Medicines Need and Access: Are there Gender Inequities ?

1. Medicines Need and Access: Are there Gender Inequities? Anita Wagner Paul Ashigbie JoãoCarapinha AakankshaPande Dennis Ross-Degnan Peter Stephens Saul Walker Catherine Vialle-Valentin WHO Collaborating Center in Pharmaceutical Policy

2. “Well, if you're not fully utilizing half the talent in the country, you're not going to get too close to the top.” Washington Post, January 27, 2007

3. The Economist, April 7, 2011

4. Reproductive Morbidity/Mortality • One woman dies every 90 seconds • 30 more suffer permanent disability

5. Lack of Physical Security http://womanstats.org/mapEntrez.htm

6. More social and statistical data are needed … to fully understand the impact of gender on access to and use of medicines. Improving access to essential medicines will be possible only if countries introduce a gender perspective in their medicines policies.

7. Selected Medicines & Gender Projects* • Household need for and access to chronic adult medicines and preventive care for children • World Health Survey, 2002, 53 mostly LMIC • Household access to acute and chronic medicines • MeTA/WHO Medicines Survey, 2007-2008, 5 African LMIC • Physician prescribing for diabetes, depression, and upper respiratory illness • IMS Health prescribing data 2007-2010, 15 LMIC • Gender in the HIV, TB, and malaria literature • Literature review, 126 studies, 1990-2010 *Supported by the UK Government

8. No. of Countries with Gender Differences: Access to Adult Chronic Care Wagner et al, work in progress

9. No. of Countries with Gender Differences: Access to Adult and Child Care Wagner et al, work in progress

10. Adjusted Gender Effects Among Adults Females coded as 1. Models control for household size; having a member age 60 years and older or a child under 5 years (adult models only); highest education of any household member; household poverty; urban location; insurance coverage; respondent age, marital status, education, and health status. Wagner et al, work in progress

11. Adjusted Gender Effects Among Children Females coded as 1. Models control for household size; having a member age 60 years and older or a child under 5 years (adult models only); highest education of any household member; household poverty; urban location; insurance coverage; respondent age, marital status, education, and health status. Wagner et al, work in progress

12. Equally Poor Access for Women & Men Median (25th, 75th percentiles) across households in 53 countries Wagner et al, work in progress

13. Acute Care for Children < 5 Years in 5 African Countries*: No Systematic Gender Bias *Gambia, Ghana, Kenya, Nigeria, Uganda Pande et al. ICIUM2011 abstract #854

14. Across Countries, More and Less than Expected Consultations for Depression Women higher than expected Women lower than expected Stephens et al. ICIUM2011 abstract #954

15. Gender & Medicines in the HIV, TB, and Malaria Literature • N=105 studies of gender effects on outcomes (HIV/AIDS: 68; TB: 26; malaria: 11) • Most studies assess access and adherence Carapinha et al. ICIUM2011 abstract #640

16. Aggregate Analyses, Based on Different Data Sources, Suggest: • Women frequently report more need for chronic illness care • When controlling for need, no consistent gender inequities in access identified • Access to care is equally poor for women and men in many countries • Need for measures of quality of care • Situations in individual countries vary widely • Need for country and regional analyses

17. Possible Explanations? • Masculinity concept • “Real men don’t get sick (or seek care or take medicines).” • Women have contact with the system • Care givers • Reproductive care • Equally poor access for men & women

18. Recommendations to Inform Decision Making • Assess content of health and essential medicines policies and programs with an equity focus • International, national, and institutional level • Monitor effects of policies and programs • By gender, socio-economic status, education, caste • Present results from medicines research by gender and assess gender impact on outcomes • In households, facilities, systems • Conduct sound comparative global and national research to address equity questions • Multi-disciplinary, multi-method

19. Manufacture & import International manufacturers SUPPLY OF MEDICINES • Key questions: • Are products for gender-specific conditions licensed? • Are they quality-controlled? • Key questions: • Are budgets allocated for gender-specific medicines? • Do distribution channels bring medicines to where women and men need them? Drug importers Domestic manufacturers • Key questions: • Do women and men access different parts of the system? • Do Standard Treatment Guidelines consider potential gender differences? • Does quality of care differ for women and men? • Are trained male and female health workers available, accessible, used? • Do all health workers treat all patients with respect, regardless of gender? Public sector care ` Private sector care Government procurement systems Wholesalers and distributors Government health facilities Pharmacies and retail outlets Private physicians/ other providers Private health facilities Consumer demand Insurance and risk carriers Consumers and patients • Key questions: • Does household decision making on care seeking and treatment differ by gender? • Can women and men access, afford, and adhere to needed medicines? • Key questions: • Do risk protection schemes cover women and men equitably? • Do they pay for gender-specific care and medicines? DEMAND FOR MEDICINES

20. “Women Hold up Half the Sky”…