Cost and availability of selected medicines after implementation of increased import verification fees.

BACKGROUND: Uganda imports approximately 90% of its medicines, with about 60% being distributed by the private sector. To discourage importation and promote local production of 37 selected locally manufactured medicines, the Ugandan government through the Ministry of Health in 2017 increased the import verification fees from 2 to 12%. The increase in verification fees ultimately affects cost and availability of these medicines. This study aimed to assess the cost and availability of the selected essential medicines after the 12% increase in verification fees in Uganda. METHODS: A cross sectional study among 328 wholesale and retail pharmacies and seven key informant interviews was conducted using a pretested data collection checklist and in-depth interview guide from February to September 2021 in Uganda. Data on the availability and prices of the medicines before (2017) and after (2020) the increase in verification fees was collected. Paired sample T-Test was used to test if there is a significant difference in prices before and after the 12% increase in verification fees. RESULTS: Mean availability of imported medicines was higher (54.8%, CI: 49.3-60.4) than the locally produced medicines (37.1%, CI: 31.9-42.7) except for locally manufactured parenteral preparations (54.6.%, CI: 49.1-60.1). Availability of locally produced medicines was mainly low (45%) while the imported medicines were fairly high (74%). Most commonly available locally manufactured medicines were Surgical spirit (89.9%), ORS (86%), Dextrose 5% solution (74.4%), Paracetamol 500 mg Tablets (73.8%) and Sodium Chloride 0.9% solution (72.9%). Most commonly available imported medicines were; Omeprazole 20 mg (94.2%), Amoxicillin Trihydrate 125 mg/5 ml (92.4%), Ciprofloxacin 500 mg (91.4%), Paracetamol Suspension 120 mg/5 ml (91.5%) and Metronidazole 200 mg Tablets (88.1%). Increase in lowest-priced local and imported medicines was significant for 10 (23.8%) and 7 (15.9%) of the medicines respectively. The median prices of imported medicines were generally higher than locally produced medicines. The median unit prices of 12 (28.6%) locally produced medicines and 20 (47.6%) imported medicines were higher than the international median unit prices. CONCLUSIONS: The overall availability of imported medicines was still higher than the local medicines. The median prices of local and imported medicines generally increased or remained the same after the introduction of import verification fees. There is a need for price controls and transparency in the private sector.

Drug safety in Africa: a review of systems and resources for pharmacovigilance.

INTRODUCTION: Pharmacovigilance on the African continent has developed over time, with 50 of the 54 countries currently being members of the WHO Programme for international drug monitoring. However, there are still challenges, such as weak regulation, insufficient resources, and differing policies. This expert opinion provides unique insights from long-term experience overcoming some of these challenges and proposes some solutions for implementing pharmacovigilance in resource-limited settings. AREAS COVERED: This was an expert opinion on the pharmacovigilance landscape in Africa with a focus on reporting, good pharmacovigilance practice inspections, resources available, and the adoption of artificial intelligence. The literature search for the review was carried out in June 2023 on selected electronic databases that included PubMed, Embase, and Web of Science to identify relevant literature published from 2017 up to date while the expert opinion is an informed position from decades of practice in the area. EXPERT OPINION/COMMENTARY: African countries are at different maturity levels and pharmacovigilance competence. A few countries have outstanding pharmacovigilance systems, while the majority do not have fully functional systems. African countries may pool resources through regional blocs to implement joint pharmacovigilance activities. With advancements in technology, countries are expected to embrace artificial intelligence to ensure sustainable pharmacovigilance practices.