Proper use of drugs and relation between purchasing power and cost of treatment prescribed in Casamance.

Abstract

In Senegal, health insurance is available only to employees in the private and public sector and to the elderly (through the Sesame program). The rest of the population, especially different categories of vulnerable people, has no health insurance. Their access to healthcare and to medications is thus limited. In this study, we sought to analyze the relation between purchasing power and costs of treatment prescribed in one city. We questioned the customers leaving pharmacies in Ziguinchor, the administrative center of the lower Casamance, in southern Senegal, and analyzed their prescriptions and over-the-counter purchases. In all, we examined 255 prescriptions/purchases including 643 drugs; 29.4% were written by prescribers in the public health sector. The customers with these prescriptions were less educated, had lower incomes, used taxis more often, and consulted nurses more often than customers with prescriptions from the private health sector. Injectables and INN (international nonproprietary names) were dispensed most often to customers with prescriptions. Dispensing was usually better when the drug was prescribed, and when it was prescribed by a doctor. Nurses appeared to be inadequately trained in the proper use of medications. The percentage of drugs purchased did not depend on the patients' financial means or educational level. Those who most often acquired all of the drugs prescribed were those who had consulted a doctor rather than another type of healthcare provider.