Implementation of medicines pricing policies in sub-Saharan Africa: systematic review

Koduah, Augustina; Baatiema, Leonard; de Chavez, Anna Cronin; Danso-Appiah, Anthony; Kretchy, Irene A.; Agyepong, Irene Akua; King, Natalie; Ensor, Timothy; Mirzoev, Tolib

doi:10.1186/s13643-022-02114-z

Table 4 Key facilitators and barriers to implementation of medicines pricing policies

From: Implementation of medicines pricing policies in sub-Saharan Africa: systematic review

	Facilitators	Barriers
Micro level factors	Knowledge of implementation status (Honda 2013, Cohen 2013 and Maiga 2010) [51, 53, 55]	Long-distance travel by individuals (Ye 2015, Tran et al. 2020) [42, 66]
	Village with a drug shop (Smith 2011) [37]
	Alternative drugs that are less effective but cheaper preferred by public (Cohen 2013) [51]
Meso level factors	Drug and therapeutic committee to regulate prices at the facility level (Ashigbie 2016) [49]	Limited access to medicines, frequent stock outs (Fink 2014, Honda 2013, Ye 2015, Smith 2011) [37, 41, 53, 66]
	Pooling resources and buying in bulk (Ashigbie 2016) [49]	Shortage of trained personnel and lack of resources to scrutinize prices of medicines and information about medicine prices by the pharmaceutical companies (Ali and Yahia 2012, Tran et al. 2020) [36, 42]
	Lower prices increase access (Cohen 2013) [51]	Lack transparency of prices in an external reference pricing (ERP) comparison where confidential discounts are negotiated (Cassar & Suleman 2019) [50]
	Subsidies/free provision of medicines (Ponsar 2011) [39]	Lack of printed retail prices on medicine pack (Ali and Yahia 2012) [36]
Macro level factors	Existing national medicine pricing policies (Steyn 2007, Ashigbie 2016) [43, 49]	Lack of state capacity to regulate (Ali and Yahia 2012) [36]
	Strong political will from government (Walwyn & Nkolele 2018, Wiedenmayer 2019, Tran et al. 2020) [42, 63, 64]	Delays in reimbursement of health facilities and supplies (Ashigbie 2016) [49]
	Donor agencies and international policies and interventions (Wilson 2012, Ye 2015, Sabot 2009, Ali 2009) [38, 48, 65, 66]	Lack of scrutiny on medicine pricing policy by regulators (Ali and Yahia 2012) [36]
		Lack of a coherent and well-functioning national medicine pricing policy (Wilson 2012) [65]
	Use of essential medicines list (Ashigbie 2016) [49], Medicine and Related Substance Amendment Act (Steyn 2007) [43]	Forex fluctuation (depreciation of the local currency) (Walwyn 2018) [63]
		Unfavourable reimbursement practices (Ashigbie 2016) [49]

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