Barriers in household access to medicines for chronic conditions in three Latin American countries

Abstract

BackgroundAccess to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries.MethodsThis was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported.ResultsA chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 – 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector.ConclusionsThe nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.

Factors associated to acceptable treatment adherence among children with chronic kidney disease in Guatemala

“…Differences in race (not ethnicity) have been shown to effect adherence, exemplifying the effects of social inequalities on medication outcomes in patients living in their country of origin, or as immigrants in foreign countries [ 37 ]. Barriers to access and utilization of health care facilities for indigenous peoples have been documented in the Guatemalan health care system, although not specifically for chronic kidney disease [ 33 , 38 , 39 ]. Findings from this study may be used to explore how language and ethnicity impact the levels of acceptable adherence in this population and others in the surrounding region.…”

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…Many interventions on diabetes care have focused on patients and/or clinicians as the primary recipients or enablers of the interventions. Because of the complex nature of the disease and the multiple factors that mediate treatment effectiveness, interventions involving other levels or elements within the health care organization or system [155,157,232,[263][264][265] or the health care workforce [158,263,266] could be considered. Interventions involving other sectors (e.g., housing, infrastructure, national or local policies) could uncover very valuable and needed strategies to enhance treatment effectiveness and potentially reduce health care costs in the long-term.…”

WHO and national lists of essential medicines in Mexico, Central and South America, and the Caribbean: are they adequate to promote paediatric endocrinology and diabetes care?

“…Unfortunately, access to medicines that have been used for decades in high income countries (HICs), which are affordable and are most often out of patent, remains low in many LMICs and prevents appropriate lifelong management of paediatric endocrine conditions. 5 In the field of paediatric endocrinology and diabetes, several organisations are facing this reality on a day-to-day basis. Caring and Living as Neighbours (CLAN) 6 is supporting patients and families in their quest to access fludrocortisone and hydrocortisone (for the management of congenital adrenal hyperplasia) and bisphosphonates (for the management of osteogenesis imperfecta) mainly in Asia.…”