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المصدر: BMC Public Health, Vol 19, Iss 1, Pp 1-10 (2019)
BMC Public Healthمصطلحات موضوعية: medicine.medical_specialty, Population, Public policy, Public Policy, 030209 endocrinology & metabolism, Accounting, Judicial decisions, Judicialization of health, Health Services Accessibility, Essential medicines, 03 medical and health sciences, 0302 clinical medicine, Right to health, Humans, Medicine, 030212 general & internal medicine, Formulary, education, Poverty, Plaintiff, education.field_of_study, Health Care Rationing, business.industry, Health Policy, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Equity (finance), lcsh:RA1-1270, Government Programs, Socioeconomic Factors, Descriptive research, Drugs, Essential, business, Brazil, Research Article, Pharmaceutical services
الوصف: Background Although public policy in Brazil supports access to essential medicines, the health system cannot meet all demand. Increasingly, the population has used legal demands to seek access to medicines, an approach that can undermine equitable access by creating policy inconsistencies (e.g., granting access to medicines outside the SUS formulary). In response, the Executive Branch has signed institutional agreements to create an administrative case for submitting requests for medicines directly to the Executive Branch. The objective of this study was to assess the degree to which the administrative cases for requests are in accordance with public policies and guidelines, e.g., if administrative cases results in fewer decisions to purchase outside the SUS formulary. Methods This descriptive study used secondary data from lawsuits filed against the Executive Branch from 2003 to 2015 and from administrative cases granted by the Executive Branch from 2010 to 2015 in the capital of a state located in the central-western region of Brazil. The variables included plaintiffs’ sociodemographic characteristics and diseases as well as the characteristics of the medical products sought via the processes. Results Comparing the requests submitted through lawsuits and the administrative cases revealed differences in the incomes of plaintiffs and the costs of medicines. Both methods for submission recorded requests for medicines for diseases of endocrine and circulatory systems; the only difference was the prevalence of diseases of the genitourinary system in the lawsuits. A higher proportion of lawsuits sought medicines outside the SUS formulary with therapeutic alternatives, while medicines outside the SUS formulary without an alternative were more commonly requested in administrative cases. Conclusion Administrative cases adhere to the public policies and guidelines of the SUS. The administrative cases results in fewer decisions to purchase outside the SUS formulary with alternative, and more decisions to purchase drugs for which there is a formulary alternative. In addition, administrative cases provide greater equity by favoring lower income applicants. However, administrative cases also reveal deficiencies in the State’s implementation of existing pharmaceutical policies. The public pressure for effective implementation of existing policies may help expand access to medicines.
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المؤلفون: Blerta Maliqi, Jane Briggs, Martha Embrey, Jennifer Harris Requejo, Lisa Hedman
المصدر: BMC Health Services Research, Vol 18, Iss 1, Pp 1-12 (2018)
BMC Health Services Researchمصطلحات موضوعية: Zimbabwe, medicine.medical_specialty, Economic growth, Countdown to 2015, Child Health Services, 030231 tropical medicine, Commodity, Zambia, Maternal, Health Services Accessibility, Essential medicines, Health administration, and Child health, Medicines, 03 medical and health sciences, Health systems, 0302 clinical medicine, Procurement, Reproductive, medicine, Humans, Maternal Health Services, Cameroon, 030212 general & internal medicine, Child, Sustainable development, business.industry, Health Policy, Public health, lcsh:Public aspects of medicine, Infant, Newborn, lcsh:RA1-1270, Millennium Development Goals, Newborn, Access, Senegal, Product (business), Policy, Healthy People Programs, Pharmaceuticals, Female, Reproductive Health Services, Drugs, Essential, business, Health commodities, Research Article
الوصف: Background In 2000, the Millennium Development Goals set targets for social achievements by 2015 including goals related to maternal and child health, with mixed success. Several initiatives supported these goals including assuring availability of appropriate medicines and commodities to meet health service targets. To reach the new Sustainable Development Goals by 2030, information is needed to address policy and systems factors to improve access to lifesaving commodities. Methods We compiled indicator data on 15 commodities related to reproductive, maternal, newborn, and child health (RMNCH) and analyzed them across 75 Countdown to 2015 countries from eight regions to identify problems with specific commodities and determinants of access. The determinants related to policy, regulatory environment, financing, pharmaceutical procurement and supply chain, and information systems. We mapped commodity information from four datasets from the World Health Organization and the United Nation’s Commission on Life Saving Commodities creating a stoplight dashboard to illustrate countries’ environment to assure access. We also developed a dashboard for policy and systems indicators for select countries. Results The commodities we identified as having the fewest barriers to access had been in use longer, including oral rehydration solution and oxytocin injection. Looking across the different systems and policy determinants of access, only Zimbabwe had all 15 commodities on both its essential medicines list and in its standard treatment guidelines, and only Cameroon and Zambia had at least one product registered for each commodity. Senegal alone procured all tracer commodities centrally in the previous year, and 70% of responding countries had costed plans for maternal, newborn, and child health. No country reported recent stock-outs of all the 15 commodities at the central level—countries always had some of the 15 commodities available; however, products with frequent stock-outs included misoprostol, calcium gluconate, penicillin injections, ceftriaxone, and amoxicillin dispersible tablets. Conclusions This analysis highlights country deficiencies in policies and systems, such as incoherent policy guidelines, problems in product registration, lack of logistics data, and central-level stock-outs that may affect access to essential RMNCH commodities. To tackle these deficiencies, countries need to integrate commodity-related indicators into other health monitoring activities to improve service quality. Electronic supplementary material The online version of this article (10.1186/s12913-018-3766-6) contains supplementary material, which is available to authorized users.
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المؤلفون: Amani Thomas Mori, Mary Temu, Rashid Bakari Kirua
المصدر: International Journal for Equity in Health
International Journal for Equity in Health, Vol 19, Iss 1, Pp 1-9 (2020)مصطلحات موضوعية: medicine.medical_specialty, National Health Programs, Developing country, Pain, Pharmacy, Tanzania, Essential medicines, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Surveys and Questionnaires, medicine, Diabetes Mellitus, Humans, Private pharmacy, 030212 general & internal medicine, Health policy, Reimbursement, health care economics and organizations, Pharmacies, Prices, biology, business.industry, 030503 health policy & services, Health Policy, Public health, lcsh:Public aspects of medicine, Research, Public Health, Environmental and Occupational Health, Health services research, Reference prices, lcsh:RA1-1270, biology.organism_classification, Cross-Sectional Studies, Cardiovascular Diseases, Private Sector, 0305 other medical science, business, Drugs, Essential
الوصف: Background High price is a major challenge limiting access to essential medicines especially among the poorest families in developing countries. The study aims to compare the prices of medicines used in the management of pain, diabetes, and cardiovascular diseases in private pharmacies and the National Health Insurance Fund (NHIF) in Tanzania. Pharmacy prices were also compared with the prices of medicines surveyed nationally by WHO/HAI in 2012. Method This cross-sectional study was conducted in Dar es Salaam, Morogoro, Dodoma, and Kilimanjaro regions from February to April 2015. Data were collected from 33 private pharmacies, NHIF and, the HAI database. The study used the WHO/HAI methodology. The analysis was done using non-parametric Kruskal-Wallis and post-hoc pair-wise comparison Dunn test, while a possible change in prices between our survey and 2012 WHO/HAI national survey data was tested using a Sign test in Stata version 16.1. Results Twenty-eight essential medicines, of which 9 are used for management of pain, 7 for diabetes, and 12 for cardiovascular diseases were analyzed. There was a significant difference in the mean pharmacy prices of some medicines between the regions and between the pharmacies and NHIF reference prices. NHIF reference prices were higher than the pharmacy prices for 16 of the 28 medicines. There was a significant increase in the prices of 5 out of the 8 medicines that were also nationally surveyed by the WHO/HAI in 2012. Conclusion The study found that medicine prices in private pharmacies vary a lot between the study regions, which raises equity concerns. Also, there was a significant difference between the pharmacy and the NHIF reimbursement prices, which may expose patients to fraudulent co-payments or hinder timely access to prescribed medicines. Therefore, effective price control policies and regulations for medicines are warranted in Tanzania.
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المؤلفون: Moliehi Matlala, Cynthia Modisakeng, Brian Godman, Johanna C Meyer
المصدر: EuroDURG 2020
BMC Health Services Research
BMC Health Services Research, Vol 20, Iss 1, Pp 1-10 (2020)مصطلحات موضوعية: Adult, Male, Economic growth, Procurement, Public sector hospitals, Universal design, 030231 tropical medicine, Contracts, Shortages, Essential medicines, Health administration, RS, Interviews as Topic, 03 medical and health sciences, South Africa, 0302 clinical medicine, Health care, Medicine, Humans, 030212 general & internal medicine, Longitudinal Studies, Qualitative Research, business.industry, Hospitals, Public, lcsh:Public aspects of medicine, Health Policy, Nursing research, Public sector, lcsh:RA1-1270, Middle Aged, Purchasing, Hospital, Female, Thematic analysis, business, Drugs, Essential, Research Article
الوصف: Background Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. Method Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. Results The ‘Procurement process’ emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. Conclusions Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.
وصف الملف: application/pdf
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المؤلفون: Hongqiao Fu, Weiyan Jian, Jianying Zeng, Ming Lu, Xiwen Chen
المصدر: BMC Health Services Research, Vol 19, Iss 1, Pp 1-8 (2019)
BMC Health Services Research
UnpayWall
Microsoft Academic Graph
DOAJ-Articles
PubMed Centralمصطلحات موضوعية: medicine.medical_specialty, Cost Control, Health informatics, Drug Costs, Health administration, 03 medical and health sciences, 0302 clinical medicine, Beijing, Environmental health, Medicine, Humans, 030212 general & internal medicine, China, Propensity Score, business.industry, Healthcare reform, 030503 health policy & services, Health Policy, Public health, Nursing research, Healthcare expenditure, lcsh:Public aspects of medicine, lcsh:RA1-1270, Quarter (United States coin), Health Care Reform, Propensity score matching, Cost containment, 0305 other medical science, business, Drugs, Essential, Research Article
الوصف: Background In September 2012, Beijing, the capital of China, selected five tertiary hospitals as pilots to remove the previously allowed 15% markup for drug sales. However, while most research demonstrated the significant decrease in drug sales, the core issue of high health expenditure was not well solved because of the unintended policy impact. This study aimed to empirically evaluate the short-term and long-term unintended impacts on controlling medical expenses of Beijing’s zero markup drug policy from 2012 to 2015. Methods This study extracted 2012–2015 individual-level data from the Beijing Urban Employee Basic Medical Insurance (UEBMI) database and performed a propensity score-matched analysis to evaluate the short-term and long-term impacts on controlling medical expenses. All inpatients in the 5 pilot reform hospitals were selected as the intervention group, while inpatients in other tertiary hospitals were selected as the control group. Results A total of 520,996 inpatients were extracted in this study. For patients in the pilot hospitals, the total expenditures per admission decreased from 17,140.3 yuan in 2012 to 15,430.1 yuan in 2013 and then increased to 16,789.8 yuan in 2015. Expenditure on drugs reduced from 5811.7 yuan in 2012 to 3903.4 yuan in 2015. However, a significant substitution effect of medical consumables was first observed in the third quarter of 2014, which undermined the impact of the policy. In the long-term, the intervention group and control group demonstrated the same trend. Conclusions After the zero markup drug policy, expenditure on drugs revealed a continuous decline. However, the decline in total expenditure was weakened by the substitution effect of medical consumables in the long term.
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المصدر: BMC Health Services Research, Vol 19, Iss 1, Pp 1-10 (2019)
BMC Health Services Researchمصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Delayed Diagnosis, Health Personnel, 030231 tropical medicine, Rural Health, Health informatics, Essential medicines, Health administration, 03 medical and health sciences, 0302 clinical medicine, Outpatients, Ambulatory Care, Humans, Hypoglycemic Agents, Medicine, Uganda, Health Workforce, 030212 general & internal medicine, Quality of Health Care, business.industry, lcsh:Public aspects of medicine, Health Policy, Nursing research, Rural health, Public health, Rural Uganda, Quality of care, Health facilities, Type 2 diabetes, lcsh:RA1-1270, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Child, Preschool, Family medicine, Workforce, Health Resources, Female, Rural area, Drugs, Essential, business, Delivery of Health Care, Barriers, Research Article
الوصف: Background Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. Methods This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. Results The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. Conclusion The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.
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المصدر: BMC Health Services Research, Vol 17, Iss S2, Pp 15-23 (2017)
BMC Health Services Researchمصطلحات موضوعية: Process management, Prescription Drugs, Context (language use), Western Cape, Pharmacists, Health informatics, Essential medicines, Health Services Accessibility, Health administration, Chronic Dispensing Unit, 03 medical and health sciences, South Africa, 0302 clinical medicine, Procurement, Health care, Medicine, Humans, Centralized dispensing, 030212 general & internal medicine, Qualitative Research, Pharmacies, Medicines supply chain, theory-driven evaluation, business.industry, 030503 health policy & services, Health Policy, Research, lcsh:Public aspects of medicine, Public sector, Access to medicines, lcsh:RA1-1270, Service provider, 0305 other medical science, business, Drugs, Essential, Delivery of Health Care
الوصف: Background Centralized dispensing of essential medicines is one of South Africa’s strategies to address the shortage of pharmacists, reduce patients’ waiting times and reduce over-crowding at public sector healthcare facilities. This article reports findings of an evaluation of the Chronic Dispensing Unit (CDU) in one province. The objectives of this process evaluation were to: (1) compare what was planned versus the actual implementation and (2) establish the causal elements and contextual factors influencing implementation. Methods This qualitative study employed key informant interviews with the intervention’s implementers (clinicians, managers and the service provider) [N = 40], and a review of policy and program documents. Data were thematically analyzed by identifying the main influences shaping the implementation process. Theory-driven evaluation principles were applied as a theoretical framework to explain implementation dynamics. Results The overall participants’ response about the CDU was positive and the majority of informants concurred that the establishment of the CDU to dispense large volumes of medicines is a beneficial strategy to address healthcare barriers because mechanical functions are automated and distribution of medicines much quicker. However, implementation was influenced by the context and discrepancies between planned activities and actual implementation were noted. Procurement inefficiencies at central level caused medicine stock-outs and affected CDU activities. At the frontline, actors were aware of the CDU’s implementation guidelines regarding patient selection, prescription validity and management of non-collected medicines but these were adapted to accommodate practical realities and to meet performance targets attached to the intervention. Implementation success was a result of a combination of ‘hardware’ (e.g. training, policies, implementation support and appropriate infrastructure) and ‘software’ (e.g. ownership, cooperation between healthcare practitioners and trust) factors. Conclusion This study shows that health system interventions have unpredictable paths of implementation. Discrepancies between planned and actual implementation reinforce findings in existing literature suggesting that while tools and defined operating procedures are necessary for any intervention, their successful application depends crucially on the context and environment in which implementation occurs. We anticipate that this evaluation will stimulate wider thinking about the implementation of similar models in low- and middle-income countries. Electronic supplementary material The online version of this article (10.1186/s12913-017-2640-2) contains supplementary material, which is available to authorized users.
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المؤلفون: Xinping Zhang, Guoqin Liu, Zinan Zhang, Chaojie Liu, Chenxi Liu, Margaret Ewen
المصدر: BMC Health Services Research, Vol 17, Iss 1, Pp 1-9 (2017)
BMC Health Services Researchمصطلحات موضوعية: Gerontology, medicine.medical_specialty, China, medicine.medical_treatment, 030209 endocrinology & metabolism, Pharmacy, WHO/HAI, Essential medicines, Health Services Accessibility, Health administration, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Insulin, 030212 general & internal medicine, Socioeconomics, Stock (geology), health care economics and organizations, Pharmacies, Public Sector, Affordability, business.industry, Hospitals, Public, Health Policy, Public health, lcsh:Public aspects of medicine, Public sector, Prescription Fees, Diabetes, Availability, lcsh:RA1-1270, Access, Price component, Bargaining power, Cross-Sectional Studies, business, Drugs, Essential, Research Article
الوصف: Background Poor access to affordable insulin results in serious and needless complications and premature deaths for those with diabetes who need this essential medicine. To help address this issue, we assessed insulin availability, prices, affordability and price components in Hubei Province as China has the heaviest burden of diabetes globally. Methods In 2016, insulin availability and price data was collected in the capital and five other cities. A total of 30 public sector outlets (hospitals and primary care institutions) and 30 private pharmacies were sampled, using an adaptation of the World Health Organization/Health Action International methodology, Data was collected for all human and analogue insulins in stock, then analyzed by type (prandial, basal or pre-mixed) and duration of action. Prices were expressed as Median Price Ratios (MPRs) to Australian PBS prices. Price components were tracked for five insulin products in two cities.. Affordability was assessed as the number of days’ wages of the lowest paid unskilled government worker needed to purchase 10 ml 100 IU/ml (approximately 30 days’ supply). Results Mean availability was highest in public hospitals for prandial (70%), basal (80%) and pre-mixed insulin (90%). In primary care institutions and private pharmacies mean availability ranged from 10% to 33%. Median prices of all insulin types were higher that Australian PBS prices in all three sectors for human and analogue insulins (ranging from1.36–2.59 times). Patients have to pay 4 to 16 days’ wages to purchase a month’s treatment depending on the insulin type and sector. The largest component of the patient price was the manufacturers’ selling price (60%). Taxes in the form of import duties and VAT are applied in some sectors. Conclusions The availability of insulin in primary care institutions and private retail pharmacies was very low in Hubei. Only public hospitals had good insulin availability. Insulin prices were high in all sectors making this life-saving medicine unaffordable, especially for those on low incomes. Governments should consider using its bargaining power to reduce prices, abolish taxes on essential medicines such as insulin, and develop strategies for more equitable access to insulin. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2553-0) contains supplementary material, which is available to authorized users.
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المساهمون: Public Health Research (PHR)
المصدر: Globalization and Health, Vol 13, Iss 1, Pp 1-10 (2017)
Globalization and Health
Globalization and Health, 13(1):53. BMCمصطلحات موضوعية: PHARMACEUTICAL POLICY, Pooled procurement, Public policy, UNIVERSAL HEALTH COVERAGE, Public expenditure, Public Policy, Price negotiations, Essential medicines, Health Services Accessibility, Medicines, 03 medical and health sciences, 0302 clinical medicine, Procurement, PRICES, DRUGS, Humans, 030212 general & internal medicine, Mexico, Pharmaceutical policy, health care economics and organizations, Government, 030505 public health, Public Sector, Public economics, Affordability, business.industry, Health Policy, Research, lcsh:Public aspects of medicine, Public sector, Public Health, Environmental and Occupational Health, Availability, lcsh:RA1-1270, CARE, Policy analysis, BRAZIL, PUBLIC PROCUREMENT, Policy, Middle-income country, 0305 other medical science, business, ACCESS, Drugs, Essential
الوصف: Background: The World Health Organization recommends establishing and implementing a national pharmaceutical policy (NPP) to guarantee effective and equitable access to medicines. Mexico has implemented several policy approaches to regulate the pharmaceutical sector, but it has no formal NPP. This article describes the approach that the Mexican government has taken to improve availability and affordability of essential medicines.Methods: Descriptive policy analysis of public pharmaceutical policy proposals and health action plans on the basis of publicly available data and health progress reports, with a focus on availability and affordability of medicines.Results: The government has implemented pooled procurement, price negotiations, and an information platform in the public sector to improve affordability and availability. The government mainly reports on the savings that these strategies have generated in the public expenditure but their full impact on availability and affordability has not been assessed.Conclusions: To increase availability and affordability of medicines in the public sector, the Mexican government has resorted on isolated strategies. In addition to efficient procurement, price negotiations and price information, other policy components and pricing interventions are needed. All these strategies should be included in a comprehensive NPP.
وصف الملف: application/pdf
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المؤلفون: J. Shen, N. Maniadakis, Georgia Kourlaba, Anke-Peggy Holtorf
المصدر: BMC Health Services Research, Vol 17, Iss 1, Pp 1-17 (2017)
BMC Health Services Researchمصطلحات موضوعية: Internationality, Pharmaceutical/drug policy, Cost Control, Population, Developing country, Drug Costs, 03 medical and health sciences, Pharmaceutical/drug pricing & reimbursement, 0302 clinical medicine, Humans, Medicine, 030212 general & internal medicine, Healthcare Disparities, Health technology assessment, education, Developing Countries, Socioeconomic status, Health policy, education.field_of_study, Public economics, business.industry, Developed Countries, 030503 health policy & services, Health Policy, lcsh:Public aspects of medicine, Health technology, lcsh:RA1-1270, Investment (macroeconomics), Pharmaceutical care, Pharmaceutical Preparations, Pharmaceutical/drug demand controls, Income, Drug and Narcotic Control, Health Expenditures, Drugs, Essential, 0305 other medical science, business, Developed country, Research Article
الوصف: Background Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country’s income status. Methods A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Results Pharmaceutical policies are linked to a country’s socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price–cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. Conclusions There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2304-2) contains supplementary material, which is available to authorized users.
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