Abstract 213ICIUM: Antalya, Turkey. November 14-18, 2011

BACKGROUND

• Medicine prices vary significantly across Sub-Saharan African countries

• Strengthening health insurance programs could improve the availability and affordability of essential medicines

• Health insurance is intended to reduce the financial burden of purchasing medicines and improve access

• Many types of national, social, private, and community-based health insurance schemes are emerging

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POLICY IMPLICATIONS

• Defining an effective, affordable minimum medicine benefits package within a health insurance context is an important step

• Strengthen transparency through improved record management systems, provider and member education,

• Mechanisms to integrate local population ownership and joint decision-making,

• Expanded risk pooling that could mitigate the effects of adverse selection

• Capacity building for medicines policy decision making is needed to strengthen existing systems

• Strong government commitment and international donor support is needed to expand medicines coverage through health insurance systems

STUDY AIMS

No published information exists on:

1. the scope of medicine benefits provided by Sub-Saharan Africa health insurance programs

2. what data these programs have available to monitor performance or evaluate effects of changes in medicines coverage

We therefore:- describe health insurance programs in Ghana,

Kenya, Nigeria, Tanzania and Uganda, their medicine benefits, and the routine data available to them

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METHODS

• We developed a survey to:– assess program structure,– characteristics of medicine benefits,– availability of routine data for decision making.

• Distributed through National Program Officers in WHO AFRO

• Sampled 82 health insurance programs, 33 (40%) returned completed survey

• Responses presented in aggregate with no individual program identified.

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Very few health insurance programs cover the poor, the unemployed, and pensioners

6Total responses: 28

RESULTS

Most programs require that inpatient and outpatient medicines be dispensed as generics

7Total responses: 23 (Blue), 23 (Red)

RESULTS

Delays in payment and fraud are a serious problem with medicines benefit

Total responses: 17 (Blue), 18 (Red)

RESULTS

Programs reported the three most important questions they would like answered

• Some medicines policy or coverage issues included:– concern about expanding pharmacy budgets and controlling

medicines prices,– addressing product selection, cost, and cost-effectiveness of

medicines,– combating counterfeit medicines,– implementing specific medicines management approaches, – improving adherence to generic prescribing,– responding to quality concerns of patients and providers about

generic medicines,– assessing the effectiveness of newer, costly therapies, and– implementing computerized data management.

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RESULTS