Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

Abstract

Improving access to medicines is a major healthcare challenge for low-income countries because the problem traverses health systems, society and multiple stakeholders. The Annapurna region of Nepal provides a valuable case study to investigate the interplay between medicines, society and health systems and their effects on access to and use of medicines. Government health facilities and international aid organizations provide some healthcare in the region, communities participate actively in healthcare organization and delivery, there is an important tourism sector and a mostly rural society. This study investigates access to and use of medicines through health facility and household-based studies using standardised tools and through a series of structured key informant interviews with various stakeholders in health. Overall, access to essential medicines at public health facilities was good, but this was not benefitting households as much as it should. People were using the private sector for medicines because of their perception about the quality and limited numbers of government-supplied free medicines. They utilised money from remittances and tourism, and subsidised healthcare from non-government organizations (NGOs) to access healthcare and medicines. A pluralistic healthcare system existed in the villages. Inappropriate use of medicines was found in households and was linked to the inadequate health system, socioeconomic and sociocultural practices and beliefs. Nevertheless, the often disadvantaged Dalit users said that they did not face any discrimination in access to health services and medicines. The government as the main stakeholder of health was unable to meet people’s health services and medicines needs; however, health aid agencies and the local community supported these needs to some extent. This study shows that the interconnectedness between medicines, society and health systems impacts the way people access and use medicines. Improving access to medicines requires an improvement in public’s perception about quality, actual coverage and appropriate use of medicines and health services via collaborative contributions of all stakeholders. Electronic supplementary material The online version of this article (10.1186/s40545-019-0172-3) contains supplementary material, which is available to authorized users.

Ethno-medicinal uses of vertebrates in Chitwan-Annapurna Landscape, central Nepal

“…The male and female ratio may indicate the dominancy of the male ethnomedicinal practitioners than female. Such type of trends was also reported in different ethnomedicinal studies [2,10,14,36] (Table 2). About 43% of the respondents were farmers and healers who had broad knowledge of ethno-medicine.…”

“…A large number of animals are used as medicine under traditional systems such as Ayurveda, Unani, Homeopathy, and Tibetan traditional medicines [4][5][6]. Many studies have shown use of animals as medicine in Nepal [5,[7][8][9][10][11][12][13] including a few studies from Chitwan-Annapurna Landscape, but are mainly related to medicinal plants [14][15][16][17] and wild edible plants [18]. Chitwan-Annapurna Landscape lies in between Chitwan National Park in the south and Annapurna Conservation area in the north with high variation in elevation (150 m to 8000 m).…”

High concentrations of pharmaceuticals emerging as a threat to Himalayan water sustainability

“…Inconsistent detection rates of pharmaceutical compounds in rural areas are potentially a factor of variable access to medicines across villages in the Annapurna region where factors such as distance to local health care facility and cost have been reported to impact patient access (Bhuvan et al 2019). Antibiotics are typically self-prescribed and can be purchased over the counter (Adhikari et al 2021);, however, limited availability of essential medicines outside of urban areas may also be a contributing factor to the lower concentrations detected in rural areas, as only 36.6% of users in health posts reported year-round availability of essential medicines in rural Nepal (Bhuvan et al 2015).…”

“…In rural locations, contaminant loads are often lower due to reduced chemical activity; however, the deterioration of surface water quality parameters, including biological oxygen demand, dissolved oxygen, and total coliforms, have been reported in response to increasing urbanisation (Harada and Karn 2001). Human-use pharmaceuticals are widely used in both urban and rural settings with public health services delivered by tertiary hospitals in urban areas and via district hospitals, primary healthcare centres and health posts in rural areas (Bhuvan et al 2019;Rai et al 2001). Due to limited sewage connectivity, in Nepal, waste is commonly stored in a pit or used as a natural fertiliser, and wastewater is often recycled or used for irrigation thereby providing a means of pharmaceuticals to enter, and become omnipresent, in the environment across rural and urban settings.…”