TABLE 3.
Indicators for Key Elements of the Antimicrobial Supply Chain in Bangladesh Based on the Constructed Framework
| Indicator | |||
|---|---|---|---|
| Characteristic | Metric(s) | Value | |
| Supply chain | Linkages | Schematic | N/A |
| Manufacturers | Market structure | Top 10 market share by value | ≈70% |
| CR4 | 255, human sector | ||
| 178, animal sector | |||
| Ownership | Domestic | 90% | |
| Overall production capacity | Supplied locally | 98% | |
| Source of active ingredients | Local | ≤3% | |
| Specialization in antimicrobial production | Proportion of manufacturers producing the top 10 by volume | 38–63%, human sector | |
| 25–84%, animal sector | |||
| Demand points | Pharmacy density | No./5 km2 | <1–7a |
| No./10,000 population | 7.2 | ||
| Pharmacist density | No./10,000 population | 1.8 | |
| Veterinary clinics/hospitals density | No. | 428 public veterinary hospitals | |
| Veterinarian density | No./1,000,000 livestock | ≈1–2 | |
| Product quality | Prevalence of SF medicines | 0.04% | |
| Regulation | Technical capacity | WHO classification of NMRA | Not a stringent regulatory authority |
| Antimicrobial products with market authorization (license) | WHO AWaRe category “Watch” | Top 10 human use | 54% |
| Medically important antibiotics | Top 10 (animal use) | 90% | |
| Listing of top 10 in EML | Top 10 (human use) | 62% | |
| Pricing/price controls | Present/absent | Present | |
Abbreviations: CR4, four firm concentration ratio; EML, Essential Medicines List; N/A, not applicable; NMRA, National Medicines Regulatory Authority; SF, standard formulary; WHO, World Health Organization.
a
Depending on the district, and based on only 30%, or 46,161 currently licensed outlets at the time of the study of 117, 354.