Availability, prices and affordability of selected antibiotics and medicines against non-communicable diseases in western Cameroon and northeast DR Congo

Autoři: Simon Schäfermann aff001;  Richard Neci aff002;  Edward Ngah Ndze aff003;  Fidelis Nyaah aff004;  Valentin Basolanduma Pondo aff005;  Lutz Heide aff001
Působiště autorů: Pharmaceutical Institute, Eberhard Karls University Tuebingen, Tuebingen, Germany aff001;  Le Dépôt Central Médico-Pharmaceutique de la 8e CEPAC (DCMP), Bukavu, Democratic Republic of Congo aff002;  Central Pharmacy, Cameroon Baptist Convention (CBC), Mutengene, Cameroon aff003;  Central Pharmacy, Presbyterian Church in Cameroon (PCC), Limbe, Cameroon aff004;  Centrale d’Approvisionnnement et de Distribution des Medicaments Essentiels (CADIMEBU), Bunia, Democratic Republic of Congo aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227515


Access to safe, effective and affordable medicines of good quality is included into the Sustainable Development Goals of the United Nations. Furthermore, WHO has developed a Global Action Plan with the aim to raise access to essential medicines against non-communicable diseases (NCDs) to 80%, and to improve their affordability. In order to contribute to the monitoring of progress towards these goals, the present study investigated the availability and affordability of seven antibiotics and six medicines against non-communicable diseases in the northeast of the Democratic Republic of Congo and the west of the Republic of Cameroon. Data on availability and prices of these medicines were collected in 60 different sites (34 in the DR Congo, 26 in Cameroon), including government health facilities, church health facilities, private pharmacies and informal vendors, as part of a study on medicine quality. The data were analyzed using a standardized procedure developed by WHO and Health Action International (HAI). Average availability of the investigated antibiotics ranged from 62% to 98% in the different types of facilities in both countries, including the informal vendors. Average availability for medicines against NCDs in the different types of facilities showed a higher variation in both countries, ranging from 11% up to 87%. The average availability of medicines against NCDs in government health facilities was only 33% in Cameroon, and as low as 11% in the DR Congo. In contrast, availability of medicines against NCDs in church health facilities in Cameroon was 70%, not far from the 80% availability goal set by WHO. Medicine prices were clearly higher in Cameroon than in the DR Congo, with median price ratios to an international reference price of 5.69 and 2.17, respectively (p < 0.001). In relation to the daily minimum wages in both countries, treatment courses with five of the seven investigated antibiotics could be considered as affordable, while in each country only one out of the five investigated medicines against NCDs could be considered as affordable. Especially generic medicines provided by government and church health facilities showed reasonable affordability in most cases, while originator medicines offered by private pharmacies were clearly unaffordable to a major part of the population. Despite some encouraging findings on the availability of antibiotics in both countries, the availability and affordability of medicines against NCDs urgently requires further improvements.

Klíčová slova:

Antibiotics – Cameroon – Cardiology – diabetes mellitus – Global health – Public and occupational health – Salaries – Vendors


1. WHO Regional Office for South-East Asia: Health situation and trend assessment, MDG 8 essential medicines. http://www.searo.who.int/entity/health_situation_trends/data/mdg/drugs/en/.

2. UN-DESA. Sustainable Development Goal 3, Progress of goal 3 in 2017. https://sustainabledevelopment.un.org/sdg3.

3. WHO: Addressing the global shortage of, and access to, medicines and vaccines. Geneva, Switzerland. 2018. Executive Board 142nd session. Provisional agenda item EB142/13. http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_13-en.pdf.

4. WHO: Global Health Observation data repository, Median availability of selected generic medicines 2007–2013. Geneva, 2015. http://apps.who.int/gho/data/node.main.488?lang=en.

5. Bazargani YT, Ewen M, de Boer A, Leufkens HG, Mantel-Teeuwisse AK. Essential medicines are more available than other medicines around the globe. PLoS One. 2014;9(2):e87576. doi: 10.1371/journal.pone.0087576 24533058

6. Ewen M, Zweekhorst M, Regeer B, Laing R. Baseline assessment of WHO’s target for both availability and affordability of essential medicines to treat non-communicable diseases. PLoS One. 2017;12(2):e0171284. doi: 10.1371/journal.pone.0171284 28170413

7. Robertson J, Mace C, Forte G, de Joncheere K, Beran D. Medicines availability for non-communicable diseases: the case for standardized monitoring. Global Health. 2015;11:18. doi: 10.1186/s12992-015-0105-0 25947094

8. van Mourik MS, Cameron A, Ewen M, Laing RO. Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data. BMC Cardiovasc Disord. 2010;10:25. doi: 10.1186/1471-2261-10-25 20534118

9. WHO: Global action plan for the prevention and control of noncommunicable diseases 2013–2020. https://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng.pdf;jsessionid=2C6428DB4B30DFBB751A184A3806EE94?sequence=1.

10. Ohene Buabeng K, Matowe L, Plange-Rhule J. Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana. J Pharm Pharm Sci. 2004;7(3):350–2. 15576016

11. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373(9659):240–9. doi: 10.1016/S0140-6736(08)61762-6 19042012

12. Preux PM, Tiemagni F, Fodzo L, Kandem P, Ngouafong P, Ndonko F, et al. Antiepileptic therapies in the Mifi Province in Cameroon. Epilepsia. 2000;41(4):432–9. doi: 10.1111/j.1528-1157.2000.tb00185.x 10756409

13. Becker J, Drucker E, Enyong P, Marx P. Availability of injectable antibiotics in a town market in southwest Cameroon. Lancet Infect Dis. 2002;2(6):325–6. doi: 10.1016/s1473-3099(02)00285-2 12144894

14. Jingi AM, Noubiap JJ, Ewane Onana A, Nansseu JR, Wang B, Kingue S, et al. Access to diagnostic tests and essential medicines for cardiovascular diseases and diabetes care: cost, availability and affordability in the West Region of Cameroon. PLoS One. 2014;9(11):e111812. doi: 10.1371/journal.pone.0111812 25369455

15. O’Connell KA, Gatakaa H, Poyer S, Njogu J, Evance I, Munroe E, et al. Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in public and private sector outlets in six malaria-endemic countries. Malar J. 2011;10:326. doi: 10.1186/1475-2875-10-326 22039838

16. Ministère de la Santé Publique (MSP): Enquête sur la Disponibilité et la capacité opérationnelle des services de santé en République Démocratique du Congo (SARA), DSSP/DSNIS, 2014, RDC. https://www.who.int/healthinfo/systems/sara_reports/en/.

17. United Nations Development Programme, Human Development Reports: Cameroon. 2018 statistical update. http://hdr.undp.org/en/countries/profiles/CMR.

18. United Nations Development Programme, Human Development Reports: Democratic Republic of the Congo. 2018 statistical update. http://hdr.undp.org/en/countries/profiles/COD.

19. Gostin LO, Kavanagh MM, Cameron E. Ebola and war in the Democratic Republic of Congo: Avoiding failure and thinking ahead. JAMA. 2019;321(3):243–4. doi: 10.1001/jama.2018.19743 30488076

20. WHO Expert Committee on Specifications for Pharmaceutical Preparations: Guidelines on the conduct of surveys of the quality of medicines. 2016. WHO Technical Report Series [Internet]. No. 996. http://apps.who.int/medicinedocs/documents/s22404en/s22404en.pdf.

21. Newton PN, Lee SJ, Goodman C, Fernandez FM, Yeung S, Phanouvong S, et al. Guidelines for field surveys of the quality of medicines: a proposal. PLoS Med. 2009;6(3):e52. doi: 10.1371/journal.pmed.1000052 19320538

22. Ministere de la Sante Publique, Republique Democratique du Congo: Liste Nationale des Medicaments Essentiels. Revision Mars 2010. http://apps.who.int/medicinedocs/en/m/abstract/Js18817fr/.

23. Ministeres de la Sante Publique, Republique du Cameroun: Liste Nationale des Medicaments et autres Produit Pharmaceutiques Essentiels, 2017. https://dpml.cm/index.php/en/catalog/national-list-of-essential-medicines.

24. Peyraud N, Rafael F, Parker LA, Quere M, Alcoba G, Korff C, et al. An epidemic of dystonic reactions in central Africa. Lancet Glob Health. 2017;5(2):e137–e8. doi: 10.1016/S2214-109X(16)30287-X 28104176

25. Health Action International: Measuring medicines prices, availability, affordability and price components. 2nd edition 2008. http://www.who.int/medicines/areas/access/OMS_Medicine_prices.pdf.

26. INFOREURO: Monthly accounting rates of the Euro. http://ec.europa.eu/budget/graphs/inforeuro.html.

27. Management Sciences for Health: The International Medical Products Price Guide 2015. http://mshpriceguide.org/en/home/.

28. World Health Organization, WHO Model Formulary 2008, Geneva Switzerland, 2009. https://www.who.int/selection_medicines/list/WMF2008.pdf.

29. US Department of State: Country Reports on Human Rights Practices for 2018. https://www.state.gov/reports/2018-country-reports-on-human-rights-practices/.

30. World Health Organization Model List of Essential Medicines 21st List, 2019. Geneva: World Health organization; 2019. https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1.

31. United Nations Millenium Development Goal 8 The Global Partnership for Development: Making rhetoric a reality: MDG Gap Task Force Report. 2012. https://www.un.org/millenniumgoals/2012_Gap_Report/MDG_2012Gap_Task_Force_report.pdf.

32. WHO, Global status report on noncommunicable diseases 2014. Geneva, Switzerland. 2014. https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf;jsessionid=8345CF691DD47D27C879E5B13E2E8228?sequence=1.

33. Hunter-Adams J, Yongsi BN, Dzasi K, Parnell S, Boufford JI, Pieterse E, et al. How to address non-communicable diseases in urban Africa. Lancet Diabetes Endocrinol. 2017;5(12):932–4. doi: 10.1016/S2213-8587(17)30220-6 28797749

34. Tsabang N, Fongnzossie E, Donfack D, Yedjou CG, Tchounwou PB, Minkande JZ, et al. Comparative study of epidemiological and anthropological aspects of diabetes and hypertension in Cameroon. J For Res. 2016;5(1). 27708987

35. Ntangsi J. An analysis of health sector expenditures in Cameroon using a national health accounts framework. 1998. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/114/2012/10/rp141.pdf.

36. Laokri S, Soelaeman R, Hotchkiss DR. Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection? BMC health services research. 2018;18(1):451. doi: 10.1186/s12913-018-3211-x 29903000

37. Aminde LN, Tindong M, Ngwasiri CA, Aminde JA, Njim T, Fondong AA, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr Disord. 2019;19(1):35. doi: 10.1186/s12902-019-0360-9 30943969

38. Wirtz VJ, Hogerzeil HV, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, et al. Essential medicines for universal health coverage. Lancet. 2017;389(10067):403–76. doi: 10.1016/S0140-6736(16)31599-9 27832874

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