Perceptions of Kenyan adults on access to medicines for non-communicable diseases: A qualitative study

Onyango, Monica Adhiambo; Vian, Taryn; Hirsch, Isabel; Salvi, Devashri; Laing, Richard; Rockers, Peter C.; Ashigbie, Paul G.; Wirtz, Veronika J.

doi:10.1371/journal.pone.0201917

Cited by 24 publications

(24 citation statements)

References 17 publications

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“…The main factors that affect patient access to essential medicines in Kenya are stockouts or unavailability and unaffordability. 37 , 38 An essential medicine is determined as one that satisfies priority healthcare needs of the populace, usually selected based upon evidential safety, efficacy, public health importance, and cost-effectiveness. 15 In addition, a patient should easily access the medicine from a functional health facility that is supplied in a suitable dosage form in a sufficient amount at an affordable price.…”

Section: Medicine Access By a Patient Within Kenya’s Health Sub-sectorsmentioning

confidence: 99%

Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya

Toroitich¹,

Dunford²,

Armitage³

et al. 2022

RMHP

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Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.

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Section: Medicine Access By a Patient Within Kenya’s Health Sub-sectorsmentioning

confidence: 99%

Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya

Toroitich¹,

Dunford²,

Armitage³

et al. 2022

RMHP

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“…Assessment of perceptions of adult patients in Kenya on the availability of medicines for NCDs found that most adult patients with NCDs in Kenya perceived that medicines were not available at the government health facilities. 20 Unavailability of medicines in government health facilities forced adult patients with NCDs to buy the medicines at private facilities and pharmacies. 20 Likewise, the ndings of this study indicated that some respondents at OPDs and healthcare centres also perceived that medicines for NCDs were out-of-stock during one point in time at OPDs and healthcare centres within the past three months before the date of data collection.…”

Section: Discussionmentioning

confidence: 99%

“…20 Unavailability of medicines in government health facilities forced adult patients with NCDs to buy the medicines at private facilities and pharmacies. 20 Likewise, the ndings of this study indicated that some respondents at OPDs and healthcare centres also perceived that medicines for NCDs were out-of-stock during one point in time at OPDs and healthcare centres within the past three months before the date of data collection. Therefore, NCDs are chronic diseases that are managed continually with medication speci c to a particular NCD a patient suffers from, and unavailability of these medicines means an interruption in the management of NCDs.…”

Section: Discussionmentioning

confidence: 99%

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

Maja

Mahlatsi

2022

Preprint

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Background Medicines for non-communicable diseases (NCDs) are essential in the management of patients with NCDs therefore, it is important that they are readily available to patients at health facilities. Objective This study aimed to assess the availability of medicines used in the management of hypertension, diabetes mellitus, asthma and epilepsy in public outpatient departments (OPDs) and healthcare centres in Lesotho. Methods A cross-sectional study was conducted at public OPDs in district hospitals and healthcare centres in Lesotho using self-administered structured questionnaires targeting all health workers in managerial positions. Ethical approval was obtained from a licenced Health Research Ethics Committee (HREC) (Ethics number: 00048-18-A1) and the Ministry of Health Ethics Committee and Review Board of Lesotho (ID120-2018). Data were analysed descriptively. Results Ten of 16 respondents at OPDs perceived that medicines for diabetes mellitus were available and nine thought those for hypertension and asthma were available. Eight of 16 respondents perceived that medicines for epilepsy were available at OPDs. At healthcare centres, 73.3% (n = 63) of respondents perceived that medicines for diabetes mellitus were available, 62.8% (n = 54) thought hypertension medicines were available, 68.6% (n = 59) indicated that medicines for asthma were available, and 61.6% (n = 53) perceived that medicines for epilepsy were also available. Conclusion The majority of health workers at OPDs and healthcare centres perceived that medicines for hypertension, diabetes mellitus, asthma and epilepsy were available at health facilities. Thus, suggesting that the public health facilities in Lesotho seem to almost always have medicines for NCDs.

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“…Households made significant tradeoffs in order to cope with the high prices of medicines, often resulting in the depletion of household wealth over time. These findings suggest that NCD medicine availability and affordability remain an ongoing issue ([ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Coping with access barriers to non‐communicable disease medicines: qualitative patient interviews in eight counties in Kenya

Raskin

Wirtz

et al. 2021

BMC Health Serv Res

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Background There is rich literature on barriers to medicines access for the treatment of non-communicable diseases (NCDs) in high-income countries. Less is known about low- and middle-income countries, in particular the differences in coping with medicines access barrier by household wealth and disease. The aim of this study was to compare the coping mechanisms of patients with the lack of availability and affordability of cardio-vascular diseases, diabetes and asthma medicines in Kenya. Methods This qualitative study was part of a larger mixed methods evaluation study conducted in eight counties of Kenya from 2016 to 2019. Forty-nine patient interviews at study end line explored their NCD journey, perceptions of availability, stockouts and affordability of NCD medicines, their enrollment in health insurance, and their relationship with the private chemists. Transcribed interviews were coded using Nvivo software. A two-step thematic approach was used, first conducting a priority coding which was followed by coding emerging and divergent themes. Results Overall, we found that patients across all disease types and wealth level faced frequent medicine stock-outs at health facilities. In the absence of NCD medicines at health facilities, patients coped by purchasing medicines from local chemists, switching health facilities, requesting a different prescription, admitting oneself to an inpatient facility, establishing connections with local staff to receive notifications of medicine stock, stocking up on medicines, utilizing social capital to retrieve medicines from larger cities and obtaining funds from a network of friends and family. Categorizing by disease revealed patterns in coping choices that were based on the course of the disease, severity of the symptoms and the direct and indirect costs incurred as a result of stockouts of NCD medicines. Categorizing by wealth highlight differences in households’ capacity to cope with the unavailability and unaffordability of NCD medicines. Conclusions The type of coping strategies to access barriers differ by NCD and wealth group. Although Kenya has made important strides to address NCD medicines access challenges, prioritizing enrollment of low wealth households in county health insurance programs and ensuring continuous availability of essential NCD medicines at public health facilities close to the patient homes could improve access.

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Perceptions of Kenyan adults on access to medicines for non-communicable diseases: A qualitative study

Cited by 24 publications

References 17 publications

Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya

Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya

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

Coping with access barriers to non‐communicable disease medicines: qualitative patient interviews in eight counties in Kenya

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