Medicine Prices, Availability, and Affordability in Private Health Facilities in Low-Income Settlements in Nairobi County, Kenya

Abstract

Medicine prices are a major determinant of access to healthcare. Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities. In low-income settlements, high retail prices are likely to push the population further into poverty and ill health. This study assessed the retail pricing, availability, and affordability of medicines in private health facilities in low-income settlements within Nairobi County. Medicine prices and availability data were collected between September and December 2016 at 45 private healthcare facilities in 14 of Nairobi’s low-income settlements using electronic questionnaires. The International Medical Products Price Guide provided international medicine reference prices for comparison. Affordability and availability proxies were calculated according to existing methods. Innovator brands were 13.8 times more expensive than generic brands. The lowest priced generics and innovator brands were, on average, sold at 2.9 and 32.6 times the median international reference prices of corresponding medicines. Assuming a 100% disposable income, it would take 0.03 to 1.33 days’ wages for the lowest paid government employee to pay for treatment courses of selected single generic medicines. Medicine availability in the facilities ranged between 2% and 76% (mean 43%) for indicator medicines. Prices of selected medicines varied within the 14 study regions. Retail medicine prices in the low-income settlements studied were generally higher than corresponding international reference prices. Price variations were observed across different regions although the regions comprise similar socioeconomic populations. These factors are likely to impact negatively on healthcare access.

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

“…Estimates by the US Food and Drug Authority (FDA) typically assume a saving potential with generics of up to 85% 48. Similar values are reported in studies from Malaysia and Kenya with savings of up to 90% or even over 90% 49,50. The large difference in prices for loperamide generic products and the comparable original preparation IMODIUM® akut reported in this study are also a reason for the considerable price differences between the medication-based and the symptom-based scenarios.…”

“…As reported in the international literature, the cost of medicines is a perceived or actual barrier to accessing treatment 50,60-63. Therefore, in light of the enormous price differences, patients should be informed by public campaigns and community sensitisation to compare prices more thoroughly in future and to also be able to access this information 58,59,64.…”

Antiviral treatment for hepatitis C: rebalancing cost, affordability, and availability

“…Finally, the analysis did not disentangle how generic drugs were procured in the studied countries (ie, whether the uptake in DAA treatment was accounted for mainly by increases in government spending or by private prescriptions by high-income groups within LMICs). 5 Nevertheless, the data support the inference that voluntary licensing has been beneficial for treatment access. Robust generic competition and the Medicines Patent Pool provide a platform for more affordable spending on DAA, which should incentivise and encourage case finding.…”

Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya

“…Brand preference based on quality (Table 2) was most likely perceptual as corroborated by studies conducted in Pakistan and Saudi Arabia [23,24], since the facilities have no suitable mechanisms of determining the product quality. For patients, brand preference is influenced by price since they mostly pay out-of-pocket for healthcare [15].…”

“…This descriptive cross-sectional survey was nested in a larger descriptive study conducted in Nairobi County, Kenya between September and December 2016 as previously reported in a related paper by Ongarora et al using similar tools within the study setting described [15].…”