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Deng J, Mayai AT, Kayitare E, Ntakirutimana T, Swallehe O, Bizimana T. Assessment of prices, availability and affordability of essential medicines in Juba County, South Sudan. J Pharm Policy Pract 2023; 16:172. [PMID: 38158563 PMCID: PMC10757353 DOI: 10.1186/s40545-023-00675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Access to safe, effective, affordable, and high-quality medications has been included in the Sustainable Development Goals (SDGs) of the United Nations as a crucial step towards attaining universal health coverage. Access to medicines is a fundamental human right. If medicines are accessible and affordable, they save lives by reducing mortality and morbidity associated with acute and chronic diseases. WHO recommends that all countries voluntarily reach the minimum target of 80% availability of medicines by 2025. The primary purpose of this research is to assess access to essential medicines in Juba County, South Sudan. METHODS This study was undertaken using the standard World Health Organization/Health Action International Organization (WHO/HAI) approach for surveying the prices, availability, and affordability of medicines. A survey was conducted in six payams of Juba County, South Sudan, and 55 health facilities were assessed. RESULTS Prices for generic medicines were better in faith-based health facilities with a median price ratio of 1.95. Private pharmacies and private clinics had MPRs of 4.64 and 4.32, respectively. Local prices were high compared to International referent prices. Availability of medicines was highest in the faith-based health facilities (65.5%) and slightly lower in private pharmacies (55.4%), private clinics (57.7%) and public (50.4%) sectors. Most of the surveyed medicines were unaffordable. The medicines needed to treat non-communicable diseases cost up to 33.7-day wages for one full course of treatment. CONCLUSIONS In South Sudan, medicines are poorly available in all sectors. Medicines are affordable in the public sector but Most medicines are unaffordable in private pharmacies, private clinics and faith-based health facilities. Poor medicines availability in the public sector contributes to the overall unaffordability of medicines in all the other sectors.
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Affiliation(s)
- Justin Deng
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Egide Kayitare
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda.
| | - Theoneste Ntakirutimana
- Department of Environmental Health Sciences, School of Public Health, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda
| | - Omary Swallehe
- Department of Business Studies, School of Business, Dar es Salaam Campus College, Mzumbe University, Mzumbe, Tanzania
| | - Thomas Bizimana
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda
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Odunyemi A, Rahman T, Alam K. Economic burden of non-communicable diseases on households in Nigeria: evidence from the Nigeria living standard survey 2018-19. BMC Public Health 2023; 23:1563. [PMID: 37592334 PMCID: PMC10433548 DOI: 10.1186/s12889-023-16498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The importance of non-communicable diseases (NCDs) in Nigeria is reflected in their growing burden that is fast overtaking that of infectious diseases. As most NCD care is paid for through out-of-pocket (OOP) expenses, and NCDs tend to cause substantial income losses through chronic disabilities, the rising NCD-related health burden may also be economically detrimental. Given the lack of updated national-level evidence on the economic burden of NCDs in Nigeria, this study aims to produce new evidence on the extent of financial hardship experienced by households with NCDs in Nigeria due to OOP expenditure and productivity loss. METHODS This study analysed cross-sectional data from the most recent round (2018-19) of the Nigeria Living Standard Survey (NLSS). Household-level health and consumption data were used to estimate catastrophic health expenditure (CHE) and impoverishing effects due to OOP health spending, using a more equitable method recently developed by the World Health Organization European region in 2018. The productivity loss by individuals with NCDs was also estimated from income and work-time loss data, applying the input-based human capital approach. RESULTS On average, a household with NCDs spent ₦ 122,313.60 or $ 398.52 per year on NCD care, representing 24% of household food expenditure. The study found that OOP on cancer treatment, mental problems, and renal diseases significantly contribute to the cost of NCD care. The OOP expenditure led to catastrophic and impoverishing outcomes for households. The estimations showed that about 30% of households with NCDs experienced CHE in 2018, using the WHO Europe method at the 40% threshold. The study also found that the cost of NCD medications was a significant driver of CHE among NCD-affected households. The results showed heterogeneity in CHE and impoverishment across states and geographical regions in Nigeria, with a higher concentration in rural and North East geopolitical locations. The study also found that 20% of NCD-affected households were impoverished or further impoverished by OOP payment, and another 10% were on the verge of impoverishment. The results showed a negligible rate of unmet needs among households with NCDs. CONCLUSIONS The study highlights the significant effect of NCDs on Nigerian households and the need for effective policy interventions to address this challenge, particularly among the poor and vulnerable.
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Affiliation(s)
- Adelakun Odunyemi
- Murdoch Business School, Murdoch University, 90 South Street, Perth, WA, 6150, Australia.
- Hospitals' Management Board, Akure, Ondo State, Nigeria.
| | - Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
- Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, 90 South Street, Perth, WA, 6150, Australia
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Stolbrink M, Thomson H, Hadfield RM, Ozoh OB, Nantanda R, Jayasooriya S, Allwood B, Halpin DMG, Salvi S, de Oca MM, Mortimer K, Rylance S. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review. Lancet Glob Health 2022; 10:e1423-e1442. [PMID: 36113528 PMCID: PMC9638033 DOI: 10.1016/s2214-109x(22)00330-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs. METHODS A systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069. FINDINGS Of 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1-351 for SABAs, 2·6-340 for ICSs, and 24 for ICS-LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days' wages, ICSs 2-7 days, and ICS-LABAs at least 6 days. The included studies showed heterogeneity. INTERPRETATION Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids. FUNDING WHO and Wellcome Trust.
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Affiliation(s)
- Marie Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa.
| | | | - Ruth M Hadfield
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia; Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA
| | - Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences Kampala, Kampala, Uganda
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; University of Sheffield, Sheffield, UK
| | - Brian Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa; Tygerberg Hospital, Cape Town, South Africa
| | - David M G Halpin
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; University of Exeter Medical School, Exeter, UK
| | - Sundeep Salvi
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Maria Montes de Oca
- Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Universidad Central de Venezuela, Caracas, Venezuela; Centro Medico de Caracas Hospital, Caracas, Venezuela
| | - Kevin Mortimer
- The International Union Against Tuberculosis and Lung Disease, Paris, France; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarah Rylance
- Noncommunicable Disease Management Unit, WHO, Geneva, Switzerland
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Hollingworth SA, Ankrah D, Uzochukwu BSC, Okeke CC, Ruiz F, Thacher E. Antihypertensive medicine use differs between Ghana and Nigeria. BMC Cardiovasc Disord 2022; 22:368. [PMID: 35948937 PMCID: PMC9364553 DOI: 10.1186/s12872-022-02799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Non-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source. METHODS We used data from mPharma-a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product. RESULTS AHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria. CONCLUSION The differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community.
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Affiliation(s)
- Samantha A. Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102 Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Ankrah
- Department of Pharmacy, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Chinyere C. Okeke
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Francis Ruiz
- International Decision Support Initiative, London School of Hygiene and Tropical Medicine, London, UK
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