Access to affordable essential medicines on a sustainable basis is one of the
indicators of compliance with the Millennium Development Goals, and can be
regarded as part of the human universal right to health. As with other basic
commodities, access to medicines depends on multiple factors, like their availability,
prices and affordability. Over the last decade, more than 50 surveys using a
methodology developed by the World Health Organization and Health Action
International have been carried out in low- and middle-income countries, to assess
these parameters in an attempt to understand the causes underlying poor access to
medicines. Findings typically reveal low availability of essential medicines,
particularly in the public health system, and high prices, especially in the private forprofit
sector.
The objective of the present study was to describe the availability, prices and
affordability of essential medicines in Timor-Leste using the WHO/HAI
methodology. Data on the availability and prices of a drug tracer list was collected
from a sample of hospitals, community health centres and private retail pharmacies.
Although results seem to show a reasonable overall availability of generic medicines
in the public sector (59.2%), some active substances and therapeutic classes were
found to be consistently out of stock across the country. In facilities located in more
remote areas, availability could be as low as 47.5%. Drug availability in private
pharmacies was found to be even lower (38.0%). Medicines are dispensed free of
charge in public health facilities, but in private pharmacies they were found to cost
up to 40 times their international reference price, even as generics. As a result, it is
estimated that a common government worker using diclofenac to treat chronic
arthritis, for instance, would have to work 2.3 days to pay for his monthly treatment
with the generic drug, or 12.5 days if the originator brand was prescribed. Other
problems affecting medicines quality and safety were also detected throughout the
study.
Despite its limitations, the present study concluded that, contrarily to the general
trend observed in similar countries, the public healthcare system in Timor-Leste
seems to perform better than private. Nevertheless, the far from ideal conditions of
most public health facilities can still push some patients to the private sector where
costs of treatment are unacceptably high. The lack of regulation of the
pharmaceutical sector (and inefficient monitoring/inspection of the existing one) seems to be contributing to the private sector’s stagnation and indirectly encouraging
lack of transparency in pharmacy practice.
Given the paucity of studies on the subject in Timor-Leste, it is hoped that the
present work will provide an important evidence base for subsequent studies, and
government intervention to better regulate the pharmaceutical sector, with the
ultimate objective to improve the public drug supply, and encourage the growth of
the private sector as a viable, affordable and safe alternative.