Availability, prices and affordability of essential medicines for treatment of diabetes and hypertension in private pharmacies in Zambia


Autoři: Andrea Hannah Kaiser aff001;  Lindsey Hehman aff002;  Birger Carl Forsberg aff003;  Warren Mukelabai Simangolwa aff002;  Jesper Sundewall aff004
Působiště autorů: Karolinska Institutet, Stockholm, Sweden aff001;  Clinton Health Access Initiative, Inc. (CHAI), Lusaka, Zambia aff002;  Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden aff003;  HEARD, University of Kwazulu-Natal and Division of Social Medicine and Global Health, Lund University, Lund, Sweden aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226169

Souhrn

Objectives

To explore availability, prices and affordability of essential medicines for diabetes and hypertension treatment in private pharmacies in three provinces of Zambia.

Methods

A cross-sectional survey was conducted in 99 pharmacies across three Zambian provinces. Methods were based on a standardized methodology by the World Health Organization and Health Action International. Availability was analysed as mean availability per pharmacy and individual medicine. Median prices were compared to international reference prices and differences in price between medicine forms (original brand or generic product) were computed. Affordability was assessed as number of days’ salaries required to purchase a standard treatment course using the absolute poverty line and mean per capita provincial household income as standard. An analysis identifying medicines considered both available and affordable was conducted.

Results

Two antidiabetics and nine antihypertensives had high-level availability (≥80%) in all provinces; availability levels for the remaining surveyed antidiabetics and antihypertensives were largely found below 50%. Availability further varied markedly across medicines and medicine forms. Prices for most medicines were higher than international reference prices and great price variations were found between pharmacies, medicines and medicine forms. Compared to original brand products, purchase of generics was associated with price savings for patients between 21.54% and 96.47%. No medicine was affordable against the absolute poverty line and only between four and eleven using mean per capita provincial incomes. Seven generics in Copperbelt/Lusaka and two in Central province were highly available and affordable.

Conclusions

The study showed that the majority of surveyed antidiabetic and antihypertensive medicines was inadequately available (<80%). In addition, most prices were higher than their international reference prices and that treatment with these medicines was largely unaffordable against the set affordability thresholds. Underlying reasons for the findings should be explored as a basis for targeted policy initiatives.

Klíčová slova:

Antihypertensives – Hypertension – Insulin – Pharmacists – Salaries – Socioeconomic aspects of health – Zambia


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