Medicines For Non-communicable Diseases Research Articles

“These are just finishing our medicines”: older persons’ perceptions and experiences of access to healthcare in public and private health facilities in Uganda

BackgroundThere is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons’ access to essential medicines in Uganda.MethodsIt is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software.ResultsThe key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities.ConclusionAccess to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare.

Trends in cost and consumption of essential medicines for non-communicable diseases in Azerbaijan, Georgia, and Uzbekistan, from 2019 to 2021.

Access to medicines is a global priority. Azerbaijan, Georgia, and Uzbekistan have different approaches to pricing policies for pharmaceuticals. The aim of this study was to analyze recent trends in the consumption and prices of non-communicable disease (NCD) medicines in Azerbaijan, Georgia, and Uzbekistan, in the outpatient setting. We included medicines for asthma and COPD, cancer, cardiovascular disease, diabetes, epilepsy, and mental disorders. Sales data for pharmaceutical products in community pharmacies were extracted from a commercial database. Changes in consumption and prices were analyzed across all included NCD medicines, by disease category and pharmacological group. Consumption of NCD medicines was highest in Georgia, at twice the levels in Azerbaijan, and four times levels in Uzbekistan. Average prices of NCD medicines, weighted by consumption, increased by 26% in Georgia, but decreased by 3% in Azerbaijan and by 0.1% in Uzbekistan. Prices increased for all disease groups in Georgia (from +13% for epilepsy medicines to +86% for cancer), varied by group in Uzbekistan (from -22% for epilepsy medicines to +47% for cancer), while changes in Azerbaijan were smaller in magnitude (from -4% for medicines for cardiovascular disease to +11% for cancer). Cancer medicines had markedly higher prices in Uzbekistan, and asthma and COPD medicines had markedly higher prices in Azerbaijan and Uzbekistan. Georgia showed the highest outpatient consumption of NCD medicines, suggesting the broadest access to treatment. However, Georgia also saw marked price increases, greater than in the other countries. In Georgia, where there was no price regulation, widespread price increases and increases in consumption both contribute to increasing pharmaceutical expenditures. In Azerbaijan and Uzbekistan, increases in outpatient pharmaceutical expenditures were primarily driven by increases in consumption, rather than increases in price. Comparing trends in consumption and pricing can identify gaps in access and inform future policy approaches.

Exploring the Interplay between Policy Texts and Local Realities in Drug Procurement for the NPCDCS Program in Bihar: An Institutional Ethnography

India has the largest number of families living below the poverty threshold, resulting in high out-of-pocket expenditure for healthcare, including essential medicines for noncommunicable diseases (NCDs). With the increasing prevalence of NCDs, the role of the Indian government becomes crucial in ensuring that patients have access to essential drugs through public health facilities. This research paper explores the institutional processes of drug procurement in the National Program for Prevention and Control of Diabetes, Cardiovascular Disease, and Stroke in Bihar, India, using institutional ethnography as its methodological approach. The data for the study was collected over a 10-months period in three districts of Bihar and involved collecting data through participant observation, interviews, and reviews of official documents and program guidelines. The findings highlight the influence of various institutional and regulatory texts that shape the implementation of integrated programs in district hospitals and carry the authority and instructions of the Ministry of Health and Family Welfare. Despite their legal entity and autonomous status, the study reveals that the governance, decision-making, and autonomy of health societies involved in the program were restricted through textual practices. The study’s contribution to social science and health system literature lies in illustrating the multiple factors that influence drug procurement at the central, state, and local levels.

Realigning noncommunicable disease monitoring with health systems priorities in the Africa region.

The African region of the World Health Organization (WHO) recently adopted a strategy aimed at more comprehensive care for noncommunicable diseases (NCDs) in the region. The WHO's World Health Assembly has also newly approved several ambitious disease-specific targets that raise the expectations of chronic care and plans to revise and update the NCD-Global Action Plan. These actions provide a critically needed opportunity for reflection and course correction in the global health response to NCDs. In this paper, we highlight the status of the indicators that are currently used to monitor progress towards global goals for chronic care. We argue that weak health systems and lack of access to basic NCD medicines and technologies have prevented many countries from achieving the level of progress required by the NCD epidemic, and current targets do little to address this reality. We identify gaps in existing metrics and explore opportunities to realign the targets with the pressing priorities facing today's health systems.

What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region

ObjectiveThis article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.SettingInformation...

Improving access to medicines for non-communicable diseases, including mental health conditions

Improving access to medicines for non-communicable diseases, including mental health conditions

Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in Osun State South-West Nigeria: a rural–urban comparative study

BackgroundGlobal response to the growing burden of non-communicable diseases (NCDs) in developing countries includes the development of WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) for Primary Health Care (PHC). The study assessed the level of preparedness of PHC facilities on implementation of essential NCD interventions in rural and urban Local Government Areas (LGAs) of Osun State, Nigeria.MethodsThe study was a comparative cross-sectional survey. Information was collected from heads of 33 rural and 33 urban PHC facilities and through direct observation on the domains of staff training, basic equipment, diagnostics and essential medicines for cardiovascular diseases, diabetes and chronic respiratory diseases (CRDs) using a semi-structured interviewer administered questionnaire.ResultsManual sphygmomanometer was found in similar proportions (84.8%) of PHC facilities in rural and urban LGAs. Glucometer was available in 45.5% of the PHC facilities in urban and 33.3% of the PHC facilities in the rural LGAs, the difference was not statistically significant (χ2 = 1.015; p = 0.314). Basic equipment for CRDs were not available in majority of PHC facilities in both locations. Moduretic tablets were the most reported essential NCD medicines, available in 15% of PHC facilities in rural LGAs and none in urban LGAs. The anti-diabetic medicines were not available in any of the PHC facilities in both locations. More than 90% (≥ 30) of the PHC facilities in both locations were not prepared to implement essential interventions for each NCD across domains of staff training and essential medicines. Overall, 97.0% of the PHC facilities in the rural LGAs and all the PHC facilities in urban LGAs were not prepared on implementation of essential interventions for the three NCDs.ConclusionThe level of preparedness of the PHC facilities on implementation of essential NCD interventions in the rural and urban LGAs of Osun State is very low. Government needs to strengthen the PHC system by providing needed essential medicines, basic diagnostics, equipment, and training of clinical health care workers for implementation of essential NCD interventions in the state.

Using government data to understand the use and availability of medicines for hypertension and diabetes: lessons from Peru

BackgroundRegular measurement of the availability and use of key medicines for non-communicable diseases allows the tracking of progress to achieve equitable access to medicines. Using a country-level public sector monitoring system for medicine supply, we aim to evaluate the availability and use of losartan 50 mg tablets and metformin 850 mg tablets between 2015 and 2020 investigating the impact of different policy changes and the COVID-19 pandemic.MethodsData from the Peruvian National System of Medicine Supply were analyzed using an interrupted time series analysis with known and unknown structural breaks. The outcomes assessed were medicine use (monthly doses dispensed at facilities over time) and medicine availability (proportion of facilities that reported having the medicine available).ResultsThe use of losartan and metformin at the primary level of care had a linear increasing trend over the period of analysis. In secondary and tertiary levels of care, there were no increases but some significant level and trend changes of doses dispensed at different times between 2017 to 2019, but none were related to the change of procurement procedures. At all levels of care, the COVID-19 onset in April 2020 caused an abrupt drop in doses dispensed especially at the primary level. Regarding availability, we found an increasing linear trend in the primary level of care for both medicines. In secondary and tertiary levels of care, the availability fluctuated between 40 and 95%. The onset of the COVID-19 pandemic did not significantly impact medicine availability, except for losartan in the tertiary level of care.ConclusionThe availability and proper dispensing of first-line medicines for hypertension and diabetes is an essential factor for sustainable and equitable treatment. Health care systems need to be prepared for forecasting the increasing demand of medicines for chronic diseases, but also to maintain effective medicine supply chains during humanitarian crisis like pandemics.

The impact of the COVID-19 pandemic on service delivery for noncommunicable diseases in the Eastern Mediterranean Region.

The COVID-19 pandemic has adversely affected the delivery of noncommunicable diseases (NCDs) services globally as health systems are overwhelmed by the response to the pandemic. The World Health Organization (WHO) Regional Office for the Eastern Mediterranean conducted an assessment to evaluate the impact of COVID-19 on NCD-related services, programmes, funding and consideration of NCDs in COVID-19 response. Data were collected from countries of the WHO Eastern Mediterranean Region (EMR) in mid-2020 through a web-based questionnaire on NCD services-related infrastructure, policies and plans, staffing, funding, NCD services disruptions and their causes, disruption mitigation strategies, data collection on comorbidity, surveillance, and suggestions for WHO technical guidance. The data were exported into Microsoft Excel and summarized. Countries were grouped according to socioeconomic level. Nineteen of the 22 countries in the EMR responded: 95% had NCD staff reallocated to support their COVID-19 response. Lower-income countries were less likely to include NCDs in their pandemic response plans and more likely to report disruption of services. The most commonly disrupted services were hypertension management (10 countries 53%), dental care (10 countries 53%), rehabilitation (9 countries 47%), palliative care (9 countries 47%) and asthma management (9 countries 47%). The COVID-19 pandemic has disrupted the continuity of NCD-related services in EMR countries. The ability to mitigate service disruptions varied noticeably between countries. The mitigation measures implemented included triaging of patients, novel NCD medicines supply chains and dispensing interventions, and the use of digital health and telemedicine. Guidance and support for systems resilience, preparedness and response to crises are recommended.

Household access to non-communicable disease medicines during universal health care roll-out in Kenya: A time series analysis.

ObjectivesThis study aims to describe trends and estimate impact of county-level universal health coverage expansion in Kenya on household availability of non-communicable disease medicines, medicine obtainment at public hospitals and proportion of medicines obtained free of charge.MethodsData from phone surveillance of households in eight Kenyan counties between December 2016 and September 2019 were used. Three primary outcomes related to access were assessed based on patient report: availability of non-communicable disease medicines at the household; non-communicable disease medicine obtainment at a public hospital versus a different outlet; and non-communicable disease medicine obtainment free of cost versus at a non-zero price. Mixed models adjusting for fixed and random effects were used to estimate associations between outcomes of interest and UHC exposure.ResultsThe 197 respondents with universal health coverage were similar on all demographic factors to the 415 respondents with no universal health coverage. Private chemists were the most popular place of purchase throughout the study. Adjusting for demographic factors, county and time fixed effects, there was a significant increase in free medicines (aOR 2.55, 95% CI 1.73, 3.76), significant decrease in medicine obtainment at public hospitals (aOR 0.68, 95% CI 0.47, 0.97), and no impact on the availability of non-communicable disease medicines in households (aβ -0.004, 95% CI -0.058, 0.050) with universal health coverage.ConclusionsAccess to universal health coverage caused a significant increase in free non-communicable disease medicines, indicating financial risk protection. Interestingly, this is not accompanied with increases in public hospitals purchases or household availability of non-communicable disease medicines, with public health centers playing a greater role in supply of free medicines. This raises the question as to the status of supply-side investments at the public hospitals, to facilitate availability of quality-assured medicines.

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.

Cost of Traditional Herbal Medicines for Noncommunicable Diseases in Rural and Urban Communities in South Africa

ObjectivesThis study assessed traditional herbal medicine (THM) and conventional medicine (CM) utilization among participants with noncommunicable disease in South Africa. MethodsA cross-sectional study of the Prospective Urban and Rural Epidemiological study collected data through face-to-face interviews using structured questionnaires in 2014. Descriptive, bivariate, and multivariate logistic regression were used to determine the effect of sociodemographic and economic factors on THM and CM use. All statistical analyses were conducted using the statistical computing and graphics language “R.” ResultsOf the total 417 randomly selected participants in this study, 85% were females, 95% with no health insurance, and 81% with monthly incomes of <2000 rand (R) ($137 equivalent) per month. Moreover, 73% spend <R100 per month (6.85 US dollar conversion) on THM compared with 46% of families spending <R100 on CM last year; 7% spent >5% of their income on THM, and 10% say they are willing to pay >R500 per year on THM to feel better. Age was significantly associated with different spending patterns after controlling for other demographic factors, given that older adults were 82% (odds ratio 0.18; 95% confidence interval 0.02-0.93) less likely to pay >R100 for THM whereas younger adults were 59% (odds ratio 0.41; 95% confidence interval 0.17-0.97) less likely to pay for CM. ConclusionsThe cost of using THM and CM largely differed by age. The economic insight into this study reveals individuals more willing to pay for THM to payors, which can ultimately clue payors into areas for medication optimization from potential drug-drug interactions and adverse events and, therefore, reduce healthcare costs.

Improving access to medicines for non-communicable diseases in rural primary care: results from a quasi-randomized cluster trial in a district in South India

BackgroundA large proportion of non-communicable diseases (NCDs) are treatable within primary health care (PHC) settings in a cost-effective manner. However, the utilization of PHCs for NCD care is comparatively low in India. The Access-to-Medicines (ATM) study examined whether (and how) interventions aimed at health service optimization alone or combined with community platform strengthening improve access to medicines at the primary health care level within the context of a local health system.MethodA quasi-randomized cluster trial was used to assess the effectiveness of the intervention (18 months) implemented across 39 rural PHCs (clusters) of three sub-districts of Tumkur in southern India. The intervention was allocated randomly in a 1:1:1 sequence across PHCs and consisted of three arms: Arm A with a package of interventions aimed at health service delivery optimization; B for strengthening community platforms in addition to A; and the control arm. Group allocation was not blinded to providers and those who assessed outcomes. A household survey was used to understand health-seeking behaviour, access and out-of-pocket expenditure (OOP) on key anti-diabetic and anti-hypertension medicines among patients; facility surveys were used to assess the availability of medicines at PHCs. Primary outcomes of the study are the mean number of days of availability of antidiabetic and antihypertensive medicines at PHCs, the mean number of patients obtaining medicines from PHC and OOP expenses.ResultThe difference-in-difference estimate shows a statistically insignificant increase of 31.5 and 11.9 in mean days for diabetes and hypertension medicines availability respectively in the study arm A PHCs beyond the increase in the control arm. We further found that there was a statistically insignificant increase of 2.2 and 3.8 percentage points in the mean proportion of patients obtaining medicines from PHC in arm A and arm B respectively, beyond the increase in the control arm.ConclusionThere were improvements in NCD medicine availability across PHCs, the number of patients accessing PHCs and reduction in OOP expenditure among patients, across the study arms as compared to the control arm; however, these differences were not statistically significant.Trial registrationTrial registration number CTRI/2015/03/005640. This trial was registered on 17/03/2015 in the Clinical Trial Registry of India (CTRI) after PHCs were enrolled in the study (retrospectively registered). The CTRI is the nodal agency of the Indian Council of Medical Research for registration of all clinical, experimental, field intervention and observation studies.

Coping with access barriers to non\u2010communicable disease medicines: qualitative patient interviews in eight counties in Kenya

BackgroundThere is rich literature on barriers to medicines access for the treatment of non-communicable diseases (NCDs) in high-income countries. Less is known about low- and middle-income countries, in particular the differences in coping with medicines access barrier by household wealth and disease. The aim of this study was to compare the coping mechanisms of patients with the lack of availability and affordability of cardio-vascular diseases, diabetes and asthma medicines in Kenya.MethodsThis qualitative study was part of a larger mixed methods evaluation study conducted in eight counties of Kenya from 2016 to 2019. Forty-nine patient interviews at study end line explored their NCD journey, perceptions of availability, stockouts and affordability of NCD medicines, their enrollment in health insurance, and their relationship with the private chemists. Transcribed interviews were coded using Nvivo software. A two-step thematic approach was used, first conducting a priority coding which was followed by coding emerging and divergent themes. ResultsOverall, we found that patients across all disease types and wealth level faced frequent medicine stock-outs at health facilities. In the absence of NCD medicines at health facilities, patients coped by purchasing medicines from local chemists, switching health facilities, requesting a different prescription, admitting oneself to an inpatient facility, establishing connections with local staff to receive notifications of medicine stock, stocking up on medicines, utilizing social capital to retrieve medicines from larger cities and obtaining funds from a network of friends and family. Categorizing by disease revealed patterns in coping choices that were based on the course of the disease, severity of the symptoms and the direct and indirect costs incurred as a result of stockouts of NCD medicines. Categorizing by wealth highlight differences in households’ capacity to cope with the unavailability and unaffordability of NCD medicines.ConclusionsThe type of coping strategies to access barriers differ by NCD and wealth group. Although Kenya has made important strides to address NCD medicines access challenges, prioritizing enrollment of low wealth households in county health insurance programs and ensuring continuous availability of essential NCD medicines at public health facilities close to the patient homes could improve access.

Barriers to access to medicines for non-communicable diseases for patients using the Brazilian Unified Health System (SUS)

This paper investigates difficulties related to access to medicines in SUS and factors associated with the inability to obtain medicines in SUS by non-communicable chronic disease (NCCD) patients who used this source for health care. We analyzed data from the National Survey on Access, Use and Promotion of Rational Use of Medicines. First analysis included individuals aged 20 years and over, diagnosed with at least one NCCD, with indication of medicine treatment and follow up of this disease (s) with a physician from SUS, and who reported having obtained some of the medicines in use from the SUS. The difficulties of obtaining medicines from SUS were investigated based on dimensions of access to medicines. Among 5.155 individuals investigated, 65.4% were women, 40 years old or older and 54.3% residents of the Southeast region of Brazil. Aspects related to availability and waiting time to obtain medicines were the most significant reported barriers to access to medicines. Regional differences were found in basically all dimensions of access and the low availability of medicines in SUS pharmacies was the main reason cited for their search in private pharmacies.

Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis.

BackgroundAvailability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time.MethodsWe carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases.ResultsAvailability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price.ConclusionsWe conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.

How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria.

Primary health centres are an effective means of achieving access to primary healthcare (PHC) in low- and middle-income countries. We assessed service availability, service readiness and factors influencing service delivery at public PHC centres in Enugu State, Nigeria. We conducted a cross-sectional study of 60 randomly selected public health centres in Enugu using the World Health Organization’s Service Availability and Readiness Assessment (SARA) survey. The most senior health worker available was interviewed using the SARA questionnaire, and an observational checklist was used for the facility assessment. None of the PHC centres surveyed had all the recommended service domains, but 52 (87%) offered at least half of the recommended service domains. Newborn care and immunization (98.3%) were the most available services across facilities, while mental health was the least available service (36.7%). None of the surveyed facilities had a functional ambulance or access to a computer on the day of the assessment. The specific-service readiness score was lowest in the non-communicable disease (NCD) area (33% in the rural health centres and 29% in the urban health centres) and NCD medicines and supplies. Availability of medicine and supplies was also low in rural PHC centres for the communicable disease area (36%) and maternal health services (38%). Basic equipment was significantly more available in urban health centres (P = 0.02). Urban location of facilities and the presence of a medical officer were found to be associated with having at least 50% of the recommended infrastructure / basic amenities and equipment. Continuing medical education, funding and security were identified by the health workers as key enablers of service delivery. In conclusion, despite a focus on expanding primary care in Enugu State, significant gaps exist that need to be closed for PHC to make significant contributions towards achieving universal healthcare, core to achieving the health-related Sustainable Development Goal agenda.

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization's African regional targets.

In Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial re-orientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC. A review of World Health Organization (WHO) reports was conducted for all 47 countries in the WHO African Region. To report each country's progress, we used an a priori framework developed by the WHO regional office for Africa (AFRO). Twelve indicators were used to measure countries' progress. The proportion of countries meeting each indicator was tabulated using a heat map. Correlation between country income status and attainment of each indicator was also assessed. No country met all the recommended indicators to integrate NCD services into PHC and seven countries met none of the indicators. Few countries (30%) had nationally approved guidelines for NCD management and very few reported availabilities of all essential NCD medicines (13%) and technologies (11%) in PHC facilities. There was no overall correlation between a country's GDP per capita and the aggregate of targets being met (rho = 0.23; P = .12). There was, however, a modestly negative correlation between out-of-pocket expenditure and overall country progress (rho = -0.58; P < .001). Progress by AFRO Member States in integrating NCD care into PHC is variable across the region. Enhanced government commitment and judicious resource allocation to prioritize NCDs are needed. Particular areas of focus include increasing the uptake of simplified guidelines for NCDs; increasing workforce capacity to manage NCDs; and removing access barriers to essential medicines and basic diagnostic technologies.

Accessing medicines for non-communicable diseases: Patients and health care workers' experiences at public and private health facilities in Uganda.

Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients' confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.

Availability and prices of medicines for non-communicable diseases at health facilities and retail drug outlets in Kenya: a cross-sectional survey in eight counties

ObjectivesThe objective of this study was to determine the availability and prices of medicines for non-communicable diseases (NCDs) in health facilities and private for-profit drug outlets in Kenya.DesignCross-sectional study.MethodsAll public...