Ref. Ozawa S, Higgins CR, Yemeke TT, Nwokike JI, Evans L, Hajjou M, et al. (2020) Importance of medicinequality in achieving universal health coverage. PLoS ONE 15(7): e0232966. https://doi.org/10.1371/journal. pone.0232966
Today I am sharing an open-access article that I think would be of great interest for most of us. The group of professor Ozawa recently developed and published a systems map connecting medicines quality assurance systems with the goals of universal health coverage (UHC). The systems map (Figure 1 in the article) connects the mechanisms to build effective medicines quality assurance systems with the health and economic benefits that quality-assured medicines can bring to UHC, highlighting the need for investments in strengthening these systems to achieve UHC. For example, using a substandard medicine could add days to recovery time or be completely ineffective, requiring a patient to seek additional care or suffer a longer illness and increase the severity of disease.
If beneficiaries require less health care to manage the consequence of bad treatment, the health system is less burdened and the quality of health services could improve, health care costs decrease, and those savings could be reinvested back into the system, for covering more medicines and services, more beneficiaries, or more costs incurred by individuals. Regulatory oversight and quality assurance mechanisms throughout the supply chain reinforce the system that ensures patients can obtain and use quality-assured medicines, and they are essential to fulfill UHC goals. These findings seem in line with our position that it is feasible to attain UHC with affordable quality medicines, through a mix of quality assurance interventions and incentive schemes (Ravinetto R, Dujardin C. https://doi.org/10.1136/bmj.l6004 PMID: 31615789).
Second, they examined the association between UHC and medicine quality in the context of essential medicines in low- and middle-income countries (LMICs), by analyzing available data on substandard and falsified essential medicines, and established indicators for UHC, namely an indicator on essential services coverage; and an indicator on the proportion of the population with large household expenditures on health as a share of total household expenditures (in addition, two indicators for government effectiveness and regulatory quality were abstracted from the World Governance Indicators of the World Bank). It appears that across 63 LMICs, the reported prevalence of substandard and falsified essential medicines was negatively associated with both an indicator for coverage of essential services (p = 0.05) and with an indicator for government effectiveness (p = 0.04).
Last, they examined the health and economic savings of improving antimalarial quality in four countries. It was estimated that investing in improving the quality of antimalarials by 10% would result in annual savings of $8.3 million in Zambia, $14 million in Uganda, $79 million in two DRC regions, and $598 million in Nigeria, and would be more impactful compared to other potential investments (costs of substandard and falsified antimalarials per malaria case ranged from $7 to $86, while costs per death due to poor-quality antimalarials ranged from $14,000 to $72,000).
Medicines quality assurance systems play a critical role in reaching UHC goals. By ensuring the quality of essential medicines, they help deliver effective treatments that lead to less illness and result in health care savings that can be reinvested towards UHC.
Have a nice reading,