e-drug
[Top] [All Lists]

[e-drug] New article about Equity in access to non-communicable disease medicines

E-DRUG: New article about Equity in access to non-communicable disease medicines
----------------------------------------------------------------------------------------------

Hi E-Druggers,

Can I draw your attention to a new article about equity (or the lack of equity) 
in access to NCD medicines. The paper has recently been published in BMJ Global 
Health with the citation Rockers PC, Laing RO, Wirtz VJ Equity in access to 
non-communicable disease medicines: a cross-sectional study in Kenya BMJ Global 
Health 2018;3:e000828. 

URL   https://gh.bmj.com/content/3/3/e000828.info 

If you cannot download the article, please let me know and I will send you a 
copy.

The abstract reads:

Introduction Wealth-based inequity in access to medicines is an impediment to 
achieving universal health coverage in many low-income and middle-income 
countries. We explored the relationship between household wealth and access to 
medicines for non-communicable diseases (NCDs) in Kenya.

Methods We administered a cross-sectional survey to a sample of patients 
prescribed medicines for hypertension, diabetes or asthma. Data were collected 
on medicines available in the home, including the location and cost of 
purchase. Household asset information was used to construct an indicator of 
wealth. We analyzed the relationship between household wealth and various 
aspects of access, including the probability of having NCD medicines at home 
and price paid.

Results Among 639 patients interviewed, hypertension was the most prevalent NCD 
(69.6%), followed by diabetes (22.2%) and asthma (20.2%). There was a positive 
and statistically significant association between wealth and having medicines 
for patients with hypertension (p=0.020) and asthma (p=0.016), but not for 
diabetes (p=0.160). Poorer patients lived farther from their nearest health 
facility (p=0.050). There was no relationship between household wealth and the 
probability that the nearest public or non-profit health facility had key NCD 
medicines in stock, though less poor patients were significantly more likely to 
purchase medicines at better stocked private outlets. The relationship between 
wealth and median price paid for metformin by patients with diabetes was 
strongly u-shaped, with the middle quintile paying the lowest prices and the 
poorest and least poor paying higher prices. Patients with asthma in the 
poorest wealth quintile paid more for salbutamol than those in all other 
quintiles.

Conclusion The poorest in Kenya appear to face increased barriers to accessing 
NCD medicines as compared with the less poor. To achieve universal health 
coverage, the country will need to consider pro-poor policies for improving 
equity in access.

The data was collected from the baseline study that was undertaken in Kenya as 
part of the evaluation of Novartis Access which is a program to provide a 
basket of NCD medicines. The data was collected from households in which one or 
more residents had been diagnosed and prescribed NCD medicines. Households were 
also characterized into five wealth quintiles based on household assets. GPS 
data on the location of the households and the health facilities were also 
collected so we know how far the houses were from the health facilities.

There were many interesting findings but the one that I found particularly 
striking was that members of the poorest households paid the most for their 
medicines. For metformin they paid about 2.5 times as much as the middle income 
quintile household, for hydrochlorothiazide it was 50% more and for salbutamol 
inhaler it was a bit more than 50% more! These are shown in Figures 3,4 and 5 
in the paper. Poorer households were more likely to live further from their 
nearest health facility than the richer quintile households. Richer households 
were more likely to purchase from the private sector pharmacies or drug stores.

The fact that poor people often pay the most for their medicines is well known 
in High Income countries but has not been reported often in LMICs. It seems to 
me that when household studies are done it is important to ask people what they 
paid for their medicines and to characterize their wealth status to know if the 
poorest pay the most.

The implications of findings such as these means that for new NCD programs the 
poorest households should be targeted with access programs.

I look forward to comments and if anyone is aware of other studies about access 
to NCD medicines and household wealth I would be interested to hear about these 
studies.

Thanks
Richard

Richard Laing
Professor, Department of  Global Health
Boston University School of Public Health,
E mail richardl@bu.edu

<Prev in Thread] Current Thread [Next in Thread>
  • [e-drug] New article about Equity in access to non-communicable disease medicines, Laing, Richard <=