[Measuring drug affordability (Senegal)]

This article presents the results of a global survey on drug accessibility conducted in Senegal in 2001. The original tool we developed to measure drug affordability for this study considered 5 marker diseases and their corresponding medical treatments and determined the theoretical amount that each population quintile can devote to the purchase of these treatments at market prices without damaging their economic status (affordability threshold). These results were then compared with those obtained as part of a field survey of 987 patients at 41 health centres and 51 private chemists (pharmacists). The main results show that the population's ability to afford treatment is low (less than 40% at public sector prices and a little over 20% at private sector prices) and that even at the lowest market prices (public sector) 20% to 60% of the population cannot afford treatments for the most common illnesses. The field survey shows, moreover, that these results are exacerbated by four external factors: additional illness-associated expenditures (i.e., transportation costs, doctor visits), lack of compliance with government-set drug prices, prescription habits and dispensing practices. When these added costs are taken into account, less than 20% of the population can actually pay the public-sector treatment costs for the marker diseases, let alone the private sector prices. This tool is also useful for highlighting the insufficiencies of the strategies adopted for the target diseases (inconsistency between pricing policies and health priorities) and for providing a baseline measurement (at t0) of different socioeconomic groups' access to given treatments. Improvement or deterioration can then be assessed with measurements at times t1, t2...tn.