https://doi.org/10.4081/hls.2023.11143
Evidence from systematic reviews on policy approaches to improving access to medicines
Submitted: 9 January 2023
Accepted: 11 July 2023
Published: 19 July 2023
Accepted: 11 July 2023
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The prevailing frameworks on access to medicines advise global procurement as a solution by assuming the presence of medicines on the global market. Yet access to medicines remains challenging, especially in developing countries. This is a global worry because the UN considers limited access to essential medicines as one of the five indicators of securing the right to health. To fill a research gap in health system studies and inform policymaking, we synthesized evidence from systematic reviews of how government policies affect low- and middle-income country (LMIC) medicine access. We chose a rapid review approach to reduce timelines and avoid missing policy “windows of opportunity.” To include only studies published after the start of COVID-19, we chose systematic reviews published between 2019 and November 2nd, 2022. This was also in line with recommendations in the literature to look at recent systematic reviews. The themes were grouped using a thematic and textual narrative approach. This review included 32 studies that examined access to medicine from various perspectives. Both supply- and demand-side policies are needed to improve medical access. LMICs cannot afford medicines, and supply never meets demand. LMICs will continue to struggle with pharmaceutical pricing due to their limited bargaining power. The urban bias in health facilities and policy changes reduce medicine availability and use. Leaders must make policy decisions to sustain domestic funds. Policymakers should consider that organizations may act against policy goals. Instead of copying developed nations, LMIC governments must develop multipronged strategies to address their unique challenges.
Montagu D, Goodman C. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector? Lancet 2016;388:613–21.
DOI: https://doi.org/10.1016/S0140-6736(16)30242-2
Montagu D, Goodman C, Berman P, Penn A, Visconti A. Recent trends in working with the private sector to improve basic healthcare: a review of evidence and interventions. Health Policy Plann 2016;31:1117–1132.
DOI: https://doi.org/10.1093/heapol/czw018
Grépin KA. Private sector an important but not dominant provider of key health services in low-and middle-income countries. Health Affairs 2016;35:1214-21.
DOI: https://doi.org/10.1377/hlthaff.2015.0862
Morgan R, Ensor T, Waters H. Performance of private sector health care: implications for universal health coverage. Lancet 2016;388:606-12.
DOI: https://doi.org/10.1016/S0140-6736(16)00343-3
McPake B, Hanson K. Managing the public–private mix to achieve universal health coverage. Lancet 2016;388:622-30.
DOI: https://doi.org/10.1016/S0140-6736(16)00344-5
Bigdeli M, Jacobs B, Tomson G, et al. Access to medicines from a health system perspective. Health Policy Plann 2013;28:692–704.
DOI: https://doi.org/10.1093/heapol/czs108
Townsend B. Defending access to medicines in regional trade agreements: lessons from the Regional Comprehensive Economic Partnership–a qualitative study of policy actors’ views. Globalization Health 2021;17:1–14.
DOI: https://doi.org/10.1186/s12992-021-00721-4
Perehudoff K, Demchenko I, Alexandrov NV, et al. Essential medicines in universal health coverage: a scoping review of public health law interventions and how they are measured in five middle-income countries. Int J Environ Res Public Health 2020;17.
DOI: https://doi.org/10.3390/ijerph17249524
Odoch WD, Dambisya Y, Peacocke E, et al. The role of government agencies and other actors in influencing access to medicines in three East African countries. Health Policy Plann 2021;36:312–21.
DOI: https://doi.org/10.1093/heapol/czaa189
Peprah Boaitey K, Tuck C. Advancing health system strengthening through improving access to medicines: A review of local manufacturing policies in Ghana. Medicine Access@ Point of Care. 2020;4:2399202620962299.
DOI: https://doi.org/10.1177/2399202620962299
Mousavi T, Nikfar S, Abdollahi M. Achieving equitable access to medicines and health services: a COVID-19-time recalled matter. Iran J Pharm Res 2021;20:450.
Jagosh J. Realist synthesis for public health: building an ontologically deep understanding of how programs work, for whom, and in which contexts. Ann Rev Public Health 2019;40:361–72.
DOI: https://doi.org/10.1146/annurev-publhealth-031816-044451
Mackintosh M, Mugwagwa J, Banda G, Tunguhole J. Local production of pharmaceuticals and health system strengthening in Africa: an evidence brief. In German Health Practice Collection (GHPC), Berlin; 2017.
Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plann 1994;9:353–70.
Mackintosh M, Tibandebage P, Karimi Njeru M, et al. Rethinking health sector procurement as developmental linkages in East Africa. Soc Sci Medi 2018;200:182-9.
DOI: https://doi.org/10.1016/j.socscimed.2018.01.008
Lugada E, Komakech H, Ochola I, et al. Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening. J Pharm Policy Practice 2022;15:1–11.
DOI: https://doi.org/10.1186/s40545-022-00412-4
Mwagomba BL, Ameh S, Bongomin P, et al. Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs: lessons from Malawi, South Africa, Swaziland and Kenya. AIDS 2018;1;32:S21-S32.
DOI: https://doi.org/10.1097/QAD.0000000000001885
Mulumba M, Machemedze R. Addressing bottlenecks to local production of medicines: Issues for international co-‐operation in East and Southern Africa. J Health Dipl 2015;1.
Tibandebage P, Wangwe S, Mackintosh M, et al. Pharmaceutical manufacturing decline in Tanzania: how possible is a turnaround to growth? In Mackintosh M, Banda G, Tibandebage P, Wamae W, editors. Making medicines in Africa. International Political Economy Series. London: Palgrave Macmillan; 2016.
DOI: https://doi.org/10.1007/978-1-137-54647-0_4
Munn Z, Stern C, Aromataris E, et al. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol 2018;18:5.
DOI: https://doi.org/10.1186/s12874-017-0468-4
Koon AD, Hawkins B, Mayhew SH. Framing and the health policy process: a scoping review. Health Policy Plann 2016;31:801–16.
DOI: https://doi.org/10.1093/heapol/czv128
Oliver S, Bangpan M, Dickson K. Producing policy relevant systematic reviews: navigating the policy-research interface. Evidence Policy 2018;14:197-220.
DOI: https://doi.org/10.1332/174426417X14987303892442
Wilson M, Lavis J, Gauvin FP. Developing a rapid-response program for health system decision-makers in Canada: Findings from an issue brief and stakeholder dialogue. Systematic Reviews 2015;4.
DOI: https://doi.org/10.1186/s13643-015-0009-3
Wilson MG, Oliver S, Melendez-Torres GJ, et al. Paper 3: Selecting rapid review methods for complex questions related to health policy and system issues. Systematic Reviews 2021;10:286.
DOI: https://doi.org/10.1186/s13643-021-01834-y
Haby M, Chapman E, Clark R, et al. What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: A rapid review. Health Res Policy Syst 2016;14.
DOI: https://doi.org/10.1186/s12961-016-0155-7
Thomas J, Harden A. Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews. BMC Med Res Methodol 2008;8:45.
DOI: https://doi.org/10.1186/1471-2288-8-45
Doyle LH. Synthesis through meta-ethnography: paradoxes, enhancements, and possibilities. Qual Res 2003;3:321–44.
DOI: https://doi.org/10.1177/1468794103033003
Dobbins M. Rapid Review Guidebook Hamilton: National Collaborating Centre for Methods and Tools; 2017.
Mirzoev T, Koduah A, Chavez AC, et al. Implementation of medicines pricing policies in sub-Saharan Africa: protocol for a systematic review. BMJ Open 2021;11:044293.
DOI: https://doi.org/10.1136/bmjopen-2020-044293
Popay J, Roberts H, Sowden A, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version. 2006.
Thomson H, Campbell M. Narrative synthesis" of quantitative effect data in Cochrane reviews: Current issues and ways forward [Internet: Cochrane Learning Live Webinar Series]; 2020.
Campbell M, McKenzie JE, Sowden A, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ 2020;368:l6890.
DOI: https://doi.org/10.1136/bmj.l6890
Lucas PJ, Baird J, Arai L, et al. Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Med Res Methodol 2007;7:1–7.
DOI: https://doi.org/10.1186/1471-2288-7-4
Kim JK, Kim KH, Shin YC, et al. Utilization of traditional medicine in primary health care in low- and middle-income countries: a systematic review. Health Policy Plann 2020;35:1070-83.
DOI: https://doi.org/10.1093/heapol/czaa022
Wang D, Wu J, Du J, et al. Acceptability of and barriers to human papillomavirus vaccination in China: A systematic review of the Chinese and English scientific literature. Eur J Cancer Care 2022;31:e13566..
DOI: https://doi.org/10.1111/ecc.13566
Albelbeisi AH, Albelbeisi A, El Bilbeisi AH, et al. Public sector capacity to prevent and control of noncommunicable diseases in twelve low- and middle-income countries based on WHO-PEN standards: a systematic review. Health Serv Insights 2021;14:1178632920986233.
DOI: https://doi.org/10.1177/1178632920986233
Kibirige D, Sanya RE, Nantanda R, et al. Availability and affordability of medicines and diagnostic tests recommended for management of asthma and chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review. Allergy Asthma Clinical Immunol 2019;15:14.
DOI: https://doi.org/10.1186/s13223-019-0329-2
Lotfizadeh A, Palafox B, Takallou A, et al. Factors associated with the availability and affordability of essential cardiovascular disease medicines in low- and middle-income countries: A systematic review. PLOS Global Public Health 2022;2:1-18.
DOI: https://doi.org/10.1371/journal.pgph.0000072
Ocran Mattila P, Ahmad R, Hasan SS, Babar ZU. Availability, affordability, access, and pricing of anti-cancer medicines in low- and middle-income countries: a systematic review of literature. Front Public Health 2021;9:628744.
DOI: https://doi.org/10.3389/fpubh.2021.628744
Ferguson I, Scott H. Systematic review of the effectiveness, safety, and acceptability of mifepristone and misoprostol for medical abortion in low- and middle-income countries. J Obst Gynaecol Canada 2020;42:1532-1542.e2.
DOI: https://doi.org/10.1016/j.jogc.2020.04.006
Stolbrink M, Thomson H, Hadfield RM, et al. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review. Lancet Global Health 2022;10:e1423—42.
DOI: https://doi.org/10.1016/S2214-109X(22)00330-8
van Hees SGM, O'Fallon T, Hofker M, et al. Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review. Int J Equity Health 2019;18:134.
DOI: https://doi.org/10.1186/s12939-019-1040-0
Aslam F, Ali I, Babar Z, Yang Y. Building evidence for improving vaccine adoption and uptake of childhood vaccinations in low- and middle-income countries: a systematic review. Drugs Ther Perspect 2022;38:133-45.
DOI: https://doi.org/10.1007/s40267-021-00890-7
Abu-Odah H, Molassiotis A, Liu J. Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews. BMC Palliative Care 2020;19:55.
DOI: https://doi.org/10.1186/s12904-020-00558-5
Ifeagwu SC, Yang JC, Parkes-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub-Saharan Africa: a systematic review. Global Health Res Policy 2021;6:8.
DOI: https://doi.org/10.1186/s41256-021-00190-7
Boro E, Stoll B. Barriers to COVID-19 health products in low-and middle-income countries during the COVID-19 pandemic: a rapid systematic review and evidence synthesis. 2022.
DOI: https://doi.org/10.3389/fpubh.2022.928065
Sekalala S, Forman L, Hodgson T, et al. Decolonizing human rights: how intellectual property laws result in unequal access to the COVID-19 vaccine. BMJ Global Health 2021;6:e006169.
DOI: https://doi.org/10.1136/bmjgh-2021-006169
Adane F, Seyoum G, Alamneh YM, et al. Herbal medicine use and predictors among pregnant women attending antenatal care in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020;20:157.
DOI: https://doi.org/10.1186/s12884-020-2856-8
Islam MD, Kaplan WA, Trachtenberg D, et al. Impacts of intellectual property provisions in trade treaties on access to medicine in low and middle income countries: a systematic review. Globalization Health 2019;15:88.
DOI: https://doi.org/10.1186/s12992-019-0528-0
Porter G, Owens S, Breckons M. A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa. Global Health Res Policy 2021;6.
DOI: https://doi.org/10.1186/s41256-021-00216-0
Belachew SA, Hall L, Selvey LA. Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis. Antimicrob Resist Infection Control 2021;10:13.
DOI: https://doi.org/10.1186/s13756-020-00880-w
Sartelli M, Hardcastle C, Catena T, et al. In use in low and middle-income countries and the challenges of antimicrobial resistance in surgery. Antibiotics Basel 2020;9:497.
DOI: https://doi.org/10.3390/antibiotics9080497
Liu WY, Hsu CH, Liu TJ, et al. Systematic review of the effect of a zero-markup policy for essential drugs on healthcare costs and utilization in China, 2015–2021. Frontiers Med 2021;8.
DOI: https://doi.org/10.3389/fmed.2021.618046
Izugbara C, Wekesah FM, Sebany M, et al. Availability, accessibility and utilization of post-abortion care in Sub-Saharan Africa: A systematic review. Health Care Women Int 2020;41:732-60.
DOI: https://doi.org/10.1080/07399332.2019.1703991
Bader L, Bates I, Schneider P, Charman W. Transforming pharmacy and pharmaceutical sciences education in the context of workforce development. UCL Discovery, 2017. Available from: https://discovery.ucl.ac.uk/id/eprint/1554666/
Wong A, Hung KK, Mabhala M, et al. Filling the gaps in the pharmacy workforce in post-conflict areas: experience from four countries in Sub-Saharan Africa. Int J Environ Res Public Health 2021;18:8132.
DOI: https://doi.org/10.3390/ijerph18158132
Banke-Thomas A, Ayomoh FI, Abejirinde IOO, et al. Cost of utilising maternal health services in low- and middle-income countries: a systematic review. Int J Health Policy Manag 2021;10:564-577.
DOI: https://doi.org/10.34172/ijhpm.2020.104
Moucheraud C, Lenz C, Latkovic M, Wirtz VJ. The costs of diabetes treatment in low- and middle-income countries: a systematic review. BMJ Glob Health 2019;4:e001258.
DOI: https://doi.org/10.1136/bmjgh-2018-001258
Chen Z, Li S, Zeng L, et al. Accessibility of Medicines for Children: A Systematic Review. Frontiers Pharmacol 2021;12:691606.
DOI: https://doi.org/10.3389/fphar.2021.691606
Ewen M, Zweekhorst M, Regeer B, Laing R. Baseline assessment of WHO’s target for both availability and affordability of essential medicines to treat non-communicable diseases. PloS One 2017;12:0171284.
DOI: https://doi.org/10.1371/journal.pone.0171284
Bashaar M, Hassali MA, Saleem F, et al. Efficacy of international approaches to medicine price regulation and control: a scoping review. J Appl Pharmaceut Sci 2017;7:227–41.
Latifah E, Kristina S, Suryawati S, Ali Kusnadi S. Overview of drug availability and influencing factors in several low, lower and upper- middle countries: a systematic review. Systematic Rev Pharm 2018;10:67-72.
DOI: https://doi.org/10.5530/srp.2019.1.11
James N, Lawson K, Acharya Y. Evidence on result-based financing in maternal and child health in low- and middle-income countries: a systematic review. Global Health Res Policy 2020;5:31.
DOI: https://doi.org/10.1186/s41256-020-00158-z
Rostampour M, Nosratnejad S. A systematic review of equity in healthcare financing in low- and middle-income countries. Value Health Regional Issues 2020;21:133-40.
DOI: https://doi.org/10.1016/j.vhri.2019.10.001
Asante A, Price J, Hayen A, et al. Equity in health care financing in low-and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PloS One 2016;11:e0152866.
DOI: https://doi.org/10.1371/journal.pone.0152866
Alkhaldi M, Al Basuoni A, Matos M, et al. Health technology assessment in high, middle, and low-income countries: new systematic and interdisciplinary approach for sound informed-policy making: research protocole. Risk Manag Healthc Policy 2021;14:2757-70.
DOI: https://doi.org/10.2147/RMHP.S310215
Hollingworth S, Fenny AP, Yu SY, et al. Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis. Cost Eff Resour Alloc 2021;19:39.
DOI: https://doi.org/10.1186/s12962-021-00293-5
El-Jardali F, Fadlallah R, Daouk A, et al. Barriers and facilitators to implementation of essential health benefits package within primary health care settings in low-income and middle-income countries: A systematic review. Int J Health Plann Manag 2019; 34:15-41.
DOI: https://doi.org/10.1002/hpm.2625
Ganle JK, Baatiema L, Quansah R, Danso-Appiah A. Barriers facing persons with disability in accessing sexual and reproductive health services in sub-Saharan Africa: A systematic review. PloS One 2020;15:e0238585.
DOI: https://doi.org/10.1371/journal.pone.0238585
Salisu WJ, Mirlashari J, Varaei S, Seylani K. Limited access to care for persons with breast cancer in Africa: A systematic review. Eur J Oncol Nursing 2021;50:101867.
DOI: https://doi.org/10.1016/j.ejon.2020.101867
Song K, Lee A. Factors influencing the effective management of diabetes during humanitarian crises in low- and middle-income countries: a systematic review. Public Health 2021;199:110-7.
DOI: https://doi.org/10.1016/j.puhe.2021.08.020
Fasehun LK, Lewinger S, Fasehun O, Brooks M. Barriers and facilitators to acceptability of the female condom in low- and middle-income countries: a systematic review. Ann Global Health 2022;88:20.
DOI: https://doi.org/10.5334/aogh.3612
Thorsteinsdóttir H, Ovtcharenko N, Kohler JC. Corporate social responsibility to improve access to medicines: the case of Brazil. Globalization Health 2017;13:1-1.
DOI: https://doi.org/10.1186/s12992-017-0235-7
Barbosa MM, Nascimento RC, Garcia MM, et al. Strategies to improve the availability of medicines in primary health care in Brazil: findings and implications. J Compar Effectiv Res 2020;10:243-53.
DOI: https://doi.org/10.2217/cer-2020-0125
Nunn A, Fonseca ED, Gruskin S. Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil. Global Public Health 2009;4:131-49.
DOI: https://doi.org/10.1080/17441690802684067
Leal AA, Rodrigues Galvão MH, Medeiros AD, Roncalli ÂG. Access to medicines among the Brazilian population based on the 2019 National Health Survey. PloS One 2023;18:e0280599.
DOI: https://doi.org/10.1371/journal.pone.0280599
Machado FLDS, Dos Santos DMSS, Lopes LC. Strategies to approach medicines litigation: an action research study in Brazil. Front Pharmacol 2021;12:612426.
DOI: https://doi.org/10.3389/fphar.2021.612426
Iwu CJ, Ngcobo N, Jaca A, et al. A systematic review of vaccine availability at the national, district, and health facility level in the WHO African Region. Expert Rev Vacc 2020;19:639-51.
DOI: https://doi.org/10.1080/14760584.2020.1791088
Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plann 1994;9:353-70.
DOI: https://doi.org/10.1093/heapol/9.4.353
Tharumia Jagadeesan C, Wirtz VJ. Geographical accessibility of medicines: a systematic literature review of pharmacy mapping. J Pharmaceut Policy Practice 2021;14:1-3.
DOI: https://doi.org/10.1186/s40545-020-00291-7
Steele P, Subramanian L, Tolani F. Interventions to improve access to medicine in developing countries: mapping WHO’s building blocks and supply chain functions. Acta Sci Pharm Sci 2019;3:111–20.
DOI: https://doi.org/10.31080/ASPS.2019.03.0323
Nguyen A. Challenges for women with disabilities accessing reproductive health care around the world: a scoping review. Sexuality Disability 2020;38:371-88.
DOI: https://doi.org/10.1007/s11195-020-09630-7
Tahir A, Abdilahi AO, Farah AE. Pooled coverage of community based health insurance scheme enrolment in Ethiopia, systematic review and meta-analysis, 2016-2020. Health Econom Rev 2022;12:38.
DOI: https://doi.org/10.1186/s13561-022-00386-8
How to Cite
Kuchena, C., & Qutieshat, A. (2023). Evidence from systematic reviews on policy approaches to improving access to medicines. Healthcare in Low-Resource Settings, 11(1). https://doi.org/10.4081/hls.2023.11143
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