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