Abstract
To explore availability, prices and affordability of essential medicines for diabetes and hypertension treatment in private pharmacies in three provinces of Zambia. A cross-sectional survey was conducted in 99 pharmacies across three Zambian provinces. Methods were based on a standardized methodology by the World Health Organization and Health Action International. Availability was analysed as mean availability per pharmacy and individual medicine. Median prices were compared to international reference prices and differences in price between medicine forms (original brand or generic product) were computed. Affordability was assessed as number of days' salaries required to purchase a standard treatment course using the absolute poverty line and mean per capita provincial household income as standard. An analysis identifying medicines considered both available and affordable was conducted. Two antidiabetics and nine antihypertensives had high-level availability (≥80%) in all provinces; availability levels for the remaining surveyed antidiabetics and antihypertensives were largely found below 50%. Availability further varied markedly across medicines and medicine forms. Prices for most medicines were higher than international reference prices and great price variations were found between pharmacies, medicines and medicine forms. Compared to original brand products, purchase of generics was associated with price savings for patients between 21.54% and 96.47%. No medicine was affordable against the absolute poverty line and only between four and eleven using mean per capita provincial incomes. Seven generics in Copperbelt/Lusaka and two in Central province were highly available and affordable. The study showed that the majority of surveyed antidiabetic and antihypertensive medicines was inadequately available (<80%). In addition, most prices were higher than their international reference prices and that treatment with these medicines was largely unaffordable against the set affordability thresholds. Underlying reasons for the findings should be explored as a basis for targeted policy initiatives.
Highlights
In line with its pledge to achieve Universal Health Coverage by 2030, the government of the Republic of Zambia is planning to establish a National Health Insurance (NHI) scheme [1]
Prices for most medicines were higher than international reference prices and great price variations were found between pharmacies, medicines and medicine forms
No medicine was affordable against the absolute poverty line and only between four and eleven using mean per capita provincial
Summary
In line with its pledge to achieve Universal Health Coverage by 2030, the government of the Republic of Zambia is planning to establish a National Health Insurance (NHI) scheme [1]. The corresponding law was passed in 2018 and mandates the National Health Insurance Management Authority to develop a comprehensive health benefits package (HBP), taking special account of the national burden of disease and national public health priorities [1,2]. One such priority area is the growing burden of noncommunicable diseases (NCDs), primarily diabetes mellitus (diabetes) and hypertension [3,4]. Data from the central health management information system (HMIS) indicate that the prevalence has been rising considerably since, a trend which is expected to continue in coming decades [7]
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