Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries

Abstract

The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.

Educational strategies for the prevention of diabetes, hypertension, and obesity

“…[17][18][19] However, although improvement to the economic condition or educational level of people is important to fight these contemporary diseases, a drastic reduction in their impact can only be achieved when the access to concrete health conditions is universalized. 17,18,[20][21][22] That is to say, the best methods or technologies will have little impact on modern and postmodern diseases if access is limited and especially coupled with economic power. Commodifying the problem means making social inequalities and the broad-spectrum of these diseases in a society worse.…”

Access to medicines for chronic diseases in Brazil: a multidimensional approach

“…Study 26 that analyzed the access to medicines for NCD in five countries of different income levels (low, medium-low, and medium-high) – Uganda, Ghana, Kenya, Philippines, and Jordan – found prevalence of access of up to 50.0%, ranging from 16.0% to 50.0%.…”

Study protocol for a cluster-randomised controlled trial of an NCD access to medicines initiative: evaluation ofNovartis Accessin Kenya

“…The study is powered to detect a 10 percentage point increase in household availability of medicines due to Novartis Access at α=0.05, assuming an intracluster correlation coefficient of 0.05, 10% loss to follow-up, and 33% availability in the control group 8. The study is also powered to detect a 10 percentage point increase in facility availability in the Novartis Access group at α=0.05, assuming 50% availability in the control group.…”

“…7 According to a recent survey, only 33% of Kenyan patients prescribed NCD medicines have them in their home. Furthermore, 82% of NCD medicines purchased are paid for out-of-pocket 8. As a result, NCD sequelae which are often avoidable with proper treatment account for more than half of hospital admissions in the country 9…”