Access To Essential Medicines Research Articles

The Impact of COVID-19 on Pharmaceutical Shortages and Supply Disruptions for Non-Communicable Diseases Among Public Hospitals of South West, Oromia, Ethiopia.

BackgroundCOVID-19 is a pandemic disease that has led to inequitable supply and shortages of essential medicines worldwide due to decreased production capacity, export bans, and national stockpiling which are affecting the global pharmaceutical supply chain. Access to essential pharmaceuticals is dependent on well-functioning supply chain systems that move medicines from the manufacturer to end users at service delivery point.ObjectiveTo assess impact of Covid-19 pandemic disease on pharmaceutical shortages and supply disruptions for non-communicable diseases among public hospitals of South West, Oromia, Ethiopia.Methods and MaterialsA multi-institutional cross sectional study design was employed. Quantitative and qualitative methods were utilized concurrently to gather data from four public hospital warehouses, dispensaries, patients, and local health authorities from March 1–30, 2021 in Ilu-Ababor and Buno-Bedelle Zones, Oromia, Ethiopia. Data were analyzed by using SPSS (version 23.0). A semi-structured interview guide was used to gather qualitative information from key informants from DTC members, patients, and local health authorities and finally analyzed through thematic approach.ResultsFrom six public hospitals in the two zones; cost of medicine increased more in Dedesa hospital compared to the other public hospital found in that zone and the effect of Covid-19 on essential medicines used for treatment of non-communicable diseases was less in Darimu Hospital. Stock status of PFSA and transportation were the major challenges during the procurement process due to Covid-19 pandemic disease. Among the EMs assessed at public hospitals, drugs used for cardiovascular diseases were out of stock for more than 90 days while anti-asthma drugs were out of stock for less than 40 days.ConclusionThe availability of essential medicine was low and there was also poor inventory management practice in some of the public hospitals during Covid-19 pandemic in the study period.

Availability of two essential medicines for mental health in Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Malawi, Senegal, and Tanzania: Evidence from nationally representative samples of 7958 health facilities.

BackgroundAccess to effective mental health services in low- and- middle income countries (LMICs) is limited, leading to a substantial global treatment gap. Amitriptyline, an anti-depressant, and diazepam, an anxiolytic drug, are classified as essential medications by the World Health Organization (WHO). They are the only psychotropic medications whose availability in health facilities is documented as part of Service Provision Assessment surveys. Our objective was to characterize the availability of these medicines in seven countries.MethodsWe pooled nationally representative data from Service Provision Assessment surveys of health facilities conducted in Bangladesh, Democratic Republic of Congo (DRC), Haiti, Malawi, Nepal, Senegal, and Tanzania, from 2012 to 2018. We estimated the distribution and determinants of facility-level amitriptyline and diazepam availability in each country.ResultsWe analysed data from 7958 health facilities. An estimated 8.2% of facilities had amitriptyline and 46.1% had diazepam on the day of assessment. There was significant heterogeneity in both amitriptyline and diazepam availability across countries and within countries across facility characteristics. Multivariable models indicated that hospitals, faith-based and private-for-profit facilities, facilities with more staff, and facilities with more technological resources were more likely to have each medicine, relative to primary care facilities, public sector facilities, facilities with fewer staff, and facilities with fewer technological resources, respectively.ConclusionOur results indicate limited availability of amitriptyline in health facilities in these seven LMICs. Diazepam is much more commonly available than amitriptyline. Efforts to narrow the global treatment gap for mental health – and especially to integrate mental health services into primary care in LMICs – will be limited without the availability of essential medicines like amitriptyline. Efforts to expand purchasing, distribution, and capacity-building in the appropriate use of essential mental health medicines in LMICs are warranted.

Availability of essential medicines for children with cancer in Sri Lanka: a prospective cohort study

The WHO Model List of Essential Medicines for children (2019 version) contains 39 antineoplastic and supportive medicines deemed essential for the successful treatment of children with cancer. The availability of these medicines varies across countries, but most reports are retrospective or short term. This study tracked the availability of these medicines in Sri Lanka's only treatment centre for childhood cancer, the National Cancer Institute of Sri Lanka, over 1 year, and examined initial mitigation strategies and implications. We prospectively tracked the availability of essential medicines at the National Cancer Institute of Sri Lanka in a customised database from April 1, 2019, to March 31, 2020. Consumption volumes and unit prices were extracted from the Sri Lankan Ministry of Health's Medical Supplies Management Information System. Availability was mapped against regimens used to treat childhood cancers, including WHO Global Initiative for Childhood Cancer index cancers, in Sri Lanka and by the International Society of Paediatric Oncology. Descriptive analyses and linear regression were used to assess factors associated with the unavailability of medicines. 31 (79%) of 39 medicines listed in the WHO Model List of Essential Medicines for children are in the Sri Lankan Essential Medicine List and 36 (92%) of 39 (48 formulations) are registered for use. Thioguanine, arsenic, and realgar-Indigo naturalis were the unregistered medicines. Over the study period, less than half (17 [44%]) of medicines were consistently available for 100% of the study period, 14 (36%) were available 75-100% of the study period, three (8%) between 50-75% of the study period, and two (5%) for less than 50% of the duration of the study period. The least available drug was procarbazine (available only on 212 [58%] of 366 days in the total study period). The availability of medicines did not reach 100% on any day in the study period. No substantial monthly variability was noted, but the best availability was in August, 2019, and the worst in January, 2020. Applying regimen-based analyses for acute lymphoblastic leukaemia, 12 stockout episodes affected seven (18%) medicines (median 37·5 consecutive days, IQR 12·0-62·0), whereas stockout mitigation strategies (low stock periods not resulting in stockout) were effective in 11 instances; only three (8%) medicines did not have alternate formulations or substitutions during stockouts (vincristine, cytarabine, and mercaptopurine). Of the WHO Global Initiative for Childhood Cancer index cancers, Hodgkin lymphoma was the most affected by stockouts, and retinoblastoma was the least affected. Annual consumption volumes (p=0·13), unit cost (p=0·5), and annual costs per medicine (p=0·091) were not significantly associated with medicine unavailability. Non-availability of essential medicines is an important problem to be addressed for children with cancer in Sri Lanka. This study showed the feasibility of prospective essential medicines tracking at the point-of-care, and how data visibility can inform stock and inventory management and help to identify mitigation strategies for stockouts. None.

Navigating Neurotrauma Management in Pakistan.

Madam, neurotrauma is defined as an injury to the brain and/or spinal cord. A WHO, sponsored study estimated that the annual global incidence of neurotrauma is approximately 500–800 per 100 000 and it accounts for about 11.8% of total global disability-adjusted life years1. In Pakistan, the annual incidence of head injured patients admitted to numerous neurosurgical centres was 50/100,000 population per year2. The lifetime medical treatment per neurotrauma case is estimated to range from US$600 000 to US$1.8 million. Neurotrauma management incorporates prehospital care lasting minutes to hours which encompasses accurate on site diagnosis and systematic treatment or during the e shifting, to an organized, well-equipped health care management, in-hospital care for hours to weeks which comprises surgical and non-surgical intervention including imaging, neuro-monitoring and critical care and finally post-acute care lasting weeks to years and denotes any form of rehabilitative interventions to enable and empower patients to have an increased quality of life1. Each component of management requires trained personnel, specific equipment, and protocols3. However, Pakistan lags in various aspects. As of a last study in 2001, there were only 35 neurosurgical centres and about 1000 neurosurgical beds to accommodate a population of 130 million2. Of the 23 Karachi hospitals studied in 2020, only 57% were well-equipped and accredited [Trauma capacity score (TCS) 67%] to perform elementary resuscitation steps to secure early stability. A sizeable number,57%, s (TCS<34%) lacked space to accommodate head, neck, and spinal injuries; 65% s were partly inadequate (TCS<67%) in diagnosis, intensive care and safety4. With low medical insurance across the country2. Inadequate availability of essential medicines was also reported in 43% of hospitals4. An organized trauma care system must be introduced to mitigate trauma mortality for local needs. It should encompass enabling those at injury site to become first responders3, an ambulance service equipped with communication systems and with properly trained personnel that can commence life-saving measures such as IV fluid resuscitation3. Trauma centres should have a referral network and hospitals that provide optimal traumatic care should be identified beforehand to transfer injured patients to this specialized facilitys4.A protocol also needs to be established that assists local doctors in immediate referral to trauma centers3. Proper allocation of resources and mobilization of staff and doctors timely can improve neurotrauma outcomes significantly. Continuous...

State Responsibility for Access and Availability of Patented Drugs for Public Health

Article 28H and Article 34 of the 1945 Constitution of the Republic of Indonesia stipulate that fulfilling the health rights of Indonesian citizens is the responsibility of the state. Human rights require that individuals have access to the availability of medicines in society. The high price of medicines, especially patent medicines, results in limited access and availability of essential medicines. This study uses normative legal research methods, with a statutory approach, and a conceptual approach. The purpose of this study is to examine and analyze the state's goals in fulfilling the right to health as a human right by the state as well as access and availability of patented drugs to fulfill the right to health. In addition to ensuring the availability of complete medicines in sufficient quantity, quality, affordable and easily accessible to the public, the government is also responsible for protecting the rights of inventors as long as the drugs are still under patent protection. To balance these two rights, the government plays the role of provider, regulator, entrepreneur and umpire.

No impact of performance-based financing on the availability of essential medicines in Burkina Faso: A mixed-methods study.

Access to safe, effective, and affordable essential medicines (EM) is critical to quality health services and as such has played a key role in innovative health system strengthening approaches such as Performance-based Financing (PBF). Available literature indicates that PBF can improve EM availability, but has not done so consistently in the past. Qualitative explorations of the reasons are yet scarce. We contribute to expanding the literature by estimating the impact of PBF on EM availability and stockout in Burkina Faso and investigating mechanisms of and barriers to change. The study used an explanatory mixed methods design. The quantitative study component followed a quasi-experimental design (difference-in-differences), comparing how EM availability and stockout had changed three years after implementation in 12 PBF and in 12 control districts. Qualitative data was collected from purposely selected policy and implementation stakeholders at all levels of the health system and community, using in-depth interviews and focus group discussions, and explored using deductive coding and thematic analysis. We found no impact of PBF on EM availability and stockouts in the quantitative data. Qualitative narratives converge in that EM supply had increased as a result of PBF, albeit not fully satisfactorily and sustainably so. Reasons include persisting contextual challenges, most importantly a public medicine procurement monopoly; design challenges, specifically a disconnect and disbalance in incentive levels between service provision and service quality indicators; implementation challenges including payment delays, issues around performance verification, and insufficient implementation of activities to strengthen stock management skills; and concurrently implemented policies, most importantly a national user fee exemption for children and pregnant women half way through the impact evaluation period. The case of PBF and EM availability in Burkina Faso illustrates the difficulty of incentivizing and effecting holistic change in EM availability in the presence of strong contextual constraints and powerful concurrent policies.

The availability of essential medicines for diabetes at health facilities in Bangladesh: evidence from 2014 and 2017 national surveys

BackgroundBangladesh ranks among the world’s top ten countries in the number of diabetic patients. The prevention of this disease requires treating patients with essential medicines, and the first crucial step in the uptake of these medicines is availability. We aimed to assess the availability of essential medicines for diabetes (EM-Diabetes) and to explore health facility characteristics associated with the availability of those medicines.MethodsWe performed the analysis using nationally representative data from the two waves of the cross-sectional Bangladesh Health Facility Survey (BHFS) in 2014 and 2017. Data are available for 1548 and 1524 health facilities in the 2014 and 2017 BHFS. Study samples of this study were 217 facilities (73 from 2014 and 144 from 2017) that offer diabetes diagnosis and treatment services. The outcome variable ‘EM-Diabetes availability’ was calculated as a counting score of the tracer medicines: metformin, glibenclamide, injectable insulin, and injectable glucose solution. A multivariable Poisson regression model was used to identify the health facility characteristics (such as, managing authority, location, external supervision, regular quality assurance activities, national guidelines for diagnosis and management of diabetes, etc.) associated with EM-Diabetes availability.ResultsSince 2014, there have been minimal increases in Bangladeshi health facilities that provide diabetes screening and treatment services (from 4.7% to 9.4%). Among facilities offering diabetes services, 64.5% (BHFS 2014) and 55.7% (BHFS 2017) facilities had no EM-Diabetes on-site at all. Between 2014 and 2017, the availability of metformin increased (from 27.5% to 40.1%), but there was a decrease in the availability of glibenclamide (from 16.5% to 9.1%), injectable insulin (from 20.4% to 11.4%), and injectable glucose solution (from 20.4% to 19.2%). Furthermore, publicly owned facilities [relative risk (RR) = 0.44, 95% confidence interval (CI): 0.25–0.78 for 2014 and RR= 0.54, 95% CI: 0.41–0.71 for 2017] and facilities in rural settings [RR= 0.26, 95% CI: 0.12–0.55 for 2014 and RR= 0.60, 95% CI: 0.44–0.81 for 2017] were significantly associated with decreased availability of EM-Diabetes in both survey years. Moreover, routine user fees [RR=3.70, 95% CI: 1.86–7.38] and regular quality assurance activities [RR= 1.62, 95% CI: 1.12–2.34] were also significantly associated with increased EM-Diabetes availability in 2017 only.ConclusionsOverall, the health facilities in Bangladesh had insufficient essential medicines for treating diabetes. In general, the availability of EM-Diabetes declined from 2014 to 2017, except for metformin. Policymakers should consider a wide range of policy implications, focusing on the management of public facilities, rural facilities, routine user fees, and quality assurance activities to improve the availability of EM-Diabetes at health facilities in Bangladesh.

Accessibility of Essential Medicines for Children in Sichuan Province of China: A Cross-Sectional Study.

Background: Essential medicines for children are those medicines that satisfy the priority health care needs of children. Access to essential medicines for children is a big challenge, particularly in low- and middle-income countries. Our study aimed to assess the accessibility of essential medicines for children in public sector in Sichuan Province of China, based on availability, affordability, and price. Methods: We adopted the modified World Health Organization/Health Action International (WHO/HAI) standardization methodology to measure the availability, affordability, and prices of 30 essential medicines for children in 20 public hospitals in nine regions of the Sichuan Province, China. Availability was expressed as the percentage of public medicine outlets that stocked surveyed medicines on the day of data collection, and prices were expressed as median price ratio (MPR). Affordability was assessed as the number of Sichuan Province’s daily wages required for the lowest-paid government unskilled worker (11.03 USD per day) to purchase one standard treatment of an acute disease or treatment for chronic disease for a month. Results: The mean availability of originator brands (OBs) and lowest priced generics (LPGs) were 9.7 and 46.5% in public sector. MPRs of only 3 OBs could be calculated, ranging from 0.55 to 13.37. MPRs of 18 LPGs ranged from 0.07 to 25.05. Among them, 2 OBs and 11 LPGs were priced at more than 1.5 times their international reference prices (IRPs) in public sector, most of which were injections. Except for cefazolin injection and ceftriaxone injection, most LPGs were affordable for the treatment of childhood diseases in public sector, as they each cost one or less than the daily wage for the lowest-paid unskilled government worker. Conclusions: Although the availability of LPGs for children was higher than OBs in public sector, the availability of children’s essential medicines was low in surveyed public sector in Sichuan Province, which was similar to previous studies in other provinces of China. The price of most medicines surveyed was higher than their IRPs in surveyed public sector, especially for some injections. The affordability of most surveyed LPGs was reasonable in surveyed public sector, except for ceftriaxone injection and cefazolin injection.

Essential medicines and technology for hypertension in primary healthcare facilities in Ebonyi State, Nigeria.

Cardiovascular diseases (CVDs) now constitute major cause of morbidity and mortality in middle and low income countries including Nigeria. One of the major efforts at controlling CVDs in Nigeria includes expanding universal access to care through the primary healthcare (PHC) system. The study was to assess essential medicines and technology for control of hypertension in PHC facilities in Ebonyi Nigeria. The study used mixed method cross-sectional survey to assess availability, affordability and accessibility of essential medicines and technology in 45 facilities and among their patients with hypertension (145). Most of the PHC facilities (71.1%) assessed were rural. The heads of facilities were mainly community health extension workers (86.7%). One (2.2%) facility had a pharmacy technician. All facilities had been supervised by the regulatory authority in the last one year. Out of 15 anti-hypertensive drugs assessed, 10 were available in some facilities (2.2%-44.4%) but essential drug availability was low (<80%). Only mercury sphygmomanometers were available in all facilities with 82.2% functioning. Stethoscopes were available in all facilities and 95.6% were functional. Glucometers were present in 20.0% of facilities and were all functional. All the respondents (100.0%) reported they could not afford their anti-hypertensive drugs. Median monthly income was 8,000 Nigerian Naira (range = 2,000-52,000). Median monthly cost of anti-hypertensive drugs was 3,500 Naira (range = 1,500-10,000). For 99 (68.3%) of the respondents, the facilities were accessible. Median cost of transportation for care was 400 Naira (range = 100-2,000). Gaps still exist in the provision of hypertension control services in PHC facilities in Ebonyi State, Nigeria. The essential drugs were not always available, and cost of the drugs were still a challenge to the patients. There is urgent need to expand health insurance coverage to rural communities to ameliorate the catastrophic out-of-pocket health expenditures and improve control of CVDs.

Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO

ObjectivesExamining the availability of essential medicines is a necessary step to monitor country-level progress towards universal health coverage. We compared the 2017 essential medicine lists (EML) of 137 countries to...

Health service utilization in Manicaland Province, Zimbabwe during the COVID-19 pandemic: results from a cross-sectional household survey

Background The coronavirus disease 2019 (COVID-19) pandemic has impacted utilization of health care, especially in low-resource settings in Sub-Saharan Africa. Here, the current state of health care utilization in Manicaland Province, Zimbabwe during the COVID-19 pandemic was assessed. Methods Cross-sectional surveys were administered to randomly selected households in three districts in Manicaland Province, Zimbabwe from August to September 2020. Data on socio-demographic characteristics, utilization and perceptions of health facilities, and COVID-19 risk perceptions and impact were collected using a structured questionnaire administered to heads of households. Factors associated with health care utilization in the 4 weeks prior to the survey were identified using logistic regression. Findings Among the 542 respondents enrolled in the study, most were married or co-habiting, were employed, had attended secondary school or higher, and headed households with more than 4 members. About half (53.3%) of households reported visiting a health facility in the previous 4 weeks. The most cited barriers of service at health facilities were the unavailability of medicines, cost of services and waiting time see a provider. The multivariate logistic regression analysis indicated that the likelihood of health care utilization in the previous 4 weeks was higher among households with a respondent who was 55 years or older, had attended secondary school or higher, and was unemployed; and among households with a child under 5 years or a pregnant woman and located in Makoni or Mutare rural districts. Conclusions These findings indicate the need to improve quality of care by increasing the availability of essential medicines, removing financial barriers to health services, and reducing waiting times. Key factors such as age and education level of the head of household and the presence of vulnerable populations such as children and pregnant women in households should be considered when targeting health awareness and education to improve health service utilization during the pandemic.

AVAILABILITY OF ESSENTIAL MEDICINES IN PUBLIC HEALTH FACILITIES OF JIMMA ZONE, SOUTHWEST ETHIOPIA

Background: Availability is the relationship between the type and quantity of product or services needed and the type and quantity of product or services provided. Availability of essential medicines at facility level is an important factor to address patients' satisfaction and increase their health seeking behavior. The objective of this study is to determine the availability and associated factors of essential medicines in public health facilities of Jimma zone, South West Ethiopia. Methods: Facility-based cross-sectional study design was employed. Based on WHO recommendation, thirty health facilities were selected from five districts and six health facilities were chosen from each district of the zone. Availability of 29 key essential medicines that were selected from 2014 Ethiopian national essential medicine list were checked in stores and dispensaries as well as the store keepers, head of health facilities and dispensaries were selected for interview. The data were checked for completeness, edited, and coded then entered and analyzed using excels 2016 and SPSS version 23. Descriptive statistics were computed and tables, graphs and numerical summary presented results. Result: Average availability of selected core essential medicines (n=29) was 78.6% in surveyed health facilities. With regard to stock level, 8% of the surveyed medicines were in critical level, 55.2% were in safe level and 36.8% were in over stock level. Six hundred six patients were participated in the study with a response rate of 97%. Among total respondents, 77.7% left the facility with all of their prescribed medicines while 22.3% received only part of their prescribed medicines. Conclusion: The availability of essential medicines was fairly high in surveyed health facilities during the study period. In this study, many patients seeking treatment in public health facilities failed to obtain significant proportion of prescribed medicines. Peer Review History: Received: 4 November 2021; Revised: 10 December; Accepted: 22 December, Available online: 15 January 2022 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Similar Articles: ACCESS TO MEDICINES STRATEGIES OF THE NATIONAL CANCER CONTROL PROGRAMME IN CAMEROON THE EFFICIENCY OF INEFFICIENCY: MEDICINE DISTRIBUTION IN SUDAN

Overview of Cancer Control in Armenia and Policy Implications.

Cancer is the second leading cause of death in Armenia. Over the past two decades, the country has seen a significant rise in cancer morbidity and mortality. This review aims to provide up-to-date info about the state of cancer control in Armenia and identify priority areas of research. The paper analyzes published literature and local and international statistical reports on Armenia and similar countries to put numbers into context. While cancer detection, diagnosis, and treatment are improving, the prevalence of risk factors is still quite high and smoking is widespread. Early detection rates are low and several important screening programs are absent. Diagnosis and treatment methods are not standardized; there is a lack of treatment accessibility due to insufficient government coverage and limited availability of essential medicines. Overall, there is room for improvement in this sector, as research is limited and multidisciplinary approaches to the topic are rare.

Evaluation of Drug Pricing in Nigeria: A Focus on Affordability and Availability of Essential Medicines in Federal Capital Territory Abuja

Critical to the success of a country’s healthcare delivery services is the affordability, availability, and accessibility of essential medicines to the populace irrespective of their income status. The price of medicines is an important determinant of medicines affordability and accessibility. Due to seeming inefficient health insurance programs, medicine financing in Nigeria is generally out-of-pocket. In Nigeria, drug prices are set mostly by market forces, with government tariffs, taxes, and distribution mark-ups accounting for a significant proportion of the final price.The following thematic areas of interest to were the focus in evaluating the current situation of drug pricing: National Drug Policy and Drug Pricing; National Drug Distribution Guideline and Drug Pricing; National Policy Framework on Drug Revolving Fund and Drug Pricing; Nigerian Pharmaceutical Market and Drug Pricing.The study evaluated drug pricing in Nigeria by comparing the availability and prices of various brands of a chosen set of essential medicines in different parts of the health sector and different types of health facilities in the Federal Capital Territory Abuja to assess the availability and affordability of these medicines.The study design used a questionnaire format data collection tool based on the 2nd edition of the World Health Organization (WHO) and Health Action International manual for measuring medicine prices, availability, affordability, and price components. The survey was carried out within the Federal Capital Territory Abuja at both public and private health facilities, including community pharmacies. A total of 145 facilities were enumerated and 20% were successfully surveyed. Key data collected included; percentage availability, price of originator brand and generics, price ratio to the international reference price, and the economic effect of current drug prices on the populace.The results showed varied and fantastic outcome, on inferential statistics in comparative analysis; Firstly, for the Public hospital vs Private hospital Medicines’ Prices, there was a significant difference (P&lt;0.05) between the price of medicines in private hospital and the median price of medicines in public hospitals. Also, price of medicines in private hospital was 2.9 times higher than the median price of medicine in public hospital ( p=0.013, t=2.9); Secondly, for the Innovator brand vs Most sold generic brand in community pharmacy, there was a significant difference between the median price of innovator brands of medicines and the median price of the most sold generics. The median price of the innovator brands was approximately 5 times the median price of the most sold generics (p=0.000291, t=4.689); Thirdly, for the Price of medicines across community pharmacies (innovator brand), there was no significant difference (p&gt;0.05) in the prices of innovator brands across the community pharmacies assessed. (p=0.459); Fourthly, for the Price of medicines across community pharmacies (Most sold generic), there was no significant difference (p&gt;0.05) in the prices of the most sold generic brands of medicines across community pharmacies assessed (P=0.915); Fifthly, for the Price of medicine across public hospitals, there was no significant difference (p&gt;0.05) between the prices of medicines across the public hospitals assessed. (p=0.877).There exists a huge price disparity between public and private health facilities, hence there is an overarching need to regulate drug prices in the health sector so as to ensure affordability and availability of essential medicines and other healthcare commodities. There is poor availability of some essential medicines particularly in the public health pharmacies, it is imperative that appropriate measures be put in place to ensure medicine availability. Improving access to medicines is key to attainment of Universal Health Coverage and Patients’ satisfaction of the healthcare delivery system. Keywords: Drug Pricing, Essential Medicines, Affordability, Availability, Nigeria, FCT Abuja DOI: 10.7176/JHMN/97-01 Publication date: January 31 st 2022

Availability of Essential Medicines, Progress and Regional Distribution In China: A Systematic Review and Meta-Analysis

Availability of Essential Medicines, Progress and Regional Distribution In China: A Systematic Review and Meta-Analysis

Prices, Availability And Affordability Of Essential Medicines For Non-Communicable Diseases: A Facility Based Survey In District Abbotabad

Background: Non communicable diseases (NCDs) are spreading like an epidemic worldwide. Essential medicines are crucial for prevention and control of NCDs. World Health Organization (WHO) has set a benchmark of 80% availability of essential medicines in public and private facilities. Availability being a predictor of access to medicines is low in Low and Middle income countries (LMICs). The objective of this study is to determine price, availability and affordability of essential medicines for NCDs in District Abbottabad. Methods: This study was based on the standardized protocol provided by WHO and Health Action International (HAI) for determination of availability, prices and affordability of medicines. A total of 50 medicines for NCDs that were enlisted in Essential Medicine List of district Khyber Pakhtun Khawa were selected for the study. Twenty seven medicine dispensing facilities belonging to public, private and other basic health units (BHUs) (managed by PPHI) sectors were surveyed in the district. Simple random sampling was employed to select facilities. Results: The mean overall percentage availability of essential medicines for NCDs was 0.1% for original brand and 1.9% for low price generic in public sector. Overall availability was better in private and other sectors (32.9% for OB and 13.8% for LPGs and 5.3% for OB and 11.1% for LPG respectively). The prices in public procurement sector were competitive. The median price ratio (MPR) in public procurement sector was 0.56. Prices were higher comparatively in private sector with MPR 2.83. Most of the medicines require less than a day wage to buy 30 days treatment. Conclusions: The availability of essential medicines for NCDs was poor in District Abbottabad. None of the sectors reached the benchmark of 80% with regard to availability of medicines. LPGs were not frequently available in the private sector. However, prices were reasonable in public sector and acceptable in private sector. Medicines were found to be affordable but affordability may differ for people living below poverty line of US $1.

Availability, prices and affordability of essential medicines: A cross-sectional survey in Hanam province, Vietnam.

To measure medicines' prices, availability, and affordability in Hanam, Vietnam. The standardized methodology developed by the World Health Organization (WHO) and Health Action International was used to survey 30 essential medicines (EMs) in 30 public health facilities and 35 private medicine outlets in 2020. The availability of medicine was computed as the percentage of health facilities in which this medicine was found on the data-collection day. International reference prices (IRPs) from Management Sciences for Health (2015) were used to compute Median Price Ratio (MPR). The affordability of treatments for common diseases was computed as the number of days' wages of the lowest-paid unskilled government worker needed to purchase medicines prescribed at a standard dose. Statistic analysis was done using R software version 4.1.1. The mean availability of originator brands (OBs) and lowest-priced generics (LPGs) was 0.7%, 63.2% in the public sector, and 13.7%, 47.9% in the private sector, respectively. In private medicine outlets, the mean availability of both OBs and LPGs in urban areas was significantly higher than that in rural areas (p = 0.0013 and 0.0306, respectively). In the public sector, LPGs' prices were nearly equal to their IRPs (median MPRs = 0.95). In the private medicine outlets, OBs were generally sold at 6.24 times their IRPs while this figure for LPGs was 1.65. The affordability of LPGs in both sectors was good for all conditions, with standard treatments costing a day's wage or less. In both sectors, generic medicines were the predominant product type available. The availability of EMs was fairly high but still lower than WHO's benchmark. A national-scale study should be conducted to provide a comprehensive picture of the availability, prices, and affordability of EMs, thereby helping the government to identify the urgent priorities and improving access to EMs in Vietnam.

Availability of Key Essential Medicines in Public Health Facilities of South Indian Union Territory: One of the Crucial Components of Universal Health Coverage.

IntroductionThe supply of essential medicines is one of the vital components of primary health care. One of the important objectives of Indian health policy is to provide all the essential medicines at an affordable cost for the public. The performance of healthcare facilities is directly affected by the supply of essential medicines. This study was conducted to check the availability of key essential medicines in selected public healthcare facilities of the South Indian Union Territory.MethodsA snapshot survey was conducted between March 2019 and February 2020 in 10 selected public health facilities to assess the availability of 50 key essential medicines. Percentage availability for all surveyed medicines for the individual facility as well as percentage availability of individual medicines in all surveyed health facilities was calculated.ResultsPercentage availability of 50 key essential medicines in 10 surveyed public health facilities was found in a range of 66 to 80%. Out of 50 medicines, 26 (52%) medicines were available in more than 80% of health facilities while six (12%) medicines were available in less than 30% of surveyed facilities.ConclusionThis study reported the high availability of essential medicines in public health facilities as compared to similar studies done in other parts of India but the availability of some essential medicines was found sub-optimal and needs to be improved.

Health facility preparedness of maternal and neonatal health services: a survey in Jumla, Nepal

BackgroundOver the past 20 years, Nepal has seen major improvements in childhood and maternal survival. In 2015, the Nepalese government introduced a new federal political structure. It is unclear how this has affected the health system, and particularly, maternal and child health care. Hence, this study aims to describe and analyse health facility preparedness in the light of the federalization process with regards to providing appropriate and timely maternal and neonatal health services.MethodsA descriptive cross-sectional study was conducted in Jumla district, Nepal in 2019 covering all 31 state health facilities (HF) to assess the availability of maternal and neonatal health services including appropriate workforce and access to essential medicines. Tests of association between demographic factors and the probability of a facility experiencing a shortage of essential medicine within the last 3 months were also conducted as exploratory procedures.ResultsOut ot 31 HFs, more than 90% of them had all their staff positions filled. Most facilities (n = 21) had experienced shortages of essential medicines within the past 3 months. The most common out of stock medicine were: Amoxicillin (n = 10); paracetamol (n = 10); Vitamin A (n = 7); and Metronidazole (n = 5). Twenty-two HFs had referred maternal and newborn cases to a higher centre within the past 12 months. However, more worryingly, twenty HFs or their catchment communities did not have emergency ambulance transport for women and newborns.ConclusionHFs reported better staffing levels than levels of available drugs. HFs should be supported to meet required minimal standards such as availability of essential medicines and the provision of emergency ambulance transport for women and newborns.

Availability of Essential Medicines in Ethiopia: A Systematic Review

Objective: Essential Medicines (EMs) are those that satisfy the priority health care needs of the population. Access to health care including EMs is a fundamental human right. In Ethiopia, studies designate the frequent drug shortages in public health facilities. Hence, this review aimed to assess and evaluate the national availability of essential medicines in Ethiopia. Method: A systematic searching for all study designs which are published and/or reported from inception to August 27/2019 strategy was conducted in two literature databases (Google Scholar and PubMed. Additionally, references of related articles were searched using different search engines. Data qualities were assessed by abstracting the quality procedures taken in each individual’s studies and cross checked with Joanna Briggs Institute (JBI) quality appraisal criteria. Results: A total of 256 studies, including duplicates, were primarily searched. Nine studies were met current study inclusion criteria. All included studies were published from 2003 to 2019 G.C. Consequently, reviewed studies conducted a total of 356 public and private drug outlets. All studies used cross-sectional study design. The most frequent concepts emerged in these documents were regarding availability and affordability of EMs (5 Articles), availability and pharmaceutical inventory management (3 Articles), one document on availability and price. The average national availability of EMs was precisely in public and private facilities scored about 70.16% and 70.1%, respectively. Results from the sub-national study indicate that, the national average stock out duration in primary health care facilities was 99.2 days, highest in Benishangul Gumuz (139 days). The most frequently reported stocked out drugs within the past 6-12 months at the time of study were; ORS, Amoxicillin syrup 125mg/5ml, Tetracycline eye ointment and tablet, Ergometrine injection in Adama and chloroquine syrup in Gondar. Whereas, carbamazepine 100mg/5ml syrup, diazepam 5mg/ml ampoule, gentamicin 20mg/2ml ampoule and ibuprofen 100mg/5ml suspension were not found in any drug outlets in both public and private sectors at the day of visit in West Wollega. Conclusion: The finding of this review indicates the average national availability of essential medicines in Ethiopia is presently under the requirements of WHO recommendations. Moreover, the longer stockout period was also perceived in healthcare facilities. Thus, might need further attention of the respective stakeholders.