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