Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen

Ibrahim, Mohamed Izham Mohamed; Alshakka, Mohammed; Al-Abd, Nazeh; Bahattab, Awsan; Badulla, Wafa F. S.

doi:10.3390/ijerph18010175

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…In the current study, key informants mentioned that the facilities encountered supply chain disruptions from the scourge of conflict in the western part of the country. Similarly, conflict and political instability affected the supply of essential medicines in the Middle East, like in Yemen [ 60 ]. This is linked to the poor engagement of government for the basic human needs and diversion of financial and human resources for immediate conflict-related actions and responses.…”

Section: Discussionmentioning

confidence: 99%

The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study

Mekonnen

Melaku

Tucho

et al. 2023

BMC Health Serv Res

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Background COVID-19 pandemic posed a major impact on the availability and affordability of essential medicines. This study aimed to assess the knock-on effects of the COVID-19 pandemic on the supply availability of non-communicable chronic disease (NCD) medicines and paracetamol products in Ethiopia. Methods A mixed methods study was conducted to assess the supply and availability of twenty-four NCD drugs and four paracetamol products listed on the national essential medicines list for hospitals. Data were collected from twenty-six hospitals located in seven zones of Oromia region in the southwestern part of Ethiopia. We extracted data on drug availability, cost and stock out for these drugs between May 2019 and December 2020. The quantitative data were entered into Microsoft Excel and exported to statistical package software for social science (SPSS) version 22 (IBM Corporation, Armonk, NY, USA) software for analysis. Results The overall mean availability of selected basket medicines was 63.4% (range 16.7% to 80.3%) during the pre-COVID-19 time. It was 46.3% (range 2.8% to 88.7) during the pandemic. There was a relative increase in the availability of two paracetamol products [paracetamol 500 mg tablet (67.5% versus 88.7%) and suppository (74.5% versus 88%)] during the pandemic. The average monthly orders fill rates for the selected products range from 43 to 85%. Pre-COVID-19, the average order fill rate was greater or equal to 70%. However, immediately after the COVID-19 case notification, the percentage of order(s) filled correctly in items and quantities began decreasing. Political instability, shortage of trained human resources, currency inflation, and limited drug financing were considered as the major challenges to medicine supply. Conclusion The overall stock out situation in the study area has worsened during COVID-19 compared to pre-COVID-19 time. None of the surveyed chronic disease basket medicines met the ideal availability benchmark of 80% in health facilities. However, availability of paracetamol 500 mg tablet surprisingly improved during the pandemic. A range of policy frameworks and options targeting inevitable outbreaks should exist to enable governments to ensure that medicines for chronic diseases are consistently available and affordable.

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Section: Discussionmentioning

confidence: 99%

The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study

Mekonnen

Melaku

Tucho

et al. 2023

BMC Health Serv Res

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“…In a more recent study by Chow et al published in 2020, the availability of all three types of cardiovascular medicines (blood pressure lowering medicines, anti-platelets and statins) was 50%, 62.8% and 87.2% respectively [ 14 ]. Another recent study in the Middle East shows cardiovascular medicine availability of 36.6–52.5% [ 15 ]. In East Africa, average availability of cardiovascular medicines in one study was 55.7%, while in another study antihypertensive medicine availability was 0–28.5% and heart failure medication availability was 0.5–49.5% [ 16 , 17 ].…”

Section: Resultsmentioning

confidence: 99%

“…In 2022, a large study reported 19.03–76.9% availability for LPG in the public sector and 41.1–80.49% availability of LPG in the private sector [ 18 ]. Availability of cardiovascular medicines is lower in public health facilities than private facilities in LMICs [ 9 , 13 , 15 , 18 ]. Branded medicines are less available than generic medicines.…”

Section: Resultsmentioning

confidence: 99%

“…Affordability was lower in low- and lower-middle-income countries than high- and upper-middle-income countries for both brand and generic medication Chow et al, 2020 [ 14 ] Survey of local pharmacies and households; Analysis of data from The Prospective Urban Rural Epi-demiological (PURE) study Community pharmacies and households in High income, middle income and low-income countries 17 low- and middle- income countries; 592 communities All 3 CV drugs 10 Availability CV medicines were not available in 6.9% to 55.8% of communities. Availability of all 3 types of CV drugs (antihypertensive, statin, antiplatelet) in communities in low- and middle-income countries was 50% to 87.2%) Affordability Percentage of High-Risk Adults with All 3 types available and affordable was 37.5% (34,974/93200) at 20% affordability Ibrahim et al, 2021 [ 15 ] survey using the World Health Organization/Health Action International (WHO/HAI) guideline Retail medicine outlets in Public Hospitals, Private Hospitals, Private Pharmacies, Public Healthcare Centers 30 facilities All 3 CV drugs 11 Availability of CV medicines was 27.2% in public hospitals, 6.1% in public health centres and 77.6% for private pharmacies Kibirige et al, 2017 [ 17 ] WHO and HAI standardised methods-based questionnaire public hospitals, private hospitals and private pharmacies in 4 regions of Uganda 145 facilities All 3 CV drugs 28 Availability of CV medicines was 39.4% and 74.1% in the public and private facilities respectively Affordability Less than 1 to 53.5 days’ wages were needed to purchase lowest priced generic drugs in both private hospitals and pharmacies Argawal et al, 2022 [ 18 ] A cross sectional survey using WHO/HAI methodology Public and private facilities in low- and middle- income countries 53 low- and middle-income countries Anti-hypertensive medication 6 Availability was 19.03% to 76.9% for LPG in the public sector. Availability of LPG in the private sector was 41.1% to 80.49% Affordability 0.2 to 3.11 days wages were needed to purchase LPG in the public sector.…”

Section: Resultsmentioning

confidence: 99%

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Access to cardiovascular medicines in low- and middle-income countries: a mini review

Harrison

Marfo

Annan

et al. 2023

glob health res policy

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Background Many cardiovascular (CV) medicines are required for long term. However, with their limited resources, low- and middle-income countries (LMICs) may have challenges with access to cardiovascular medicines. The aim of this review was to provide a summary of available evidence on access to cardiovascular medicines in LMICs. Methods We searched PubMed and Google scholar for English language articles on access to cardiovascular medicines for the period 2010–2022. We also searched for articles reporting measures for challenges in access to CV medicines from 2007 to 2022. Studies conducted in LMICs, and reporting availability and affordability were included for review. We also reviewed studies reporting affordability or availability using the World Health Organisation/Health Action International (WHO/HAI) method. Levels of affordability and availability were compared. Results Eleven articles met the inclusion criteria for review on availability and affordability. Although availability appears to have improved, many countries did not meet the availability target of 80%. Between economies and within countries, there are equity gaps in access to CV medicines. Availability is lower in public health facilities than private facilities. Seven out of 11 studies reported availability less than 80%. Eight studies which investigated availability in the public sector reported less than 80% availability. Overall, CV medicines, especially combined treatments are not affordable in the majority of countries. Simultaneous achievement of availability and affordability target is low. In the studies reviewed, less than 1–53.5 days wages were required to purchase one month supply of CV medicines. Failure to meet affordability was 9–75%. Five studies showed that, on average 1.6 days’ wages of the Lowest-Paid Government Worker (LPGW) was required to purchase generic CV medicines in the public sector. Efficient forecasting and procurement, increased public financing and policies to improve generic use, among others are measures for improving availability and affordability. Conclusions Significant gaps exist in access to cardiovascular medicines in LMICs, and in many low—and lower middle—income countries access to cardiovascular medicines is low. To improve access and achieve the Global Action Plan on non-communicable diseases in these countries, policy interventions must be urgently instituted.

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“…42,64,101,102,112 Of the 88 studies included in the review, only ve studies described the provision of family planning and contraception services, 40,48,52,70,103 screening for HIV/AIDS and management of acute sexually transmitted infections were carried out in four studies, 50,56,58,81 health promotion activities for lifestyle changes in chronic diseases and good hygiene practices were identi ed in ve studies, 56,62,86,92,101 and interventions for smoking cessation were identi ed in one study. 43 Monitoring of patients with hypertension was outlined in seven studies 35,38,71,74,78,87,98 ; only one study described screening for both type 2 diabetes mellitus and hypertension, while promotion of access to essential medicines was observed in ve studies, 47,64,77,79,85,117 antiepileptic medicines for children, 41 anticancer medicines, 80,99 medicines for cardiovascular diseases, 55 antibiotics and medicines for childhood diarrhoeal illness, 32,73,82,83,105,113 and medicines for migraine headaches. 94 Another study reported screening for osteoporosis in a population of high-risk women.…”

Section: Search Strategymentioning

confidence: 99%

Primary Health Care: Roles of Community Pharmacists in Low- and Middle-Income Countries—A Systematic Review

Hedima,

Okoro

2024

Preprint

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Community pharmacists (CPs) play vital roles in primary healthcare (PHC), yet they are not officially recognised as PHC providers, particularly in low- and middle-income countries (LMICs). Objectives: This review aims to uncover the provision of PHC services by CPs in LMICs and identify barriers to these services, as well as strategies to overcome them. Methods: Medline, CINAHL, Google Scholar, and others were searched for articles published between 2000 and 2022 that reported on CPs’ provision of PHC services in LMICs. Eligible studies were evaluated, and data were extracted and assessed for quality using the mixed methods appraisal tool (MMAT). Results: Only 23 articles were of considerable quality (MMAT 75-<100%), while 13 had a high quality rating (MMAT 100%). The most common PHC services reported were health education, referral to GPs, medication review, point-of-care testing, self-care for chronic illnesses (n=17 countries), and promoting access to essential medicines (n=11 countries). The major hindrances to PHC activities included unfriendly government policies (n=25), lack of time and effective collaboration (n=14), physical barriers and limited knowledge in patient care (n=11). The majority of studies recommended enacting pharmacy-friendly policies to designate CPs as PHC providers (n=17) and continuous professional development (n=18). Conclusion: Pharmacists in LMICs play a vital role in PHC. Policies that provide primary care providers and continuous training could improve their PHC services.

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Availability of Essential Medicines in a Country in Conflict: A Quantitative Insight from Yemen

Cited by 13 publications

References 22 publications

The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study

The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study

Access to cardiovascular medicines in low- and middle-income countries: a mini review

Primary Health Care: Roles of Community Pharmacists in Low- and Middle-Income Countries—A Systematic Review

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