SDG indicator 3.b.3 – an analysis of its robustness and challenges for measuring access to medicines for children

Abstract

Background Sustainable Development Goal (SDG) indicator 3.b.3 monitors progress in medicines’ accessibility for adults and has significant limitations when applying to medicines for children. An adapted indicator methodology was developed to fill this gap, but no proof of its robustness exists. We provide this evidence through sensitivity analyses. Methods Data on availability and prices of child medicines from ten historical datasets were combined to create datasets for analysis: Dataset 1 (medicines selected at random) and Dataset 2 (preference given to available medicines, to better capture affordability of medicines). A base case scenario and univariate sensitivity analyses were performed to test critical components of the methodology, including the new variable of number of units needed for treatment (NUNT), disease burden (DB) weighting, and the National Poverty Line (NPL) limits. Additional analyses were run on a continuously smaller basket of medicines to explore the minimum number of medicines required. Mean facility scores for access were calculated and compared. Results The mean facility score for Dataset 1 and Dataset 2 within the base case scenario was 35.5% (range 8.0–58.8%) and 76.3% (range 57.2–90.6%). Different NUNT scenarios led to limited variations in mean facility scores of + 0.1% and -0.2%, or differences of + 4.4% and -2.1% at the more critical NPL of $5.50 (Dataset 1). For Dataset 2, variations to the NUNT generated differences of + 0.0% and -0.6%, at an NPL of $5.50 the differences were + 5.0 and -2.0%. Different approaches for weighting for DB induced considerable fluctuations of 9.0% and 11.2% respectively. Stable outcomes with less than 5% change in mean facility score were observed for a medicine basket down to 12 medicines. For smaller baskets, scores increased more rapidly with a widening range. Conclusion This study has confirmed that the proposed adaptations to make SDG indicator 3.b.3 appropriate for children are robust, indicating that they could be an important addition to the official Global Indicator Framework. At least 12 child-appropriate medicines should be surveyed to obtain meaningful outcomes. General concerns that remain about the weighting of medicines for DB and the NPL should be considered at the 2025 planned review of this framework.

Monitoring Access to Child Medicines: Introducing a Standardized Set of Age-Appropriate Medicines

“…SDG indicator 3.b.3 intends to correct for this by weighting according to the regional burden of diseases [ 6 ]. Whether this is the optimal approach to account for this remains to be determined [ 12 ]. Furthermore, the core sets comprise several medicines administered through injections.…”

“…To allow monitoring of access to child-appropriate medicines through SDG indicator 3.b.3, we proposed and validated a methodology tailored to children, effectively addressing the technical challenges associated with calculating affordability [ 8 , 12 ]. However, as part of these adaptations, the child indicator—similar to the original indicator—requires the survey of a standardized set of tracer essential medicines [ 6 ].…”

Measuring access to essential medicines in the sustainable development goals

“…However, the weight offers limited value, as availability in the indicator is a binary variable which does not capture volumes needed to match demand over time. 10 Additional survey instruments, such as the WHO Essential Medicines and Health Products Price and Availability Monitoring Mobile Application (WHO EMP MedMon), were introduced that increase data requirements.…”