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The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study

INTRODUCTION: The Malawian government recently introduced cost-covering consultation fees for self-referral patients in tertiary public hospitals. Previously, patients received medicines free of charge in government-owned health facilities, but must pay elsewhere. Before the government implements a...

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Autores principales: Khuluza, Felix, Haefele-Abah, Christine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372227/
https://www.ncbi.nlm.nih.gov/pubmed/30753219
http://dx.doi.org/10.1371/journal.pone.0212125
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author Khuluza, Felix
Haefele-Abah, Christine
author_facet Khuluza, Felix
Haefele-Abah, Christine
author_sort Khuluza, Felix
collection PubMed
description INTRODUCTION: The Malawian government recently introduced cost-covering consultation fees for self-referral patients in tertiary public hospitals. Previously, patients received medicines free of charge in government-owned health facilities, but must pay elsewhere. Before the government implements a payment policy in other areas of health care, it is important to investigate the prices, affordability and availability of essential medicines in Malawi. METHODS: Data on availability and prices of 50 essential medicines were collected in 44 health facilities in two major cities and two districts. These included 12 public facilities, 11 facilities of the Christian Health Association of Malawi (CHAM), nine retail pharmacies, eight wholesalers and four private clinics/hospitals. Price, availability and affordability were assessed based on the methodology developed by the World Health Organization and Health Action International, which compares local prices to international reference prices. RESULTS AND DISCUSSION: The overall availability of medicines was 48.5% in public facilities, 71.1% in retail pharmacies, 62.9% in CHAM facilities and 57.5% in private clinics. The availability of essential medicines varied from 0% for ethosuximide to 100% for amoxicillin and cotrimoxazole tablets. Antibiotic formulations for adults were widely available, in contrast to the low availability of pediatric formulations. Several medicines for non-communicable diseases like sodium valproate, phenytoin, paraldehyde, captopril and simvastatin showed poor availability and affordability. The overall median price ratio compared to the international reference price was 1.11 for wholesalers, 2.54 in CHAM facilities, 2.70 in retail pharmacies, and 4.01 in private clinics, which is low compared to other countries. But nevertheless, for 18 out of 32 medicines assessed, the cost of one course exceeded the statutory minimum daily wage, making them unaffordable to a majority of the population. Therefore, continued provision of free public health care is still of critical importance for the foreseeable future until other financing mechanisms have been explored.
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spelling pubmed-63722272019-03-01 The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study Khuluza, Felix Haefele-Abah, Christine PLoS One Research Article INTRODUCTION: The Malawian government recently introduced cost-covering consultation fees for self-referral patients in tertiary public hospitals. Previously, patients received medicines free of charge in government-owned health facilities, but must pay elsewhere. Before the government implements a payment policy in other areas of health care, it is important to investigate the prices, affordability and availability of essential medicines in Malawi. METHODS: Data on availability and prices of 50 essential medicines were collected in 44 health facilities in two major cities and two districts. These included 12 public facilities, 11 facilities of the Christian Health Association of Malawi (CHAM), nine retail pharmacies, eight wholesalers and four private clinics/hospitals. Price, availability and affordability were assessed based on the methodology developed by the World Health Organization and Health Action International, which compares local prices to international reference prices. RESULTS AND DISCUSSION: The overall availability of medicines was 48.5% in public facilities, 71.1% in retail pharmacies, 62.9% in CHAM facilities and 57.5% in private clinics. The availability of essential medicines varied from 0% for ethosuximide to 100% for amoxicillin and cotrimoxazole tablets. Antibiotic formulations for adults were widely available, in contrast to the low availability of pediatric formulations. Several medicines for non-communicable diseases like sodium valproate, phenytoin, paraldehyde, captopril and simvastatin showed poor availability and affordability. The overall median price ratio compared to the international reference price was 1.11 for wholesalers, 2.54 in CHAM facilities, 2.70 in retail pharmacies, and 4.01 in private clinics, which is low compared to other countries. But nevertheless, for 18 out of 32 medicines assessed, the cost of one course exceeded the statutory minimum daily wage, making them unaffordable to a majority of the population. Therefore, continued provision of free public health care is still of critical importance for the foreseeable future until other financing mechanisms have been explored. Public Library of Science 2019-02-12 /pmc/articles/PMC6372227/ /pubmed/30753219 http://dx.doi.org/10.1371/journal.pone.0212125 Text en © 2019 Khuluza, Haefele-Abah http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Khuluza, Felix
Haefele-Abah, Christine
The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study
title The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study
title_full The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study
title_fullStr The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study
title_full_unstemmed The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study
title_short The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study
title_sort availability, prices and affordability of essential medicines in malawi: a cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372227/
https://www.ncbi.nlm.nih.gov/pubmed/30753219
http://dx.doi.org/10.1371/journal.pone.0212125
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