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Senegal Assessment Louis Teulieres

Senegal Assessment Louis Teulieres. The purpose of this study is to:. Determine the key elements of access to medicines in Senegal Estimate the various roles of operators in the pharmaceutical sector Identify factors on which it would be possible to act to improve the situation

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Senegal Assessment Louis Teulieres

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  1. Senegal

  2. Senegal Assessment Louis Teulieres Senegal

  3. The purpose of this study is to: • Determine the key elements of access to medicines in Senegal • Estimate the various roles of operators in the pharmaceutical sector • Identify factors on which it would be possible to act to improve the situation • Propose possible actions to be implemented to improve access Senegal

  4. Economic and Health/Social Context • GDP per capita: USD $435 in 1999 • Heavy burden of debt limits the volume of public financing assigned to social sectors. • High incidence of poverty, more than 30% of households • Main diseases (public facility consultations): malaria (33.2%), skin diseases (13%), diarrhea (8.1%), ENT conditions (6.7%) and respiratory diseases (6%) • Attendance at public facilities is low (30% on average), and there are strong regional disparities Senegal

  5. Characteristics of the Pharmaceutical Sector • Most drugs on the market imported • Local production by two pharmaceutical companies: • most branded products under license • some generics (branded or International Nonproprietary Names [INN]) -- less than 5% of turnover • Distribution of medicines undertaken by: • private sector (85% of the market, 2,500 references): three wholesalers and 532 retail pharmacies • public sector: five regional warehouses, and at base, health care centers with essential medicines under INN (350 references) with full cost recovery from population • illicit market supply Senegal

  6. Price of Medicines Retail prices of medicines are controlled by the Administration. They are calculated (in the two licit distribution channels) by applying ad valorem margins to the purchase prices, leading to high multipliers (1.86 for the private field and 1.80 for the public field) and a retail price nearly twice as large as the “before-tax French wholesale price” (BTWP). Senegal

  7. Price of Medicines (2) Senegal

  8. Financing of Pharmaceutical Expenditures Senegal

  9. Financing of Pharmaceutical Expenditures (2) Senegal

  10. Method Access to medicine is defined as a combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of dispensation. • Definition of Access: • Environmental factors (geographic access, physical availability and financial accessibility) • Effectiveness factors that strengthen or attenuate the former ones • Access Measurement: • A theoretical approach to elaborate measure indicators • A practical approach using two surveys Senegal

  11. Geographical Accessibility • Median coverage: 1 pharmacy per 18,000 • One health post with essential drugs for 7,400 people • 78% of the population lives within 5 km of a facility with a “sustainable” stock of pharmaceuticals Senegal

  12. Geographical Accessibility (2)Population Coverage Compared to Poverty Senegal

  13. Availability • Determined from list of 26 tracer essential drugs • 80% availability in the private sector • 64% availability in the public sector • 41% of surveyed patients stated they could not buy a whole prescription because of availability problems Senegal

  14. Availability (2) Senegal

  15. Financial Accessibility50% of population spends less than $3 per year on health. 5% of the population spends over $35 per year. Senegal

  16. Financial Accessibility (2) Senegal

  17. DS/Health Spending • National Survey Results: • Median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60% of the population • 24% of patients at public facilities were given a second prescription to be filled in a private pharmacy where median cost is 2,661 Fcfa, for a total cost of 3,661 Fcfa, higher than theoretical accessibility for 80% • Comparison of Drug Expenditure with Daily Spending (DS): • In public facilities, cost of recent drug purchases is 1.4 times DS (1,591 Fcfa). In private pharmacies, costs are 1.6 times DS (4,735 Fcfa). • Cost was higher than 1 DS in public facilities for 29% of cases, and for 50% of cases in private pharmacies • For 15% of patients at public facilities and 30% of those at private pharmacies, purchasing costs were equal or superior to 3 DS Senegal

  18. DS/Health Spending (2) • DS of customers at public facilities: • Between 3,401 Fcfa and 5,160 Fcfa • Corresponds to food expenditures of the 2nd and 3rd quintiles of households in the DMS  • DS of customers at private pharmacies: • Between 5,918 Fcfa in 10,341 Fcfa • Corresponds to 4th and 5th quintiles Senegal

  19. DS/Health Spending (3) • Two Lessons: • The 20% poorest population (1st quintile) seem to be excluded from the system • A clear cut difference exists between the two sets of populations Senegal

  20. Quality of Products and Services • Average number of lines on a prescription: • 2.8 in the public sector • 2.6 in the private sector • Essential drugs on prescriptions: • 44% in the private sector (9% as INN, 91% as brands) • 72% in the public sector (47% as INN) • Irrational combination of two products of same class: • 35% in the public sector • 26% in the private sector Senegal

  21. Quality of Products and Services (2) • 19% of public sector patients receive a second prescription to be bought in a private pharmacy • Substitution: in 52% of cases, for a more expensive product (private sector) • Dispensation: only 22% of patients know what the drugs are for, while 40% know how long they should be taken Senegal

  22. Quality of Products and Services (3) Senegal

  23. Patients Behavior and Opinion • 36% patients buy prescription drugs without a prescription • 35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education) • 26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location) • Satisfaction: 93% in the private sector, 82% in the public sector Senegal

  24. Conclusions • Drug access in Senegal is low • Price setting mechanisms, based on proportional markups, end up greatly multiplying pre-tax wholesale price • In the public sector, unauthorized price increases lead to prices sometimes as high as private sector • Prescription and dispensation practices contribute to the situation Senegal

  25. Conclusions (2) • Dispensation practices often not satisfactory in private sector • Behaviors can be attributed to several factors: • Payment system: based on proportional markups • Unchecked commercial promotion of manufacturers: target private sector doctors and prescribers in public sector facilities • Markups and promotion largely responsible for partial failure of essential drug policy based on generics • Illicit Market Appeal: for a significant part of population, role keeps growing, consequences on treatment duration and observance Senegal

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