Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level

Abstract

Background Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system. Methods The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.” Results Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed. Conclusions The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.

Deep learning model for forecasting COVID-19 outbreak in Egypt

“…Many scholars have studied the COVID-19 spread in Egypt from various perspectives: a) impact of partial and complete lockdown on the air quality and health environment ( Abou El-Magd and Zanaty, 2020 ), b) public awareness and attitude towards the COVID-19 ( Abdelhafiz et al, 2020 ), c) psychological impact of COVID-19 on healthcare professionals and the public ( Elkholy et al, 2020 ; AboKresha et al, 2021 ; Arafa et al, 2021 ), d) influence of COVID-19 pandemic on education in medical schools ( Shehata et al, 2020 ), e) skeleton of the health services post COVID-19 ( Kamel, 2020 ). This research is concerned with applying time-series analysis to estimate the number of COVID-19 cases.…”

Implementing essential diagnostics-learning from essential medicines: A scoping review

“…They contributed to the improved availability of essential medicines. Procurement and distribution-related barriers were addressed through direct distribution of supplies from partners 50,60,130,164,167 , PBF 62 , RDF programmes 92,121,200 , and utilization of ICT 68,70 203,204 , RE-AIM (Reach, effectiveness, adoption, implementation, and maintenance) 204,205 , and PRISM (practical, robust implementation sustainability model) 206,207 frameworks would be crucial when planning the implementation of the essential lists to guide adoption, adaptation, and evaluation of the lists. Qualitative research and process evaluations can be done to evaluate the impact of the essential lists and identify enablers and challenges to their implementation.…”

“…The enablers for the EDL and EML are opposite to the barriers mentioned above 113,33,63,68,79,92 . The enabler unique to the EML was compliance with the national EML in rural settings compared to urban 68 .…”

“…The barriers related to the relationship with norms and standards for the EDL implementation included poor availability of diagnosis and management guidelines, noting the unavailability of diabetes guidelines in any surveyed clinics 165 . Other barriers unique to the EML included incompliance to guidelines 50,53,131,149,153,166,168,169 , incompliance to national EMLs 48,68,79,132,145,170 , lack of national EMLs in facilities 128,171 , disconnect between guidelines on treatment protocols 47,75 , disconnect between policy, guidelines and practice 46,167 , and lack of standard operating procedures 135 .…”

“…The influential people-related barriers to the EML implementation included pharmaceutical promotions to influence prescription practice and revisions of standard treatment guidelines 50,66 and implementation of international recommendations separate from other national programmes, for instance, the vertical programmes 66 . Other barriers included the limited influence of health care managers on policy and resource development 36 , lack of support to the local pharmaceutical production leading to reliance on importations 68 , and donors' operation outside the policy framework 46 .…”