Co-payment mechanism in Uganda: Awareness of healthcare personnel and Implications on availability of Artemisinin agents in private drug outlets  

Abstract

Background Malaria treatment is faced with the challenge of access, affordability, availability, and quality of antimalarial medicines. Affordable medicines facility-malaria (AMFm) program and subsequently Co-payment mechanism were developed to help increase access to quality assured Artemisinin Combination Therapies (ACTs) in seven countries in sub-Saharan Africa. We explored through a qualitative study, experience of healthcare personnel on Co-payment mechanism and the implication on access and availability of ACTs in private drug outlets in Uganda. Method All private drug outlets reporting stocking antimalarial agents in low and high malaria transmission settings were purposely selected for the study. In each drug outlet, data was collected from pharmacists/dispensers through key informant interview. The interview covered the following areas, (i) awareness of the co-payment mechanism, (ii) Knowledge of quality assured artemisinin combination therapies (QAACT), (iii) stocking of QAACTs, (iv) dispensing price of QAACTs), and (v) determinants of dispensing price of QAACTs. Data was managed using Atlas.ti and analyzed using framework methodology. Results Data was collected from 25 key informants. Five themes emerged following data analysis, (i) considerations taken while stocking antimalarial agents, (ii) access and purchasing behavior of clients, (iii) antimalarial dispensing, (iv) awareness of QAACT, and (v) awareness of Co-payment mechanism. None of the respondents was aware of Co-payment mechanism and QAACT (green leaf ACT). Duocotecin brand of ACTs (non-QAACT) was the most stocked antimalarial agent. Every seven in ten drug outlet clients request to purchase ACTs without a prescription and preferred buying cheaper brands. Drug outlets stocked and sold both ACT and non-ACT antimalarial agents. Most drug outlet clients cannot afford buying a full dose of an ACT. None of the respondents considered using Co-payment mechanism while stocking ACTs. Conclusion There is lack of awareness of Co-payment mechanism and QAACT among pharmacists/ dispensers close to a decade after its introduction in private sector. There was reportedly no difference in the dispensing price between QAACT and non-QAACT. The dispensing of less than a full dose of ACTs to drug outlet clients is a common practice. The Ministry of Health needs to create awareness through public campaigns on the Co-payment mechanism in the country.