Access to affordable essential medicines
63
Figure 2 Ratio of consumer prices to international reference prices for selected lowestpriced generic medicines in public and private facilities during the period 2007-2011 14
13.8
Maximum Mean Minimum Average in private sector Average in public sector
12 11.3 10 8 6.5
6
5.3 4.7
4 3.1 2
1.8
2.6 2.0
0 Public sector 6
5.0
Private sector 10
Low-income and lower-middle income countries
1.3 1.2 1.0 Public sector 2
1.3 Private sector 7
Upper-middle income countries
Although these findings are based on a limited number of country surveys, they are indicative enough to cause concern over deficiencies in affordable access to medicines in some middle-income countries, especially where large shares of the population live in poverty. In some cases, social insurance systems with outpatient medicine benefits provide some protection against high costs. These typically provide coverage for only a limited share of the population.
Availability and prices of antiretroviral medicine Worldwide, about 34 million people were living with HIV in 2010.16 The number of people dying from AIDS-related causes fell from a peak of 2.2 million in 2005 to 1.8 million in 2010. Greater efforts at prevention and behavioural change have contributed to this positive trend, but the recent reduction in deaths can be attributed to a larger extent to increased access to ARV treatment. In 2010 alone, an estimated 700,000 AIDS-related deaths were prevented through scaled-up access to ARV treatment. At the end of 2010, 47 per cent of people living with HIV in low- and middle-income countries in need of treatment were receiving ARV therapy, compared with 39 per cent at the end of 2009, with coverage improving across all regions. In sub-Saharan Africa, the most affected region, ARV coverage rose 20 per cent between 2009 and 2010, reaching 49 per cent. Universal access to treatment, defined as coverage of 80 per cent or above, was reached in Botswana, 16 Joint
United Nations Programme on HIV/AIDS (UNAIDS), World AIDS Day Report 2011 (Geneva, 2011); and WHO, UNAIDS, United Nations Children’s Fund (UNICEF), Progress Report 2011: Global HIV/AIDS Response (Geneva: WHO, 2011).
Source: World Health Organization/Health Action International, using data from medicine price and availability surveys undertaken from 2007 to 2011 using the WHO/ HAI standard methodology, available from http://www. haiweb.org/medicineprices. Note: Figures above the income group labels denote number of countries. Baskets of survey medicines differ among countries. Data are not adjusted for differences in the year of IRP used (Management Sciences for Health (MSH) prices), exchange-rate fluctuations, national inflation rates, variations in purchasing power parities, levels of development or other factors.