Table 2.
Total access to medicine indicators extracted from literatures review
| Dimension | Indicator | Source of indicator |
|---|---|---|
| Physical availability & geographical accessibility | Existence and year of last update of a published national list of essential medicines [3, 8] | Gray literature |
| The availability of certain tracer drugs [9] | Systematic search | |
| Medicines not found in any outlets [8] | ||
| Medicines found in less than 25% of outlets [8] | ||
| Medicines found in 25 to 50% of outlets [8] | ||
| Medicines found in 50 to 75% of outlets [8] | ||
| Medicines found in over 75% of outlets [10] | Systematic search | |
| Mean percentages of availability of selected medicines by condition of morbidity and version of medicine, according to sector [11, 12] | Systematic search | |
| Drugs included in the WHO Model List | Gray literature (governmental document) | |
| Availability of vaccines (EPI) | Gray literature (governmental document) | |
| Availability of vaccines (none EPI) | Gray literature (governmental document) | |
| Availability of key medicines in public health facility dispensaries, private drug outlets and warehouses supplying the public sector.(availability of essential medicines) [4] | Gray literature | |
| Essential medicines production as percentage of licenses held by manufacturers [13] | Systematic search | |
| Stock out duration at public health facility dispensaries and warehouses supplying the public sector [4] | Gray literature | |
| % of adequate record keeping at public health facility dispensaries and warehouses supplying the public sector [4] | Gray literature | |
| Number of medicines shortage in public hospitals | Gray literature (governmental document) | |
| Number of facilities [14] | Systematic search | |
| Proportion of each pharmaceutical cadre by facility type and sector [8] | Gray literature | |
| Travel time to access healthcare [15] | Systematic search | |
| Distance to access healthcare [15–19] | Systematic search | |
| % medicines obtained in the public sector [20] | Systematic search | |
| % medicines obtained in the private sector [20] | Systematic search | |
| Percentage of municipalities covered [21] | Systematic search | |
| Pharmacy Facilities Density (number of pharmacies affiliated with the subsidized medicines-essential medicines- per 100,000 inhabitants) [21] | Systematic search | |
| %All prescribed medicines are available in any pharmacy | Gray literature (governmental document) | |
| %Patient is forced to change his/her drug, but the alternative drug is available in any pharmacy | Gray literature (governmental document) | |
| %Patient has to go to a specific public pharmacy to obtain his/her medicine/s | Gray literature (governmental document) | |
| %The prescribed medicines are obtained with several visits to pharmacies | Gray literature (governmental document) | |
| %Patient has to trip toa bigger city toobtainhis/her medicine/s | Gray literature (governmental document) | |
| %patient has to trip toa bigger city and to a specific public pharmacy toobtainhis/her medicine/s | Gray literature (governmental document) | |
| %Patient must trip to the capital city to take his/her medicine/s | Gray literature (governmental document) | |
| %Patient has to take his/her medicine from black market | Gray literature (governmental document) | |
| %The prescribed medicine is not available at all | Gray literature (governmental document) | |
| Financing | Total pharmaceutical out-of-pocket expenditure [22] | Systematic search |
| Pharmaceutical out-of-pocket expenditure as % of total pharmaceutical expenditure(inpatients/outpatients) | Gray literature (governmental document) | |
| Medicines’ inflation rate | Gray literature (governmental document) | |
| % Obtained medicines for free [20] | Systematic search | |
| per patient drug expenditure (monthly drug costs divided by the number of patients dispensed drugs, i.e. costs per patient) [23] | Systematic search | |
| unit prices (monthly drug costs divided by the number of units dispensed, i.e. costs per unit) [23] | Systematic search | |
| co-payment for medicines per patient | ||
| Average spent on medicines in the last 4 weeks [24] | Systematic search | |
| % of people have to refuse dispensation of medicines due to co-payment [24] | Systematic search | |
| Were there any medicines prescribed or recommended for you in the last 30 days that you were not able to find or buy? [25] | Systematic search | |
| Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. [10, 26–28] | Systematic search | |
| Affordability (GDP per capita) [22] | Systematic search | |
| Dollars per generic, preferred or non-preferred equivalents (coverage) In questionnaire: | ||
|
1.receiving free samples from the doctor [28] 2.skip filling prescription because of high cost [28] 3.taking less medication than prescribed by doctor to save money [28] 4.being talked about the use of brand vs. generic drugs [29] |
Systematic search | |
| Real expenditure per capita [30] | Systematic search | |
| Effective co-payment rate (Cost-sharing expenditure divided by total expenditure) [30] | Systematic search | |
| Median MPR (median price ratio) of Innovator brand, most sold generic and low price generic drugs in Public Procurement Sector, Private Sector Retail Pharmacies, and Dispensing Doctors’ Sector [31] | Systematic search | |
| During the past 12 months, was there any time you needed prescription medicines but didn’t get them because you couldn’t afford it [32] | Systematic search | |
| % Households whose monthly medicine expenditures represent at least >20% of total expenditures [3] | Systematic search | |
| Average household medicine expenditures as % of total expenditures [3] | Gray literature | |
| Average household medicine expenditures as % of non-food expenditures [3] | Gray literature | |
| Average household medicine expenditures as % of total health expenditures [3] | Gray literature | |
| Average annualized health expenditures per person [3] | Gray literature | |
| Average HH medicine expenditures for a reported illness as a % of total expenditures [3] | Gray literature | |
| % HH with at least partial insurance coverage for at least one medicine [3] | Gray literature | |
| % respondents who say that prescribed medicines were not taken “because HH cannot afford medicines” [3] | Gray literature | |
| % respondents who can get free medicines at public health care facility [3] | Gray literature | |
| % respondents who agree medicines are more expensive at private pharmacies [3] | Gray literature | |
| % respondents who say they can get credit from the private pharmacy [3] | Gray literature | |
| % respondents who can usually afford to buy medicines they need [3] | Gray literature | |
| % respondents who agree that better insurance coverage would increase their use of medicines [3] | Gray literature | |
| % respondents who have had to borrow money or sell things to pay for medicines [3] | Gray literature | |
| Measuring Price Components [28] | Gray literature | |
| Types of free medicines [33] | Gray literature | |
| Types of fees charged [33] | Gray literature | |
| Type of insurance coverage [33] | Gray literature | |
| Percentage of cost covered [33] | Gray literature | |
| Public medicines budget and per capita drug expenditures [33] | Gray literature | |
| Affordability of treatment for adults and children under 5 years of age at public health facility dispensaries and private drug outlets [4] | Gray literature | |
| Price variation of key medicines in public health facility dispensaries and private drug outlets [4] | Gray literature | |
| Average cost of medicines at public health facilities and private drug outlets(by patient) [4] | Gray literature | |
| Price of key medicines [4] | Gray literature | |
| Price of pediatric medicines [4] | Gray literature | |
| Pharmaceutical spending per person and growth rate [34] | Systematic search | |
| Percent of population reporting not filling a prescription or skipping a dose because of costs during the previous 12 months [34] | Systematic search | |
| Human resources | Number of pharmacists (per 1000 pop) [35] | Systematic search |
| Density of pharmacists and pharmaceutical technicians per region [35] | Systematic search | |
| Number of pharmacists employed in the public and private sector or NGO [35] | Systematic search | |
| Density of pharmaceutical human resources per 10,000 population by cadre [8] | Gray literature | |
| Density of each pharmaceutical cadre per 10,000 population by facility type [8] | Gray literature | |
| Proportion of the workforce by cadre [8] | Gray literature | |
| Proportion of facilities with non-pharmaceutical cadres providing pharmaceutical services [8] | Gray literature | |
| % of facilities that comply with the law (presence of a pharmacist) [4] | Gray literature | |
| Quality & safety | % facilities with pharmacist, nurse, pharmacy aide/health assistant or untrained staff | |
| Dispensing [4] | Gray literature | |
| % facilities with doctor, nurse, trained health worker/health aide prescribing [4] | Gray literature | |
| % facilities with prescriber trained in RDU [4] | Gray literature | |
| Number of Quality Control samples taken for testing annually | Gray literature (governmental document) | |
| Number of annual tested samples failed to meet quality standards | Gray literature (governmental document) | |
| % of SSFFC medicines per Total medicines | Gray literature (governmental document) | |
| Information and rational use | medication error in prescribing and administration | Gray literature (governmental document) |
| abuse of selected medicines (according to DID) | Gray literature (governmental document) | |
| Average number of medicine prescribed per patient encounter [1, 36, 37] | Gray literature & systematic search | |
| Encounters with only one drug prescribed [36] | Systematic search | |
| Encounters with five or more drugs prescribed [36] | Systematic search | |
| Percentage of medicines prescribed by generic name [1, 36–38] | Gray literature & systematic search | |
| Percentage of medicine prescribed from an EML or formulary [1, 37] | Gray literature & systematic search | |
| Percentage encounters with an antibiotic prescribed [1, 36–38] | Gray literature & systematic search | |
| Percentage encounters with an injection prescribed [1, 36–38] | Gray literature & systematic search | |
| Prescriptions contain corticosteroids medicine as % of total prescription | Gray literature (governmental document) | |
| Annual consumption of selected narcotic pain killers (mg/capita) | Gray literature (governmental document) | |
| % HH medicines taken for acute illness by category of providers who recommended or prescribed them [3] | Gray literature | |
| % HH medicines by source [3] | Gray literature | |
| % acute illnesses for which the class of medicines taken does not reasonably match recalled symptoms [3] | Gray literature | |
| % of acute illnesses treated with injections [3] | Gray literature | |
| % HH medicines with adequate label [3] | Gray literature | |
| % HH medicines with adequate primary packaging [3] | Gray literature | |
| % respondents who said prescribed medicines were not taken for a reason related to acceptability [3] | Gray literature | |
| % respondents who said prescribed medicines were not taken because of previous side effects [3] | Gray literature | |
| % HH classes of medicines kept for future use [3] | Gray literature | |
| % HH reporting a serious acute illness who did not seek care outside and did not take medicines [3] | Gray literature | |
| % HH reporting a serious acute illness who sought care outside but did not take all prescribed medicines [3] | Gray literature | |
| % HH with a chronically ill person who was never told to take medicines [3] | Gray literature | |
| % HH with a chronically ill person who does not take recommended medicines regularly [3] | Gray literature | |
| Drugs included in the WHO Model List [36] | Systematic search | |
| Drugs included in the National List of Essential Medicines [36] | Systematic search | |
| Drugs included in the local List of Essential Medicines [36] | Systematic search | |
| Drugs available in the same facility of the consultation [36] | Systematic search | |
| % of facilities that comply with the law (presence of a pharmacist) [4] | Gray literature | |
| % facilities with pharmacist, nurse, pharmacy aide/health assistant or untrained staff | ||
| Dispensing [4] | Gray literature | |
| % facilities with doctor, nurse, trained health worker/health aide prescribing [4] | Gray literature | |
| % facilities with prescriber trained in RDU [4] | Gray literature |