methodology and

standards are available but data are not regularly produced by countries;

Tier III: no established methodology or standards are available for the

indicator and methodology/standards are being developed and tested for the

indicator.

Tier III -> Tier II -> to start reporting the indicator:

Requirement:

Data available for at least 50% of the countries (by region)



3.b.3 Proportion of health facilities that have a core set of

relevant essential medicines available and affordable on a

sustainable basis

SDG-IAEG

reports the

revision to the

indicator

Major revision of

the Indicator

Mar ’17

48-th session

Statistical

commission

By fall ’17

2025

UNSC meeting

Possible minor

changes/refinements

to the indicator

agreement on

the methodology

for current

indicator

Proposal for major

methodological

review/changes

2020

UNSC meeting

2020

UNSC

meeting

a

gre

e

do

no

t a

gre

e

2018

IAEG-SDGs

meeting

2025

UNSC

meeting

X

X *X – change of the tier


IAEG-SDGs

yearly review

Meeting (every fall)

To get tier

change


Existing methods of measurement for

Availability and Affordability



INDICATOR METHODOLOGY

SUMMARIES

Summarized under these subsections:

• Description of the indicator:

a) Numerator

b) Denominator

c) Main characteristics

• Fulfillment of the requirements

• Limitations



WHO/HEALTH ACTION

INTERNATIONAL (HAI)

SURVEY METHODOLOGY



• Proportion of facilities with a specific drug availability

• Affordability: 1) Number of daily wages (LPGW) that are required to

buy a one-month course of treatment

• Affordability: 2) Price per drug relative to the International

Reference Price

These 3 indicators are measured for each medicine

Availability & affordability according to

the WHO/HAI approach




the WHO/HAI approach

Characteristics:

1) Looks at specific drugs availability and

affordability on the day of the survey

2) Limited funding for national data collection (costly

process)




WHO/HAI approach



HAI/WHO Method for Availability &

Affordability

Limitations: Availability: 1. Does not consider temporary stock-outs

2. No minimal set of drugs (basket) is set as the core standard

3. No threshold or minimum acceptable standard

Affordability: 1. No reference to the total population (those with income

below LPGW)

2. No threshold or minimum acceptable standard



Unaffordability of Medicine

by L. Niens



• Proportion of individuals who drop below the poverty line

(PL) after paying for medicines from out-of-pocket (OOP)

Unaffordability of Medicine by

L. Niens




L. Niens

Characteristics :

1. Identifies whether after spending on medication

individuals fall below the poverty line

2. Measures the fraction of individuals who cannot

afford basic needs due to out-of-pocket spending

on medicines

3. Uses aggregated data such as general

expenditures per income quintile




L. Niens



1. Strong assumptions (everyone in the population takes medicines)

2. International PLs may lead to the overestimation of unaffordability in poor countries and underestimation in wealthier settings

3. Data from the WDI overestimates total consumption, a lot of missing data

4. Per capita income is linearly distributed inside each income group of the population

Limitations: Unaffordability of Medicines by

L. Niens



Methodological options for SDG

indicator



Proportion of health facilities that have a

basket of essential medicines available and

affordable per country

The proportion of health facilities with the core basket of

medicines that are available & affordable:

1






Characteristics :

a) available → when can be found in the % of facilities that is

higher than the agreed threshold (i.e. 80 %)

b) affordable → with no extra number of daily wages (>0)

required to afford one course of the most expensive

medicine in the basket, after fulfilling basic needs

→ Use national poverty lines as a threshold for analysis

making the indicator country specific

1





affordable per country 1



Limitations:

1) Based on facility surveys, as opposed to traditional

data collection sources for SDGs

2) It doesn’t refer to the population

3) Several thresholds to be agreed upon (availability,

number of working days per month etc.)

4) Does not account for differences between acute

and chronic diseases (and their associated needs)

but could be adapted




1



Proportion of expenditures on core basket of

drugs by the government

Looks at the investment on the core basket

of drugs as a proportion of the total budget

allocation for all drugs by the government

2



Characteristics :

1.Only focuses on the government’s proportional

expenditure on the core basket of drugs

2.It collects the procurement level expenditure

data made by the government



2





2



Limitations:

1) Analysis is at national level not at the individual level

2) For drugs with high purchasing prices percentage of government spending will not provide a meaningful indicator



2



Proportion of government expenditure on the

country specific core basket of drugs out of

projected expenditure

Calculates the proportion of general government expenditure (GGE) for the core basket of drugs compared to the projected required expenditure for drugs based on the burden of disease.

3



Characteristics:

1. Based on priority diseases representing the highest burden in the country

2.Focuses on government expenditures

3.Takes into consideration the maximum required coverage based on prevalence




3






3



Limitations:

1) For drugs with high purchasing prices percentage of government spending will not provide a meaningful indicator

2) Required expenditures in the denominator are based on assumptions (i.e. uniformity of the severity of disease, dosage requirements, mean price etc.)




3



Summary: No indicator is perfect

Indicator / method

Basket of core

medicines

Responsiveness to change

Frequency of

data collection price coverage

1. Proportion of health facilities that

have a basket of essential medicines

available and affordable per country

2. Proportion of expenditures on

core basket of drugs by the

government

3. Proportion of government

expenditure on the country specific

core basket of drugs out of


The third indicator accounts for the unmet needs while the second does not

Methodologically, the first indicator is the most feasible



Thank you!

Questions?


SDG: Access to Medicine Indicator · SDG-IAEG reports the revision to the indicator Major revision...

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