Universal Health Coverage Day 2015: Managing Medicines Benefits, Making #HealthforAll a Reality

Universal Health Coverage Day 2015: Managing Medicines Benefits, Making #HealthforAll a Reality

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

The universal health coverage (UHC) movement has reached a turning point. With an unprecedented coalition of global partners rallying behind the UHC movement, the inclusion of UHC as a key aim of the newly launched sustainable development goals, and growing recognition of health as a human right, the real work of achieving UHC has begun – many countries are now grappling with the challenge of making UHC a reality.

As a key partner in bringing the UHC agenda to the forefront of the global community MSH is on the leading edge of translating this global momentum into tangible gains for women, children, and families at the country level. This UHC Day, MSH is working to advance by recognizing that UHC means that people should have access to not only the health services they need, but also to the essential medicines and heath commodities that help to treat many of the most serious global health threats.

Ensuring equitable and affordable access to medicines is a key component of achieving UHC, but one that is often left out of the conversation. As many low- and middle-income countries start implementing a range of UHC policies, programs, and initiatives, MSH is taking steps to ensure that access to medicines remains on the agenda.

Through the publication of its new manual, Management of Medicines Benefit Programs in Low- and Middle-Income Settings, MSH is working to foster a common understanding of the essential elements required to implement medicines benefit programs in the context of health insurance. A medicines benefit program is the component of a health insurance plan that covers medicines prescribed and dispensed to plan members.

The new manual is meant to serve as a primer for managers, government officials, and consultants who are tasked by a government, health insurance plan, or other institution with designing or implementing a medicines benefit program. The manual outlines potential options and elements to consider in the design of a medicines benefit program based on a variety of country contexts.

Key elements of medicines benefit program design covered in the manual include:


  • Political, legal, and regulatory context
  • Scope and scale of coverage
  • Funding to ensure equity
  • Governance and management of the medicines benefit program
  • Claims processing systems
  • Management information systems
  • Management of beneficiary and provider services
  • Delivery of medicines to beneficiaries
  • Medicine formulary management
  • Medicine purchasing strategies
  • Information and education programs
  • Utilization review and performance monitoring


Medicines Benefit Programs: Country Context

Understanding that each country context is unique, MSH designed the manual to present best practices from a variety of well documented, proven programs, without prescribing a single program design to fit all situations. To help further customize the components of the manual to individual country settings, MSH is also developing an accompanying MSH Medicines Benefit Program Assessment Tool for Developing Countries. Together, the manual and the assessment tool for medicines benefit programs can help program managers analyze their situation, identify options, and develop a set of recommendations that will lay a path toward widespread and equitable access to medicines under health insurance plans.

Through the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, MSH piloted the first version of the assessment tool in Ghana, Namibia, and South Africa. In Ghana, SIAPS worked in partnership with the National Health Insurance Scheme to use the assessment tool to conduct a thorough qualitative and quantitative analysis of the challenges faced by the NHIS as it aims to scale up coverage, quality, and social protection of its programs. The NHIS will be using these recommendations to address gaps in program coverage, expand its services to new populations, and achieve long-term solvency.

As more and more countries join Ghana and others working to achieve UHC, international groups like MSH can support these efforts through ensuring these programs are implemented in line with best practices and international standards, and are driven by the best data available. This year, we acknowledge the major challenges that UHC represents and celebrate the impressive steps that are being taken all over the world toward making a reality for the world's communities.