The WHO/HAI method for measuring medicine prices, availability and affordability assesses affordability as the number of days wages needed by the lowest paid unskilled government worker to purchase a course of treatment for an acute disease or a months treatment for a chronic disease. But in many countries most people earn less or a lot less than this government worker and so this metric may overestimate medicine affordability for most of the population.
To address this problem Laurens Niëns (Erasmus University) undertook a research internship at HAI and WHO's Essential Medicines department. The outcome of the work has been published as an article in PLoS Medicine entitled Quantifying the Impoverishing Effects of Purchasing Medicines:A Cross-Country Comparison of the Affordability of Medicines in the Developing World
Affordability was assessed in terms of the proportion of the population being pushed below US$1.25 or US$2 per day poverty levels because medicines are purchased. The prices of four commonly used medicines - salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab - were obtained from HAIs database (findings from surveys undertaken using the WHO/HAI methodology). The World Bank's World Development Indicators provided household expenditure data and information on income distributions. In the countries studied, purchasing these medicines would impoverish large portions of the population (up to 86%). Originator brand products were less affordable than the lowest-priced generic equivalents. In the Philippines, for example, originator brand atenolol would push an additional 22% of the population below US$1.25 per day, whereas for the lowest priced generic equivalent this demographic shift is 7%. Given related prevalence figures, substantial numbers of people are affected by the unaffordability of medicines.
The authors concluded that the high cost of medicines alone is having catastrophic effects on poor people. Concerted action is urgently required to improve medicine affordability and prevent poor populations from being pushed further into poverty. Such action includes actively promoting the use of quality assured, low-cost generic medicines; ensuring the availability of essential medicines in the public sector at little or no charge to poor people; establishing health insurance systems with outpatient medicine benefits; and encouraging pharmaceutical companies to differentially price patented medicines.