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