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A National Survey of Price and Affordability of Key Essential Medicines for Children in Sri Lanka

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Abstract

Objective

To investigate the price and affordability of key essential medicines for children in Sri Lanka.

Methods

This national survey investigated the prices and affordability of 25 key essential medicines for children in private sector pharmacies using the WHO/Health Action International (HAI) medicine price methodology. Data were collected from a representative sample of 48 private sector pharmacies selected from 8 Provinces using a multistage clustered approach. At each pharmacy prices of originator brand (OB) and lowest priced generics (LPG) of the selected medicines were collected. Medicine prices were compared with international reference prices to obtain a median price ratio (MPR). Income of the lowest paid unskilled government worker was used to establish the affordability.

Results

The median MPR of retail prices to patients was 3.7 for OB (range 0.23–20) and 1.35 for LPG (range 0.05–3.75). MPR >5 was observed for OBs of 5 medicines: ceftriaxone injection, diazepam injection, mebendazole syrup, mebendazole chewable tablet and metronidazole tablet whereas MPR >2.5 was observed only for LPGs of 3 medicines: chlorphenamine syrup, clotrimazole topical cream, and paracetamol syrup. Mean percent difference in price between OB and LPG products was 365 % (range −21, 2343). Rational treatment for acute infections such as mild lower respiratory tract infections and acute gastroenteritis seems to be affordable but treatment for chronic illnesses requiring liquid or inhaled dosage forms were largely unaffordable.

Conclusions

Intervention is needed to improve the economic access to key essential medicines for children indicated in the treatment of chronic diseases.

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Acknowledgments

The authors acknowledge the WHO/Sri Lanka and South East Asian Regional Office (SEARO) for funding (SE SRL DDE RB 08 17.1.1), Ministry of Health and State Pharmaceuticals Corporation of Sri Lanka authorities for approving the survey, Provincial Health authorities and hospital administrators for granting permission to collect data, pharmacists in the respective survey settings for providing the data, Drs S A C Senadeera and R Thanikaivasan for assisting in data entry, Ms Priyani Perera and Ms Inoka Gammune of the Department of Pharmacology, Faculty of Medicine, Colombo for secretarial assistance. They also acknowledge the WHO and HAI for the use of the methodology.

Conflict of Interest

SSR: Served on WHO’s Paediatric Subcommittee of the Expert Committee of the Selection and Use of Essential Medicines (2007), member of the WHO Expert Committee on Selection and Use of Essential Medicines (2013), temporary adviser to Essential Medicines Section of the WHO- South East Asian Region Programs (WHO-SEARO) (2007), and Convenor of Sri Lankan EML Committee, 2006, 2009, 2012.

BVSHB: Member of the Sri Lankan EML committee 2006, 2009, 2012 and Director of Division of Medical Supplies and Technology, Ministry of Health which publishes the Sri Lankan EML.

Role of Funding Source

One of the authors (SSR) received a grant from the WHO/Sri Lanka and South East Asian Regional Office (SEARO) for the study. Funding source (WHO/Sri Lanka and South East Asian Regional Office (SEARO)) did not play any other role in the study.

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Authors and Affiliations

  1. Department of Pharmacology, Faculty of Medicine, University of Colombo, PO Box 271, Colombo 8, Sri Lanka

    R. Balasubramaniam & Shalini Sri Ranganathan

  2. Division of Medical Supplies and Technology, Ministry of Healthcare and Nutrition, 120, Norris Canal Road, Colombo 10, Sri Lanka

    B. V. S. H. Benaragama

Authors
  1. R. Balasubramaniam
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  2. B. V. S. H. Benaragama
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  3. Shalini Sri Ranganathan
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Corresponding author

Correspondence to Shalini Sri Ranganathan.

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Balasubramaniam, R., Benaragama, B.V.S.H. & Sri Ranganathan, S. A National Survey of Price and Affordability of Key Essential Medicines for Children in Sri Lanka. Indian J Pediatr 81, 362–367 (2014). https://doi.org/10.1007/s12098-013-1024-9

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  • DOI: https://doi.org/10.1007/s12098-013-1024-9

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