Abstract
BackgroundThe burden of non-communicable diseases (NCDs) in low- and middle-income countries is increasing. Where patients are expected to make increased out-of-pocket payments this can lead to treatment interruptions or non-adherence. Swaziland is no exception in this regard.AimThe aim of the study was to investigate the availability of medicines for NCDs in a hospital and the impact of out-of-pocket spending by patients for medicines not available at the hospital.SettingThe study was conducted at Raleigh Fitkin Memorial Hospital in Manzini, Swaziland.MethodsExit interviews to assess availability of a selected basket of medicines were conducted with 300 patients diagnosed with diabetes, hypertension or asthma. The stock status record of a basket of medicines for these conditions in 2012 was assessed at the Central Medical Stores. Results were analysed using the Statistical Package for Social Sciences version 20.0.ResultsMost of the patients (n = 213; 71%) confirmed not receiving all of their prescribed medicines at each visit to the hospital in the past six months. On average patients spent 10–50 times more on their medicines at private pharmacies compared to user fees in the health facility. Stock-outs at the Central Medical Stores ranging from 30 days to over 180 days were recorded during the course of the assessment period (12 months), and were found to contribute to inconsistent availability of medicines in the health facility.ConclusionOut-of-pocket expenditure is common for patients with chronic conditions using this health facility, which suggests the possibility of patients defaulting on treatment due to lack of affordability.
Highlights
Non-communicable diseases (NCDs) have emerged as a clear threat to human health and to development and economic growth globally
The study was a prospective cross-sectional survey that evaluated the impact on patients on chronic medication in the event that their prescribed medicines for asthma, diabetes http://www.phcfm.org or hypertension were out of stock at Raleigh Fitkin Memorial Hospital (RFMH) in Manzini, Swaziland
40% of patients seen at RFMH have asthma, diabetes or hypertension
Summary
Non-communicable diseases (NCDs) have emerged as a clear threat to human health and to development and economic growth globally. The World Economic Forum estimated that 63% of all deaths occurring globally are caused by NCDs.[1] NCDs are no longer considered only to be diseases of the affluent, and affect large number of patients in developing countries. Eighty percent of deaths from NCDs are said to be occurring in low- and middleincome countries, which poses a real challenge to health systems in these countries.[1] globally NCDs are increasingly becoming common amongst all age groups, with a quarter of all related deaths occurring amongst people below the age of 60 years.[2] In addition NCDs account for over 48% of healthy life-years lost globally, compared to 40% for communicable diseases and 1% for injuries.[3]. The burden of non-communicable diseases (NCDs) in low- and middle-income countries is increasing.
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