Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries.

Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients' spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.

Effect of the expanded Senior Citizens Act of 2010 (Republic Act of 9994) on drug accessibility among the elderly

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aims to determine the effect of the Expanded Senior Citizens Act of 2010 on drug accessibility among elderly.<br /><strong>METHODS:</strong> Descriptive, cross-sectional design involving 775 senior citizens from Manila,Pampanga, Iloilo, Bacolod, Cagayan De Oro and Iligan.<br /><strong>RESULTS:</strong> Thirty-eight percent (38%) of senior citizens were not aware of the law, but 90% knew about the 20% discount and 54% knew about the 12% VAT exemption. Half (50%) of them ask for 20% discount all the time when they buy their medicines. Only half are given full discount every time they ask for it, and 32% are given to the VAT exemption. As a result, less than half (48%) are able to buy all their medicines.<br /><strong>CONCLUSION:</strong> Privileges are not fully enjoyed by senior citizens either due to lack of awareness or noncompliance of drug outlets to the provisions of the Law.</p>

Medicines management in the Philippine public sector during the response to Haiyan.

INTRODUCTION: Health service delivery in the Philippines is constantly challenged by disasters and emergencies. This descriptive study documented existing policies for medicines management in the Philippines and then assessed these in the public sector response post-Haiyan. METHOD: We used desk a review of existing laws, regulations and related issuances and a series of interviews of key informants from various national and local health agencies. RESULTS: We found that while numerous national policies covered critical aspects of medicines management, implementation post-Haiyan was problematic at all levels of the decentralized health-care system. We identified issues of quantification, warehousing, distribution, utilization monitoring and disposal. Donated medicines also added additional burden for storage and disposal, especially for expired and unwanted medicines. DISCUSSION: While the process of managing medicines during disasters did not differ greatly from non-emergency situations, the Haiyan experience highlighted the system's weaknesses. With the current gaps in implementation, as well as the logistical obstacles brought about by disasters, there is a need to have integrated mechanisms for medicines management in the Philippines. This assessment provided an important opportunity to review the medicines management policies at national and local levels.