Abstract
In Kenya, noncommunicable diseases (NCDs) account for 27% of all deaths. Adult Kenyans have an 18% chance of dying prematurely from cancers, diabetes, cardiovascular diseases or chronic respiratory diseases. A Novartis Access Initiative is making medicines available to treat cardiovascular diseases, diabetes, chronic respiratory diseases, and breast cancer in 30 countries, including Kenya. Little is known about patients’ perceptions of access to medicines for NCDs in Kenya. The study objective was to understand patients’ perceptions of access to medicines; as well as barriers and facilitators at the household, community, and healthcare system level. A baseline qualitative study was conducted in eight of 47 counties as part of an evaluation of the Novartis Access Initiative in Kenya. The 84 patients interviewed through a household survey had been diagnosed and treated for an NCD. Although medicines at government facilities were free or cheaper than those sold in private pharmacies, the availability of medicines presented a constant challenge. Patients often resorted to private pharmacies, where NCD medicines cost more than at public facilities. Participants with an NCD took their health seriously and strove to get the medicines, even under difficult circumstances. Buying NCD medicines put a strain on the household budget, especially for the lower-income participants. Some actions to overcome affordability barriers included: borrowing money, selling assets, seeking help from relatives, taking on extra work, buying partial dosages, leaving without the medicines, or resorting to non-medical alternatives. In conclusion, access to NCD medicines is a major challenge for most adults in Kenya. As a result, they engage in complex interactions between public, private facilities and pharmacies to overcome the barriers. The government should ensure well-stocked public sector pharmacies and subsidize prices of medicines for lower-income patients. Integration of industry-led access to medicine programs may help governments to obtain low cost supplies.
Highlights
While global life expectancy from birth increased from 61.7 years in 1980 to 71.8 years in 2015, deaths from NCDs such as cardiovascular disease, cancers, chronic respiratory diseases, and diabetes have steadily increased [1]
Most participants stated that medicines were not available at the government facilities, which forced them to buy the medicines at private facilities and pharmacies
Medicines such as analgesics and anti-malarial medicines were more available than NCD medicines
Summary
While global life expectancy from birth increased from 61.7 years in 1980 to 71.8 years in 2015, deaths from NCDs such as cardiovascular disease, cancers, chronic respiratory diseases, and diabetes have steadily increased [1]. Over 86% of premature deaths from NCDs occur in lowand middle-income countries [2]. Interventions for the prevention and control of NCDs are influenced by many factors, including the availability of affordable technologies and essential medicines for treatment in the public and private sector. In Kenya, NCDs account for 27% of all deaths, and people have an 18% chance of dying prematurely from cancers, diabetes, cardiovascular diseases or chronic respiratory diseases [7]. Kenya faces challenges in NCD control and treatment programs due to workforce shortages, frequent stock-outs of medicines, and problems guaranteeing the quality of medicines [8, 9]. Patients often have to pay for medicines, and out-of-pocket payments can be high [10]
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