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Senegal Assessment Louis Teulieres. The purpose of this study is to:. Determine the key elements of access to medicines in Senegal Estimate the various roles of operators in the pharmaceutical sector Identify factors on which it would be possible to act to improve the situation - PowerPoint PPT Presentation
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Senegal Assessment
Louis Teulieres
The purpose of this study is to:Determine the key elements of access to medicines in Senegal Estimate the various roles of operators in the pharmaceutical sector
Identify factors on which it would be possible to act to improve the situation
Propose possible actions to be implemented to improve access
Economic and Health/Social ContextGDP per capita: USD $435 in 1999Heavy burden of debt limits the volume of public financing assigned to social sectors. High incidence of poverty, more than 30% of householdsMain diseases (public facility consultations): malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%)Attendance at public facilities is low (30% on average), and there are strong regional disparities
Characteristics of the Pharmaceutical SectorMost drugs on the market imported
Local production by two pharmaceutical companies:most branded products under license some generics (branded or International Nonproprietary Names [INN]) -- less than 5% of turnover
Distribution of medicines undertaken by: private sector (85% of the market, 2,500 references): three wholesalers and 532 retail pharmacies public sector: five regional warehouses, and at base, health care centers with essential medicines under INN (350 references) with full cost recovery from populationillicit market supply
Price of MedicinesRetail prices of medicines are controlled by the Administration.They are calculated (in the two licit distribution channels) by applying ad valorem margins to the purchase prices, leading to high multipliers (1.86 for the private field and 1.80 for the public field) and a retail price nearly twice as large as the before-tax French wholesale price (BTWP).
Price of Medicines (2)
diapo 15
Conclusions
This study shows that drug access in Senegal is low. .
This situation results in large part from the price setting mechanisms, based on proportional markups, which end up greatly multiplying the before-tax wholesale price. In the public sector unauthorized price increases, lead to prices sometimes as high as
Prescription and dispensation practices contribute to the situation.
In the private sector, dispensation practices are often not satisfactory.
These behaviors can be attributed to several factors: the payment system, based on proportional markups and the unchecked commercial promotion of manufacturers that does not only target private sector doctors, but also prescribers in public sector facilit
The appeal for a significant part of the population of the illicit market, the role of which keeps growing, with consequences on the duration of treatments, and the observance.
&R15
diapo 14
Patients behaviour and opinion
36% patients buy prescription drugs without prescription.
35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education)
26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location).
Satisfaction: 93% in the private sector, 82% in the public sector.
&R14
diapo 13
19% of public sector patients receive a second prescription to be bought in a private pharmacy.
Substitution: in 52% cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, 40% know how long they should be taken.
Prescription Understanding
Health Post CustomersPharmacy Customers
Total Understanding26.20%28.30%
Partial Understanding70.00%64.10%
No Understanding3.80%7.60%
Source: Enqute nationale
&R13
diapo 12
Average number of lines on a prescription : 2.8 in the public sector against 2.6 in the private sector)
Essential drugs on prescriptions:
- 44% in the private sector (9% in INN, 91% in brands)
-72% in the public sector (47% in INN)
&R12
diapo 11
i) DS of the customers at public facilities was between 3,401 Fcfa and 5,160 Fcfa; corresponding to the food expenditures of the second and third quintiles of households in the DMS
Two lessons : (i) the 20 % poorest population (first quintile) seem to be excluded from the system, (ii) there is a clear cut difference between the two sets of populations.
&R11
diapo 10
Results of the National survey : (i) the median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60 % of the population, (ii) 24 % of the patients at public facilities were given a second prescription, to be filled in a p
Comparison of the drug expenditure with Daily Spending (DS).
In public facilities, cost of recent drug purchases represents 1.4 times DS (1,591 Fcfa) and 1.6 times for customers of the private pharmacies (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, in private pharmacies :50% For
&R10
diapo 9
50% of the population spends less that $3 per year on health. 5% of the population spends over $35 per year on health.
QuintilesSpendingFoodOutside foodHealth PartHealth SpendingDrugAccessibility level
12,0201,36465666%43632%139
24,7913,0981,69366%1,12432%360
37,4344,5992,83566%1,88232%602
411,6706,0465,62466%3,73440%1,494
534,70610,21224,49466%16,26450%8,132
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1 494Quintile 5 8132
Public PrivateEcart PublicPrivate PublicPrivate PublicPrivate PublicPrivate PublicPrivate
Fever (malaria)0.539207 519- 60% 1,53,7 0,71,6 0,30,9 0,10,3 0,00.1
diarrhoea0.131282 1 951- 86% 2,014,0 0,96,2 0,53,2 0,21,3 0,00.2
Skin0.211343 1 574- 78% 2,511,3 1,15,0 0,62,6 0,21,1 0,00.2
ARI0.098452 1 904- 76% 3,313,7 1,46,0 0,83,2 0,31,3 0,10.2
STI0.021403 5 856- 93% 2,942,1 1,318,5 0,79,7 0,33,9 0,00.7
Median cost1.000274 1 177- 77% 2,08,5 0,93,7 0,52,0 0,20,8 0,00.1
&R9
diapo 8
Determined on a list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
In addition, 41% of surveyed patients stated they could not buy a whole prescription because of availability problems.
Availability
ClassesTotal Region Dakar
PublicPrivatePublicPrivatePublicPrivate
Number of products262626262626
100%232458
De 80 % 99 %71269511
De 50 % 79 %109111164
De 25 % 49 %414162
De 0 % 24 %313121
0%000020
Median availability64%80%65%78%62%84%
Source : SNIP National Survey
&R8
diapo 7
Median coverage: 1 pharmacy for 18,000 people
One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Population's coverage (private) compared to poverty
Zones Population PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
&R7
diapo 6
Method
Access to medicine is defined combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of di
1 - Definition of access
i) Environment offactors (geographic access, physical availability and financial accessibility,
2 - Access measurement
&R6
diapo 5
Financing of the pharmaceutical expenditures
SourcingHousecholdspublic or associative financingTotal
directcontributive
Private61.17.1
Public46.33.249.5
Other11
Total52.33.22.157.6
Source: estimation du consultant partir des donnes budgtaires, des donnes de la PNA et de celles de la DPM.
&R5
diapo 4
Price of medicines
Private SectorPublic Sector
SpecialtiesSocial ListeHospital
C.I.F. (%)1010100
Local Transit (%)1.51.51.50
Importateurs (%)18.39.92220
Whole sale margin return fee to French wholesaler3.53.53.5
Statistics1111
(UEMOA) Tax1111
(CDAO) Tax0.50.50.50.5
Subtotal Wholesaler (%)29.821.433.520
Retailers Margin40.79.956.350
Subtotal Retailer40.79.956.350
Multiplier1.861.352.131.8
Part of BTWP in the Public Price53.874.146.955.5
&R4
diapo 3
Characteristics of the pharmaceutical sector
Most of the drugs on the market are imported. Local production, by two pharmaceutical companies, ( brand name or under INN (less than 5% of their turnover).
Distribution of medicines is undertaken by: i) the private sector (85% of the market, 2,500 references ) 3 wholesalers and 532 retail pharmacies, ii) a public sector (without monopoly),five regional warehouses and, at the base, health care centers with
&R3
diapo 2
Economic and health/social context
GDP per capita : of 435 USD in 1999. Heavy burden of the debt limits the volume of public financing assigned to social sectors. High incidence of poverty, which hit more than 30 % of households.
Main diseases (public facilities consultations) : malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%). Attendance at public facilities is low (30% on average), and there are strong regional dispariti
&R2
diapo 1
The purpose of this study is to determine the key elements of access to medicines in Senegal, estimate the various roles of operators in the pharmaceutical sector, identify factors on which it would be possible to act to improve the situation and propose
&R1
MBD00112817.xls
Graph1
0.9079861111
0.0555555556
0.0364583333
Housechold indirect5,6%
Public and associative financing3,6%
Housechold direct90,8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
0
0
0
Feuil2
Feuil3
Financing of Pharmaceutical Expenditures
diapo 15
Conclusions
This study shows that drug access in Senegal is low. .
This situation results in large part from the price setting mechanisms, based on proportional markups, which end up greatly multiplying the before-tax wholesale price. In the public sector unauthorized price increases, lead to prices sometimes as high as
Prescription and dispensation practices contribute to the situation.
In the private sector, dispensation practices are often not satisfactory.
These behaviors can be attributed to several factors: the payment system, based on proportional markups and the unchecked commercial promotion of manufacturers that does not only target private sector doctors, but also prescribers in public sector facilit
&R15
diapo 14
Patients behaviour and opinion
36% patients buy prescription drugs without prescription.
35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education)
26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location).
Satisfaction: 93% in the private sector, 82% in the public sector.
&R14
diapo 13
19% of public sector patients receive a second prescription to be bought in a private pharmacy.
Substitution: in 52% cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, 40% know how long they should be taken.
Prescriptions' understanding
Health posts customersPharmacies' customers
Total understanding26.20%28.30%
Partial understanding70.00%64.10%
No understanding3.80%7.60%
Source: Enqute nationale
&R13
diapo 12
Average number of lines on a prescription : 2.8 in the public sector against 2.6 in the private sector)
Essential drugs on prescriptions:
- 44% in the private sector (9% in INN, 91% in brands)
-72% in the public sector (47% in INN)
&R12
diapo 11
i) DS of the customers at public facilities was between 3,401 Fcfa and 5,160 Fcfa; corresponding to the food expenditures of the second and third quintiles of households in the DMS
Two lessons : (i) the 20 % poorest population (first quintile) seem to be excluded from the system, (ii) there is a clear cut difference between the two sets of populations.
&R11
diapo 10
Results of the National survey : (i) the median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60 % of the population, (ii) 24 % of the patients at public facilities were given a second prescription, to be filled in a p
Comparison of the drug expenditure with Daily Spending (DS).
In public facilities, cost of recent drug purchases represents 1.4 times DS (1,591 Fcfa) and 1.6 times for customers of the private pharmacies (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, in private pharmacies :50% For
&R10
diapo 9
50% of the population spends less that $3 per year on health. 5% of the population spends over $35 per year on health.
QuintilesSpendingFoodOutside foodHealth PartHealth SpendingDrugAccessibility level
12,0201,36465666%43632%139
24,7913,0981,69366%1,12432%360
37,4344,5992,83566%1,88232%602
411,6706,0465,62466%3,73440%1,494
534,70610,21224,49466%16,26450%8,132
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1 494Quintile 5 8132
Public PrivateEcart PublicPrivate PublicPrivate PublicPrivate PublicPrivate PublicPrivate
Fever (malaria)0.539207 519- 60% 1,53,7 0,71,6 0,30,9 0,10,3 0,00.1
diarrhoea0.131282 1 951- 86% 2,014,0 0,96,2 0,53,2 0,21,3 0,00.2
Skin0.211343 1 574- 78% 2,511,3 1,15,0 0,62,6 0,21,1 0,00.2
ARI0.098452 1 904- 76% 3,313,7 1,46,0 0,83,2 0,31,3 0,10.2
STI0.021403 5 856- 93% 2,942,1 1,318,5 0,79,7 0,33,9 0,00.7
Median cost1.000274 1 177- 77% 2,08,5 0,93,7 0,52,0 0,20,8 0,00.1
&R9
diapo 8
Determined on a list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
In addition, 41% of surveyed patients stated they could not buy a whole prescription because of availability problems.
Availability
ClassesTotal Region Dakar
PublicPrivatePublicPrivatePublicPrivate
Number of products262626262626
100%232458
De 80 % 99 %71269511
De 50 % 79 %109111164
De 25 % 49 %414162
De 0 % 24 %313121
0%000020
Median availability64%80%65%78%62%84%
Source : SNIP National Survey
&R8
diapo 7
Median coverage: 1 pharmacy for 18,000 people
One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Population's coverage (private) compared to poverty
Zones Population PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
&R7
diapo 6
Method
Access to medicine is defined combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of di
1 - Definition of access
i) Environment offactors (geographic access, physical availability and financial accessibility,
2 - Access measurement
&R6
diapo 5
Financing of the pharmaceutical expenditures
SourcingHouseholdsPublic or associative financingTotal
DirectContributive
Private61.17.1
Public46.33.249.5
Other11
Total52.33.22.157.6
Source: estimation du consultant partir des donnes budgtaires, des donnes de la PNA et de celles de la DPM.
&R5
diapo 4
Price of medicines
Private sectorpublic
SpcialitsSocial Listehospital
C.I.F. (%)1010100
local transit (%)1.51.51.50
importateurs (%):18.39.92220
Whole sale margin return fee to french wholesaler3.53.53.5
Statistics1111
(UEMOA) tax1111
0.50.50.50.5
Sub total wholesaler (%)29.821.433.520
Retailers' margin40.79.956.350
Sub total retailer40.79.956.350
Multiplyer1.861.352.131.8
Part of BTWP in the public price53.874.146.955.5
&R4
diapo 3
Characteristics of the pharmaceutical sector
Most of the drugs on the market are imported. Local production, by two pharmaceutical companies, ( brand name or under INN (less than 5% of their turnover).
Distribution of medicines is undertaken by: i) the private sector (85% of the market, 2,500 references ) 3 wholesalers and 532 retail pharmacies, ii) a public sector (without monopoly),five regional warehouses and, at the base, health care centers with
&R3
diapo 2
Economic and health/social context
GDP per capita : of 435 USD in 1999. Heavy burden of the debt limits the volume of public financing assigned to social sectors. High incidence of poverty, which hit more than 30 % of households.
Main diseases (public facilities consultations) : malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%). Attendance at public facilities is low (30% on average), and there are strong regional dispariti
&R2
diapo 1
The purpose of this study is to determine the key elements of access to medicines in Senegal, estimate the various roles of operators in the pharmaceutical sector, identify factors on which it would be possible to act to improve the situation and propose
&R1
MBD00112817.xls
Graph1
0.9079861111
0.0555555556
0.0364583333
Housechold indirect5,6%
Public and associative financing3,6%
Housechold direct90,8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
0
0
0
Feuil2
Feuil3
Financing of Pharmaceutical Expenditures (2)
Graph1
0.9079861111
0.0555555556
0.0364583333
Household Indirect5.6%
Public and Associative Financing3.6%
Household Direct90.8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
Feuil2
Feuil3
MethodAccess to medicine is defined as a combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of dispensation.
Definition of Access:Environmental factors (geographic access, physical availability and financial accessibility) Effectiveness factors that strengthen or attenuate the former ones
Access Measurement:A theoretical approach to elaborate measure indicators A practical approach using two surveys
Geographical Accessibility Median coverage: 1 pharmacy per 18,000 One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Geographical Accessibility (2)
Population Coverage Compared to Poverty
diapo 15
Conclusions
This study shows that drug access in Senegal is low. .
This situation results in large part from the price setting mechanisms, based on proportional markups, which end up greatly multiplying the before-tax wholesale price. In the public sector unauthorized price increases, lead to prices sometimes as high as
Prescription and dispensation practices contribute to the situation.
In the private sector, dispensation practices are often not satisfactory.
These behaviors can be attributed to several factors: the payment system, based on proportional markups and the unchecked commercial promotion of manufacturers that does not only target private sector doctors, but also prescribers in public sector facilit
&R15
diapo 14
Patients behaviour and opinion
36% patients buy prescription drugs without prescription.
35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education)
26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location).
Satisfaction: 93% in the private sector, 82% in the public sector.
&R14
diapo 13
19% of public sector patients receive a second prescription to be bought in a private pharmacy.
Substitution: in 52% cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, 40% know how long they should be taken.
Prescriptions' understanding
Health posts customersPharmacies' customers
Total understanding26.20%28.30%
Partial understanding70.00%64.10%
No understanding3.80%7.60%
Source: Enqute nationale
&R13
diapo 12
Average number of lines on a prescription : 2.8 in the public sector against 2.6 in the private sector)
Essential drugs on prescriptions:
- 44% in the private sector (9% in INN, 91% in brands)
-72% in the public sector (47% in INN)
&R12
diapo 11
i) DS of the customers at public facilities was between 3,401 Fcfa and 5,160 Fcfa; corresponding to the food expenditures of the second and third quintiles of households in the DMS
Two lessons : (i) the 20 % poorest population (first quintile) seem to be excluded from the system, (ii) there is a clear cut difference between the two sets of populations.
&R11
diapo 10
Results of the National survey : (i) the median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60 % of the population, (ii) 24 % of the patients at public facilities were given a second prescription, to be filled in a p
Comparison of the drug expenditure with Daily Spending (DS).
In public facilities, cost of recent drug purchases represents 1.4 times DS (1,591 Fcfa) and 1.6 times for customers of the private pharmacies (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, in private pharmacies :50% For
&R10
diapo 9
50% of the population spends less that $3 per year on health. 5% of the population spends over $35 per year on health.
QuintilesSpendingFoodOutside foodHealth PartHealth SpendingDrugAccessibility level
12,0201,36465666%43632%139
24,7913,0981,69366%1,12432%360
37,4344,5992,83566%1,88232%602
411,6706,0465,62466%3,73440%1,494
534,70610,21224,49466%16,26450%8,132
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1 494Quintile 5 8132
Public PrivateEcart PublicPrivate PublicPrivate PublicPrivate PublicPrivate PublicPrivate
Fever (malaria)0.539207 519- 60% 1,53,7 0,71,6 0,30,9 0,10,3 0,00.1
diarrhoea0.131282 1 951- 86% 2,014,0 0,96,2 0,53,2 0,21,3 0,00.2
Skin0.211343 1 574- 78% 2,511,3 1,15,0 0,62,6 0,21,1 0,00.2
ARI0.098452 1 904- 76% 3,313,7 1,46,0 0,83,2 0,31,3 0,10.2
STI0.021403 5 856- 93% 2,942,1 1,318,5 0,79,7 0,33,9 0,00.7
Median cost1.000274 1 177- 77% 2,08,5 0,93,7 0,52,0 0,20,8 0,00.1
&R9
diapo 8
Determined on a list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
In addition, 41% of surveyed patients stated they could not buy a whole prescription because of availability problems.
Availability
ClassesTotal Region Dakar
PublicPrivatePublicPrivatePublicPrivate
Number of products262626262626
100%232458
De 80 % 99 %71269511
De 50 % 79 %109111164
De 25 % 49 %414162
De 0 % 24 %313121
0%000020
Median availability64%80%65%78%62%84%
Source : SNIP National Survey
&R8
diapo 7
Median coverage: 1 pharmacy for 18,000 people
One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Population's coverage (private) compared to poverty
Zones Population PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
&R7
diapo 6
Method
Access to medicine is defined combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of di
1 - Definition of access
i) Environment offactors (geographic access, physical availability and financial accessibility,
2 - Access measurement
&R6
diapo 5
Financing of the pharmaceutical expenditures
SourcingHousecholdspublic or associative financingTotal
directcontributive
Private61.17.1
Public46.33.249.5
Other11
Total52.33.22.157.6
Source: estimation du consultant partir des donnes budgtaires, des donnes de la PNA et de celles de la DPM.
&R5
diapo 4
Price of medicines
Private sectorpublic
SpcialitsSocial Listehospital
C.I.F. (%)1010100
local transit (%)1.51.51.50
importateurs (%):18.39.92220
Whole sale margin return fee to french wholesaler3.53.53.5
Statistics1111
(UEMOA) tax1111
0.50.50.50.5
Sub total wholesaler (%)29.821.433.520
Retailers' margin40.79.956.350
Sub total retailer40.79.956.350
Multiplyer1.861.352.131.8
Part of BTWP in the public price53.874.146.955.5
&R4
diapo 3
Characteristics of the pharmaceutical sector
Most of the drugs on the market are imported. Local production, by two pharmaceutical companies, ( brand name or under INN (less than 5% of their turnover).
Distribution of medicines is undertaken by: i) the private sector (85% of the market, 2,500 references ) 3 wholesalers and 532 retail pharmacies, ii) a public sector (without monopoly),five regional warehouses and, at the base, health care centers with
&R3
diapo 2
Economic and health/social context
GDP per capita : of 435 USD in 1999. Heavy burden of the debt limits the volume of public financing assigned to social sectors. High incidence of poverty, which hit more than 30 % of households.
Main diseases (public facilities consultations) : malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%). Attendance at public facilities is low (30% on average), and there are strong regional dispariti
&R2
diapo 1
The purpose of this study is to determine the key elements of access to medicines in Senegal, estimate the various roles of operators in the pharmaceutical sector, identify factors on which it would be possible to act to improve the situation and propose
&R1
MBD00112817.xls
Graph1
0.9079861111
0.0555555556
0.0364583333
Housechold indirect5,6%
Public and associative financing3,6%
Housechold direct90,8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
0
0
0
Feuil2
Feuil3
Availability Determined from list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
41% of surveyed patients stated they could not buy a whole prescription because of availability problems
Availability (2)
diapo 15
Conclusions
This study shows that drug access in Senegal is low. .
This situation results in large part from the price setting mechanisms, based on proportional markups, which end up greatly multiplying the before-tax wholesale price. In the public sector unauthorized price increases, lead to prices sometimes as high as
Prescription and dispensation practices contribute to the situation.
In the private sector, dispensation practices are often not satisfactory.
These behaviors can be attributed to several factors: the payment system, based on proportional markups and the unchecked commercial promotion of manufacturers that does not only target private sector doctors, but also prescribers in public sector facilit
The appeal for a significant part of the population of the illicit market, the role of which keeps growing, with consequences on the duration of treatments, and the observance.
&R15
diapo 14
Patients behaviour and opinion
36% patients buy prescription drugs without prescription.
35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education)
26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location).
Satisfaction: 93% in the private sector, 82% in the public sector.
&R14
diapo 13
19% of public sector patients receive a second prescription to be bought in a private pharmacy.
Substitution: in 52% cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, 40% know how long they should be taken.
Prescription Understanding
Health Post CustomersPharmacy Customers
Total Understanding26.20%28.30%
Partial Understanding70.00%64.10%
No Understanding3.80%7.60%
Source: Enqute nationale
&R13
diapo 12
Average number of lines on a prescription : 2.8 in the public sector against 2.6 in the private sector)
Essential drugs on prescriptions:
- 44% in the private sector (9% in INN, 91% in brands)
-72% in the public sector (47% in INN)
&R12
diapo 11
i) DS of the customers at public facilities was between 3,401 Fcfa and 5,160 Fcfa; corresponding to the food expenditures of the second and third quintiles of households in the DMS
Two lessons : (i) the 20 % poorest population (first quintile) seem to be excluded from the system, (ii) there is a clear cut difference between the two sets of populations.
&R11
diapo 10
Results of the National survey : (i) the median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60 % of the population, (ii) 24 % of the patients at public facilities were given a second prescription, to be filled in a p
Comparison of the drug expenditure with Daily Spending (DS).
In public facilities, cost of recent drug purchases represents 1.4 times DS (1,591 Fcfa) and 1.6 times for customers of the private pharmacies (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, in private pharmacies :50% For
&R10
diapo 9
50% of the population spends less that $3 per year on health. 5% of the population spends over $35 per year on health.
QuintilesSpendingFoodOutside foodHealth PartHealth SpendingDrugAccessibility level
12,0201,36465666%43632%139
24,7913,0981,69366%1,12432%360
37,4344,5992,83566%1,88232%602
411,6706,0465,62466%3,73440%1,494
534,70610,21224,49466%16,26450%8,132
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1 494Quintile 5 8132
Public PrivateEcart PublicPrivate PublicPrivate PublicPrivate PublicPrivate PublicPrivate
Fever (malaria)0.539207 519- 60% 1,53,7 0,71,6 0,30,9 0,10,3 0,00.1
diarrhoea0.131282 1 951- 86% 2,014,0 0,96,2 0,53,2 0,21,3 0,00.2
Skin0.211343 1 574- 78% 2,511,3 1,15,0 0,62,6 0,21,1 0,00.2
ARI0.098452 1 904- 76% 3,313,7 1,46,0 0,83,2 0,31,3 0,10.2
STI0.021403 5 856- 93% 2,942,1 1,318,5 0,79,7 0,33,9 0,00.7
Median cost1.000274 1 177- 77% 2,08,5 0,93,7 0,52,0 0,20,8 0,00.1
&R9
diapo 8
Determined on a list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
In addition, 41% of surveyed patients stated they could not buy a whole prescription because of availability problems.
Availability
ClassesTotalRegionDakar
PublicPrivatePublicPrivatePublicPrivate
Number of Products262626262626
100%232458
From 80% to 99%71269511
From 50% to 79%109111164
From 25% to 49%414162
From 0% to 24%313121
0%000020
Median Availability64%80%65%78%62%84%
Source : SNIP National Survey
&R8
diapo 7
Median coverage: 1 pharmacy for 18,000 people
One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Population's coverage (private) compared to poverty
Zones Population Private PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
Zones Population PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
&R7
diapo 6
Method
Access to medicine is defined combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of di
1 - Definition of access
i) Environment offactors (geographic access, physical availability and financial accessibility,
2 - Access measurement
&R6
diapo 5
Financing of the pharmaceutical expenditures
SourcingHousecholdspublic or associative financingTotal
directcontributive
Private61.17.1
Public46.33.249.5
Other11
Total52.33.22.157.6
Source: estimation du consultant partir des donnes budgtaires, des donnes de la PNA et de celles de la DPM.
&R5
diapo 4
Price of medicines
Private SectorPublic Sector
SpecialtiesSocial ListeHospital
C.I.F. (%)1010100
Local Transit (%)1.51.51.50
Importateurs (%)18.39.92220
Whole sale margin return fee to French wholesaler3.53.53.5
Statistics1111
(UEMOA) Tax1111
(CDAO) Tax0.50.50.50.5
Subtotal Wholesaler (%)29.821.433.520
Retailers Margin40.79.956.350
Subtotal Retailer40.79.956.350
Multiplier1.861.352.131.8
Part of BTWP in the Public Price53.874.146.955.5
&R4
diapo 3
Characteristics of the pharmaceutical sector
Most of the drugs on the market are imported. Local production, by two pharmaceutical companies, ( brand name or under INN (less than 5% of their turnover).
Distribution of medicines is undertaken by: i) the private sector (85% of the market, 2,500 references ) 3 wholesalers and 532 retail pharmacies, ii) a public sector (without monopoly),five regional warehouses and, at the base, health care centers with
&R3
diapo 2
Economic and health/social context
GDP per capita : of 435 USD in 1999. Heavy burden of the debt limits the volume of public financing assigned to social sectors. High incidence of poverty, which hit more than 30 % of households.
Main diseases (public facilities consultations) : malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%). Attendance at public facilities is low (30% on average), and there are strong regional dispariti
&R2
diapo 1
The purpose of this study is to determine the key elements of access to medicines in Senegal, estimate the various roles of operators in the pharmaceutical sector, identify factors on which it would be possible to act to improve the situation and propose
&R1
MBD00112817.xls
Graph1
0.9079861111
0.0555555556
0.0364583333
Housechold indirect5,6%
Public and associative financing3,6%
Housechold direct90,8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
0
0
0
Feuil2
Feuil3
Financial Accessibility
50% of population spends less than $3 per year on health. 5% of the population spends over $35 per year.
diapo 15
Conclusions
This study shows that drug access in Senegal is low. .
This situation results in large part from the price setting mechanisms, based on proportional markups, which end up greatly multiplying the before-tax wholesale price. In the public sector unauthorized price increases, lead to prices sometimes as high as
Prescription and dispensation practices contribute to the situation.
In the private sector, dispensation practices are often not satisfactory.
These behaviors can be attributed to several factors: the payment system, based on proportional markups and the unchecked commercial promotion of manufacturers that does not only target private sector doctors, but also prescribers in public sector facilit
&R15
diapo 14
Patients behaviour and opinion
36% patients buy prescription drugs without prescription.
35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education)
26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location).
Satisfaction: 93% in the private sector, 82% in the public sector.
&R14
diapo 13
19% of public sector patients receive a second prescription to be bought in a private pharmacy.
Substitution: in 52% cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, 40% know how long they should be taken.
Prescriptions' understanding
Health posts customersPharmacies' customers
Total understanding26.20%28.30%
Partial understanding70.00%64.10%
No understanding3.80%7.60%
Source: Enqute nationale
&R13
diapo 12
Average number of lines on a prescription : 2.8 in the public sector against 2.6 in the private sector)
Essential drugs on prescriptions:
- 44% in the private sector (9% in INN, 91% in brands)
-72% in the public sector (47% in INN)
&R12
diapo 11
i) DS of the customers at public facilities was between 3,401 Fcfa and 5,160 Fcfa; corresponding to the food expenditures of the second and third quintiles of households in the DMS
Two lessons : (i) the 20 % poorest population (first quintile) seem to be excluded from the system, (ii) there is a clear cut difference between the two sets of populations.
&R11
diapo 10
Results of the National survey : (i) the median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60 % of the population, (ii) 24 % of the patients at public facilities were given a second prescription, to be filled in a p
Comparison of the drug expenditure with Daily Spending (DS).
In public facilities, cost of recent drug purchases represents 1.4 times DS (1,591 Fcfa) and 1.6 times for customers of the private pharmacies (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, in private pharmacies :50% For
&R10
diapo 9
50% of the population spends less that $3 per year on health. 5% of the population spends over $35 per year on health.
QuintilesSpendingFoodOutside foodHealth PartHealth SpendingDrugAccessibility level
12,0201,36465666%43632%139
24,7913,0981,69366%1,12432%360
37,4344,5992,83566%1,88232%602
411,6706,0465,62466%3,73440%1,494
534,70610,21224,49466%16,26450%8,132
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1 494Quintile 5 8132
Public PrivateEcart PublicPrivate PublicPrivate PublicPrivate PublicPrivate PublicPrivate
Fever (malaria)0.539207 519- 60% 1,53,7 0,71,6 0,30,9 0,10,3 0,00.1
diarrhoea0.131282 1 951- 86% 2,014,0 0,96,2 0,53,2 0,21,3 0,00.2
Skin0.211343 1 574- 78% 2,511,3 1,15,0 0,62,6 0,21,1 0,00.2
ARI0.098452 1 904- 76% 3,313,7 1,46,0 0,83,2 0,31,3 0,10.2
STI0.021403 5 856- 93% 2,942,1 1,318,5 0,79,7 0,33,9 0,00.7
Median cost1.000274 1 177- 77% 2,08,5 0,93,7 0,52,0 0,20,8 0,00.1
&R9
diapo 8
Determined on a list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
In addition, 41% of surveyed patients stated they could not buy a whole prescription because of availability problems.
Availability
ClassesTotal Region Dakar
PublicPrivatePublicPrivatePublicPrivate
Number of products262626262626
100%232458
De 80 % 99 %71269511
De 50 % 79 %109111164
De 25 % 49 %414162
De 0 % 24 %313121
0%000020
Median availability64%80%65%78%62%84%
Source : SNIP National Survey
&R8
diapo 7
Median coverage: 1 pharmacy for 18,000 people
One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Population's coverage (private) compared to poverty
Zones Population PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
&R7
diapo 6
Method
Access to medicine is defined combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of di
1 - Definition of access
i) Environment offactors (geographic access, physical availability and financial accessibility,
2 - Access measurement
&R6
diapo 5
Financing of the pharmaceutical expenditures
SourcingHousecholdspublic or associative financingTotal
directcontributive
Private61.17.1
Public46.33.249.5
Other11
Total52.33.22.157.6
Source: estimation du consultant partir des donnes budgtaires, des donnes de la PNA et de celles de la DPM.
&R5
diapo 4
Price of medicines
Private sectorpublic
SpcialitsSocial Listehospital
C.I.F. (%)1010100
local transit (%)1.51.51.50
importateurs (%):18.39.92220
Whole sale margin return fee to french wholesaler3.53.53.5
Statistics1111
(UEMOA) tax1111
0.50.50.50.5
Sub total wholesaler (%)29.821.433.520
Retailers' margin40.79.956.350
Sub total retailer40.79.956.350
Multiplyer1.861.352.131.8
Part of BTWP in the public price53.874.146.955.5
&R4
diapo 3
Characteristics of the pharmaceutical sector
Most of the drugs on the market are imported. Local production, by two pharmaceutical companies, ( brand name or under INN (less than 5% of their turnover).
Distribution of medicines is undertaken by: i) the private sector (85% of the market, 2,500 references ) 3 wholesalers and 532 retail pharmacies, ii) a public sector (without monopoly),five regional warehouses and, at the base, health care centers with
&R3
diapo 2
Economic and health/social context
GDP per capita : of 435 USD in 1999. Heavy burden of the debt limits the volume of public financing assigned to social sectors. High incidence of poverty, which hit more than 30 % of households.
Main diseases (public facilities consultations) : malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%). Attendance at public facilities is low (30% on average), and there are strong regional dispariti
&R2
diapo 1
The purpose of this study is to determine the key elements of access to medicines in Senegal, estimate the various roles of operators in the pharmaceutical sector, identify factors on which it would be possible to act to improve the situation and propose
&R1
MBD00112817.xls
Graph1
0.9079861111
0.0555555556
0.0364583333
Housechold indirect5,6%
Public and associative financing3,6%
Housechold direct90,8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
0
0
0
Feuil2
Feuil3
Financial Accessibility (2)
Sheet1
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1,494Quintile 5 8,132
PublicPrivateEcartPublicPrivatePublicPrivatePublicPrivatePublicPrivatePublicPrivate
Fever (malaria)0.539207519-60%1,53,70,71,60,30,90,10,30,00.1
diarrhoea0.1312821,951-86%2,014,00,96,20,53,20,21,30,00.2
Skin0.2113431,574-78%2,511,31,15,00,62,60,21,10,00.2
ARI0.0984521,904-76%3,313,71,46,00,83,20,31,30,10.2
STI0.0214035,856-93%2,942,11,318,50,79,70,33,90,00.7
Median cost1.0002741,177-77%2,08,50,93,70,52,00,20,80,00.1
Sheet2
Sheet3
DS/Health Spending National Survey Results: Median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60% of the population 24% of patients at public facilities were given a second prescription to be filled in a private pharmacy where median cost is 2,661 Fcfa, for a total cost of 3,661 Fcfa, higher than theoretical accessibility for 80%
Comparison of Drug Expenditure with Daily Spending (DS):In public facilities, cost of recent drug purchases is 1.4 times DS (1,591 Fcfa). In private pharmacies, costs are 1.6 times DS (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, and for 50% of cases in private pharmaciesFor 15% of patients at public facilities and 30% of those at private pharmacies, purchasing costs were equal or superior to 3 DS
DS/Health Spending (2)DS of customers at public facilities: Between 3,401 Fcfa and 5,160 Fcfa Corresponds to food expenditures of the 2nd and 3rd quintiles of households in the DMS
DS of customers at private pharmacies:Between 5,918 Fcfa in 10,341 FcfaCorresponds to 4th and 5th quintiles
DS/Health Spending (3)Two Lessons: The 20% poorest population (1st quintile) seem to be excluded from the system A clear cut difference exists between the two sets of populations
Quality of Products and ServicesAverage number of lines on a prescription: 2.8 in the public sector2.6 in the private sector
Essential drugs on prescriptions: 44% in the private sector (9% as INN, 91% as brands)72% in the public sector (47% as INN)
Irrational combination of two products of same class:35% in the public sector26% in the private sector
Quality of Products and Services (2)19% of public sector patients receive a second prescription to be bought in a private pharmacy
Substitution: in 52% of cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, while 40% know how long they should be taken
Quality of Products and Services (3)
diapo 15
Conclusions
This study shows that drug access in Senegal is low. .
This situation results in large part from the price setting mechanisms, based on proportional markups, which end up greatly multiplying the before-tax wholesale price. In the public sector unauthorized price increases, lead to prices sometimes as high as
Prescription and dispensation practices contribute to the situation.
In the private sector, dispensation practices are often not satisfactory.
These behaviors can be attributed to several factors: the payment system, based on proportional markups and the unchecked commercial promotion of manufacturers that does not only target private sector doctors, but also prescribers in public sector facilit
The appeal for a significant part of the population of the illicit market, the role of which keeps growing, with consequences on the duration of treatments, and the observance.
&R15
diapo 14
Patients behaviour and opinion
36% patients buy prescription drugs without prescription.
35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education)
26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location).
Satisfaction: 93% in the private sector, 82% in the public sector.
&R14
diapo 13
19% of public sector patients receive a second prescription to be bought in a private pharmacy.
Substitution: in 52% cases, for a more expensive product (private sector)
Dispensation: only 22% of patients know what the drugs are for, 40% know how long they should be taken.
Prescription Understanding
Health Post CustomersPharmacy Customers
Total Understanding26.20%28.30%
Partial Understanding70.00%64.10%
No Understanding3.80%7.60%
Source: Enqute nationale
&R13
diapo 12
Average number of lines on a prescription : 2.8 in the public sector against 2.6 in the private sector)
Essential drugs on prescriptions:
- 44% in the private sector (9% in INN, 91% in brands)
-72% in the public sector (47% in INN)
&R12
diapo 11
i) DS of the customers at public facilities was between 3,401 Fcfa and 5,160 Fcfa; corresponding to the food expenditures of the second and third quintiles of households in the DMS
Two lessons : (i) the 20 % poorest population (first quintile) seem to be excluded from the system, (ii) there is a clear cut difference between the two sets of populations.
&R11
diapo 10
Results of the National survey : (i) the median price for drug purchase is 1,000 Fcfa, higher than theoretical accessibility for 60 % of the population, (ii) 24 % of the patients at public facilities were given a second prescription, to be filled in a p
Comparison of the drug expenditure with Daily Spending (DS).
In public facilities, cost of recent drug purchases represents 1.4 times DS (1,591 Fcfa) and 1.6 times for customers of the private pharmacies (4,735 Fcfa). Cost was higher than 1 DS in public facilities for 29% of cases, in private pharmacies :50% For
&R10
diapo 9
50% of the population spends less that $3 per year on health. 5% of the population spends over $35 per year on health.
QuintilesSpendingFoodOutside foodHealth PartHealth SpendingDrugAccessibility level
12,0201,36465666%43632%139
24,7913,0981,69366%1,12432%360
37,4344,5992,83566%1,88232%602
411,6706,0465,62466%3,73440%1,494
534,70610,21224,49466%16,26450%8,132
DiseasesFrequenceMedian price cheapest treatmentQuintile 1 139Quintile 2 317Quintile 3 602Quintile 4 1 494Quintile 5 8132
Public PrivateEcart PublicPrivate PublicPrivate PublicPrivate PublicPrivate PublicPrivate
Fever (malaria)0.539207 519- 60% 1,53,7 0,71,6 0,30,9 0,10,3 0,00.1
diarrhoea0.131282 1 951- 86% 2,014,0 0,96,2 0,53,2 0,21,3 0,00.2
Skin0.211343 1 574- 78% 2,511,3 1,15,0 0,62,6 0,21,1 0,00.2
ARI0.098452 1 904- 76% 3,313,7 1,46,0 0,83,2 0,31,3 0,10.2
STI0.021403 5 856- 93% 2,942,1 1,318,5 0,79,7 0,33,9 0,00.7
Median cost1.000274 1 177- 77% 2,08,5 0,93,7 0,52,0 0,20,8 0,00.1
&R9
diapo 8
Determined on a list of 26 tracer essential drugs
80% availability in the private sector
64% availability in the public sector
In addition, 41% of surveyed patients stated they could not buy a whole prescription because of availability problems.
Availability
ClassesTotal Region Dakar
PublicPrivatePublicPrivatePublicPrivate
Number of products262626262626
100%232458
De 80 % 99 %71269511
De 50 % 79 %109111164
De 25 % 49 %414162
De 0 % 24 %313121
0%000020
Median availability64%80%65%78%62%84%
Source : SNIP National Survey
&R8
diapo 7
Median coverage: 1 pharmacy for 18,000 people
One health post with essential drugs for 7,400 people
78% of the population lives within 5 km of a facility with a sustainable stock of pharmaceuticals
Population's coverage (private) compared to poverty
Zones Population PharmaciesRatio population by pharmacy
Dakar2 326 929 24,4% 306 57,6%7,604
7 Towns > 100 000 Hab. 1 257 745 13,2% 89 16,8%14,132
Rest of the country 5 941 974 62,4% 136 25,6%43,691
Senegal9 526 648 100,0% 531 100,0%17,941
&R7
diapo 6
Method
Access to medicine is defined combination of geographic accessibility, the nature and the availability of the supply, the ability to pay, together with more qualitative factors, such as the quality of the prescription, quality of drugs, and quality of di
1 - Definition of access
i) Environment offactors (geographic access, physical availability and financial accessibility,
2 - Access measurement
&R6
diapo 5
Financing of the pharmaceutical expenditures
SourcingHousecholdspublic or associative financingTotal
directcontributive
Private61.17.1
Public46.33.249.5
Other11
Total52.33.22.157.6
Source: estimation du consultant partir des donnes budgtaires, des donnes de la PNA et de celles de la DPM.
&R5
diapo 4
Price of medicines
Private sectorpublic
SpcialitsSocial Listehospital
C.I.F. (%)1010100
local transit (%)1.51.51.50
importateurs (%):18.39.92220
Whole sale margin return fee to french wholesaler3.53.53.5
Statistics1111
(UEMOA) tax1111
0.50.50.50.5
Sub total wholesaler (%)29.821.433.520
Retailers' margin40.79.956.350
Sub total retailer40.79.956.350
Multiplyer1.861.352.131.8
Part of BTWP in the public price53.874.146.955.5
&R4
diapo 3
Characteristics of the pharmaceutical sector
Most of the drugs on the market are imported. Local production, by two pharmaceutical companies, ( brand name or under INN (less than 5% of their turnover).
Distribution of medicines is undertaken by: i) the private sector (85% of the market, 2,500 references ) 3 wholesalers and 532 retail pharmacies, ii) a public sector (without monopoly),five regional warehouses and, at the base, health care centers with
&R3
diapo 2
Economic and health/social context
GDP per capita : of 435 USD in 1999. Heavy burden of the debt limits the volume of public financing assigned to social sectors. High incidence of poverty, which hit more than 30 % of households.
Main diseases (public facilities consultations) : malaria(33.2%), skin diseases(13%), diarrhea (8.1%), ENT conditions(6.7%) and respiratory diseases (6%). Attendance at public facilities is low (30% on average), and there are strong regional dispariti
&R2
diapo 1
The purpose of this study is to determine the key elements of access to medicines in Senegal, estimate the various roles of operators in the pharmaceutical sector, identify factors on which it would be possible to act to improve the situation and propose
&R1
MBD00112817.xls
Graph1
0.9079861111
0.0555555556
0.0364583333
Housechold indirect5,6%
Public and associative financing3,6%
Housechold direct90,8%
Feuil1
Mnages (achats directs)90.8%52.3
Mnages (systmes contributifs)5.6%3.2
Financements publics et associatifs)3.6%2.1
57.6
Feuil1
0
0
0
Feuil2
Feuil3
Patients Behavior and Opinion36% patients buy prescription drugs without a prescription 35% patients use traditional medicines (37% with no education, 30% primary education, 26% secondary education) 26% use the illegal market (64% because drugs are cheaper, 27% because prescription not needed, 17% because of location)Satisfaction: 93% in the private sector, 82% in the public sector
ConclusionsDrug access in Senegal is low
Price setting mechanisms, based on proportional markups, end up greatly multiplying pre-tax wholesale price
In the public sector, unauthorized price increases lead to prices sometimes as high as private sector Prescription and dispensation practices contribute to the situation
Conclusions (2)Dispensation practices often not satisfactory in private sector
Behaviors can be attributed to several factors:Payment system: based on proportional markupsUnchecked commercial promotion of manufacturers: target private sector doctors and prescribers in public sector facilities
Markups and promotion largely responsible for partial failure of essential drug policy based on generics
Illicit Market Appeal: for a significant part of population, role keeps growing, consequences on treatment duration and observance