Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries

Abstract

Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients’ spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.

Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: Scoping review

“…Thirty-two articles were included in this scoping review. The included articles addressed the following six domains: prevention, detection, and response to SF medicine marketing and use 13 , 33 , 41 , 44 , 45 ; regulatory framework and national capacity 25 , 31 , 35 , 46 , 47 ; SF medicine marketing control challenges 27 , 28 , 30 , 36 , 48 ; and health and economic burden of SF medicines. 14 , 32 , 38 , 49 , 50 The role of collaboration and networking for combatting SF medicine marketing and use, 26 , 39 , 51 , 52 strategies for combating SF medicines including improved access,16,41 poor alignment of research and development with the public need, 16 , 53 – 56 and policy framework and leadership commitment.…”

“… 14 , 32 , 38 , 49 , 50 The role of collaboration and networking for combatting SF medicine marketing and use, 26 , 39 , 51 , 52 strategies for combating SF medicines including improved access,16,41 poor alignment of research and development with the public need, 16 , 53 – 56 and policy framework and leadership commitment. 25 , 35 , 40 , 41 , 47 , 56 , 57 A majority of studies emphasized the importance of addressing both access to medicine and SF medicine problems together. 14 , 26 , 32 , 38 , 39 , 49 – 52 …”

The Pathway to Achieving Universal Health Coverage in the Democratic Republic of Congo: Obstacles and Prospects

“…Furthermore, adequate procurement or reimbursement systems should be established to minimise out-of-pocket payments. A few years ago, a scoping review of five middle-income countries (Ecuador, Ghana, the Philippines, South Africa, and Ukraine) assessed how UHC-related regulations promote the affordability and financing of essential medicines [ 40 ]. The review highlighted that in Ecuador, consumers have a legal right to access the retail prices of medicine labels.…”

“…South Africa has implemented stricter regulations, providing consumers with details of the single exit price, availability, pricing mechanism, supply chain, distributors, retailers, and wholesale prices. In Ukraine, individuals have the right to be informed about the medicines they are entitled to under the medical guarantee program [ 40 ]. The economic context of these countries, although not directly comparable to that of the DRC, exemplifies the measures undertaken by certain nations to implement UHC for their respective populations.…”

Mitigation of the potential fraud in the era of business digitalization in the covid 19 pandemic: exploration of accountant’s role and challenges

“…Technology was created to help humans carry out their roles more effectively and efficiently (Akrout & Ayadi, 2021). There will always be opportunities for human resources to play a role in various essential processes in all areas of life (Perehudoff et al, 2020). However, things that need to be observed are related to the need for humans to also participate in developing their capacity to always be better through adaptation to technological developments around them.…”