Governments need reliable information on the price, availability and affordability of medicines to develop sound medicine pricing policies and to evaluate the impact of policy implementation. To help researchers collect this information in their countries, Health Action International offers a free standardised methodology.

The methodology pulls together and analyses data on medicine prices for both patient out-of-pocket expenses and government procurement prices across sectors and country regions. It also assesses medicine availability, affordability and price components, such as taxes and mark-ups.

In an effort to improve transparency, we also publish data from surveys on our publicly accessible database.

For more information about the methodology, contact Marg Ewen.

Update to the manual (July 2020)

In the methodology, median supplier prices listed in MSH’s International Medical Products Price Guide are recommended as the source of the international reference prices.  In the past, MSH updated these prices annually but this has not happened for some years. The most recent prices in the Guide are for 2015. As these prices are now quite old, there are two options when undertaking a survey

1. Use the 2015 International Medical Products Price Guide prices but report median prices of individual medicines in local currency (not as Median Price Ratios (MPR) to the reference prices). They are automatically calculated in the data entry pages of the workbook – see column EI when the ratios are turned on. Across the basket of medicines, in each sector the workbook gives you the median MPR for originator brands and the median MPR for lowest priced generics. Rather than report the median MPRs themselves, you should compare and report them as a percentage i.e. across the medicines, originator brands are X% higher priced than lowest priced generics. Likewise when comparing prices across sectors (Sector Summary page of the workbook), report the percentage differences (columns F and L) rather than the median MPRs.  The affordability data is unaffected as it is calculated in local currency only.
2. Select a different source of international reference prices where prices are more up-to-date and where prices are available for all your survey medicines. If you do this, you need to be aware of the price type – are they government procurement prices, wholesale prices, patient prices or something else? This is important in interpreting MPRs in your report. Ideally you should use procurement prices. If you select a different source of international reference prices then delete the MSH 2015 prices for the core list medicines that are pre-entered into the workbook.  It is important to not have a mix of MSH prices for some medicines and prices from another source for others.

Update to the manual (May 2016):
(1) In the global core list of survey medicines, atenolol 50mg tab/cap has been replaced by bisoprolol 5mg tab/cap, and glibenclamide 5mg tab/cap has been replaced by metformin 500mg tab/cap.
(2) The regional lists have been removed.  The 50 survey medicines consist of 14 from the global core list and 36 chosen by the national investigator.

Measuring Medicine Prices, Availability, Affordability and Price Components (2^nd Edition)

by Health Action International and World Health Organization (2008)

The WHO/HAI medicine price, availability and affordability survey methodology can be downloaded for free below. To request a hard copy, email the World Health Organization’s Essential Medicines and Health Products department.

Download Complete Manual

Electronic Workbooks

Part 1: Prices, availability and affordability (Multi-language)
Note:
(1) Regional core lists of survey medicines have been removed from the workbook. The 50 survey medicines consist of 14 from the global core list and 36 chosen by the national investigator.
(2) To survey three product types for each medicine (e.g., originator brand, highest-priced generic equivalent or most-sold generic equivalent, and lowest-priced generic equivalent), email Marg Ewen at Health Action International to request an expanded workbook that accommodates three product types

Part 2: Price components (Multi-language)

Download Manual by Sections

Table of Contents, Abbreviations, Foreword and Acknowledgements

Chapter 1: Introduction

Chapter 2: Survey Overview and Pre-survey Planning
Supporting materials:

• Abridged questionnaire on structures and processes of country pharmaceutical situation, Annex 1
  (EN | RU | FR and ES available in Annexes below)
• Example of a letter of endorsement, Annex 2
  (EN | RU | FR and ES available in Annexes below)

Chapter 3: Preparation
Supporting materials:

• Survey protocol template (EN)
• Measuring medicine prices and availability in the non-formal health sector (EN)
• Using the WHO/HAI medicine price methodology to survey a therapeutic group of medicines (EN | ES | RU)
• Medicine lists from other surveys:
  – Priority life-saving medicines for women and children (EN)

Chapter 4: Training Area Supervisors, Data Collectors and Data Entry

Supporting Materials:
Sample presentations

• Introduction to the survey and training workshop (EN | ES | RU)
• Overview of the survey methodology (EN | ES | RU)
• Data collection procedures (EN | ES | RU)
• Completing the data collection form (EN | ES | RU)
• Data entry (EN| ES | RU)
• Data quality and checking (EN | ES | RU)

Handouts

• Instructions for area supervisors (EN | FR | ES | RU)
• Instructions for data collectors (EN | FR | ES | RU)
• Instructions for completing the Medicine Price Data Collection Form (EN | FR | ES | RU)

Exercises

• • Spot the mistakes exercise (EN | FR | ES | RU) and answer key (EN | FR | ES | RU)

• • Data checker exercise (Multi-language)

• Sample training evaluation form (EN | FR | ES | RU)

Chapter 5: Preparing for Data Collection in the Field
Supporting materials:

• Letter of introduction from survey manager, Annex 4 (EN | RU | FR and ES available in Annexes below)

Chapter 6: Data Collection in the Field

Chapter 7: Data Entry

Chapter 8: Data Analysis and Interpretation

Chapter 9: Measuring Price Components
Supporting materials:

• Price components interview guide, Annex 6 (EN | RU | FR and ES available in Annexes below)
• Price components data collection form, Annex 7 (EN | RU | FR and ES available in Annexes below)

Chapter 10: International Comparisons

Chapter 11: Exploring Possible Policy Options and Lines of Action

Supporting materials:

• Simulated client approach to explore which medicines are sold and prices clients pay (EN | ES | RU)

Chapter 12: Reporting
Supporting materials:

• Survey report template instructions (EN | ES | RU)

Chapter 13: Using the Evidence and Getting the Messages Out
Supporting materials:

• Hovland, I. Successful Communication A Toolkit for Researchers and Civil Society Organisations. London: ODI, 2005 (EN)
• Chetley A, Hardon A, Hodgkin C, Haaland A, Fresle D. How to improve the use of medicines by consumers. Geneva: WHO; 2007 (EN)
• Hardon A, Hodgkin C, Fresle D. How to investigate the use of medicines by consumers. Geneva: WHO and the University of Amsterdam; 2004 (EN)

Chapter 14: Monitoring Medicine Prices and Availability
Supporting materials:

• Guidance on setting up a national price monitoring system (EN | RU)
• Monitoring report example (EN)

Chapter 15: Next Steps in the WHO/HAI Project on Medicine Prices

Annexes

1. Abridged questionnaire on structures and processes of country pharmaceutical situations
2. Example of a letter of endorsement
3. Trainer’s guide for training area supervisors, data collectors and data entry personnel
4. Example of a letter of introduction from the survey manager
5. Checklist for manual check of survey data
6. Price components interview guide
7. Price components data collection form
8. International comparison of MPRs: adjustment for reference price year, inflation /deflation and purchasing power parity

Glossary

Updates to Manual and Workbooks (EN)

Technical Support

Health Action International offers online support to survey managers who are using our methodology to conduct a medicine price, availability and affordability survey. At a minimum, the process involves checking documents and data at various stages of the survey:

1. Survey protocol, which involves at least two steps: initial comments on the draft protocol and after the protocol has been updated (but before it is finalised).
2. Workbook (Part 1), prior to training survey personnel.
3. Workbook (Part 1), after data has been entered and checked by the survey manager. Price components of the survey protocol should be updated by the survey manager at this stage. This update should also be submitted and reviewed.
4. Workbook (Parts 1 and 2) and the draft survey report, which consists of the final check of the price and availability data in Part 1 of the workbook and the only check of the price components data in Part 2 of the workbook. The draft survey report will also be reviewed so it is consistent with the findings.

We encourage survey managers to contact us at any time throughout the survey process with questions.