Availability and Affordability of Essential Medicines from the WHO Global Core List in Albania: A Cross-Sectional Survey Using the WHO/HAI Methodology

There is limited information on the current state of access to essential medicines in Albania. Therefore, this study investigated the accessibility of essential medicines using an adapted version of the World Health Organization/Health Action International (WHO/HAI) methodology. A cross-sectional survey of 30 private pharmacies was undertaken, across six urban areas, and for 14 medicines from the Global Core List (GCL). Data on availability, patient prices, and affordability were collected, with affordability measured using the daily wage of the lowest-paid government worker (LPGW) and the median price ratio (MPR). MPRs were calculated to compare local prices with international reference and regional benchmarks.

The mean availability of the GCL medicines was 79.8%, falling short of the WHO’s 80% benchmark, though it improved to 83.3% when availability of alternative formulations were included. Ceftriaxone, amoxicillin, and salbutamol were among the least available medicines and were frequently reported as out of stock. All medicines, except ceftriaxone, met the LPGW affordability criteria. MPR analysis showed that while most medicines were priced competitively, some, like diclofenac and ceftriaxone, were significantly more expensive than international reference prices. Price comparisons indicated that Albanian medicine prices were generally lower than those in selected Balkan and EU countries, although MPRs for five medicines were 4 times higher compared to international reference prices.

Overall, 64% of the surveyed medicines met both availability and affordability thresholds. It was found that access to medicines in Albania is primarily limited by availability rather than affordability. The study highlights significant gaps in the availability of key antibiotics and asthma medications, emphasizing the need for policy reforms to improve rational use and other pharmaceutical value chain interventions. These results are important for shaping Albania’s health policy in advancing towards equal access to essential medicines