Patient experiences of access to NCD medicines in Sri Lanka: Evidence of the success story towards universal coverage

Abstract

Introduction: In Sri Lanka in 2013, 16 medicines were identified as priority to manage non-communicable disease (NCD), and in 2017, 48 NCD medicines were price-regulated. Objective: The aim of the present study was to describe the experiences on availability of drugs and out-of-pocket expenditure (OOPE) for drugs among patients with NCDs in Sri Lanka. Methods: This community-based, household survey was conducted in nine districts of the country. The survey included 1100 adults (aged 50 years and above) with a diagnosis of NCD for 5 years. They were interviewed by trained pharmacy students. Results: Approximately 66%, 49% and 21.6% suffering from hypertension, diabetes and ischaemic heart disease, respectively, with a majority having more than one NCD. The evidence showed that prescribers align to drugs that have been recognized to be made more available and more affordable. Of all, 14% had prescriptions with all NCD medicines classified in the list, while 40% had only one or two of the drugs prescribed which are not in the list. Most of the prescribed drugs were also included in the price regulation – with 29% having all medicines included, while 31.6% having only one or two drugs prescribed out of the list. Approximately, two-thirds (64.2%) had exclusively used government hospitals for NCD care during the past 5 years. A majority (58.3%) had all prescribed drugs available at the last visit to the state sector clinic, while almost all of the others (35.7%) had some of the drugs available. Conclusion: The study concluded that patient experiences in Sri Lanka showed good availability and access to NCD medicines in Sri Lanka.

Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care

“…AF, stroke, hypertension and ischaemic heart disease) are rising [ 13 ]. The prevalence of AF is currently unknown in Sri Lanka; although, the burden of stroke is high, and current strategies such as the ABC pathway are not commonly employed [ 14 , 15 ]. Within neighbouring China, strategies including the ABC framework and raising the profile and understanding of the disease within the healthcare professional (HCP) and public communities have proven effective at improving timely recognition and management of AF [ 16 ].…”

Perception of health workers on availability of medicines for non-communicable diseases in public health facilities in Lesotho

“…Similarly, prescribers in health facilities in Sri Lanka aligned to medicines for NCDs that were included in the list of priority drugs to manage NCD at primary-level healthcare institutions (published in 2013) or the list of price-regulated drugs published in 2017. 17 Thus, patients with NCDs were prescribed more available and more affordable medicines so, patient experiences in Sri Lanka showed good availability and access to NCD medicines. 17 The WHO Model List of Essential Medicines 21st 2019 is a guide for the development of national and institutional EML which list good quality, readily available, and affordable drugs necessary for the management of NCDs and other diseases.…”

“…17 Thus, patients with NCDs were prescribed more available and more affordable medicines so, patient experiences in Sri Lanka showed good availability and access to NCD medicines. 17 The WHO Model List of Essential Medicines 21st 2019 is a guide for the development of national and institutional EML which list good quality, readily available, and affordable drugs necessary for the management of NCDs and other diseases. 15 The medicines for NCDs available for managing hypertension, diabetes mellitus, asthma and epilepsy in the public health facilities of Lesotho were as per the WHO Model List of Essential Medicines 21st 2019 and the Lesotho EML 2017.…”

Factors associated with the availability and affordability of essential cardiovascular disease medicines in low- and middle-income countries: A systematic review

“…Of the included studies, 40 were in English , two were in Spanish [57,58], and one was in Portuguese [59]. Thirty-four studies focused on availability [17, 18, 20-24, 26-36, 38, 40-42, 44, 45, 47, 48, 50-54, 56, 58, 59], seven on affordability [19,25,37,39,43,46,55], and two on both [49,57]. Risk of bias assessment revealed heterogeneity in the quality of the included studies.…”

“…Risk of bias assessment revealed heterogeneity in the quality of the included studies. Fifteen of the cross-sectional studies had one or more domains with high risk of bias [23,24,27,32,35,37,43,[49][50][51][52][53][54][55]57] while another seven had unclear risk of bias in at least one domain [20,22,30,44,53,54,59]. Detailed characteristics of included studies and the results of risk of bias assessments are described in Table 2.…”