Top

BMC Health Services Research

Published in:

Open Access 01-12-2022 | Misoprostol | Research

Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia

Authors: Fantaye Teka Dinkashe, Kinfe Haile, Fatimetu Mohammed Adem

Published in: BMC Health Services Research | Issue 1/2022

Abstract

Background

Access to life-saving medicines for maternal health remains a major challenge in numerous developing nations. Periodic and continuous assessment of access to lifesaving commodities is of enormous importance to measure progress and ensure sustainable supply. This study aimed to assess the availability and affordability of priority lifesaving maternal medicines in Addis Ababa in January 2021.

Methods

An institutional-based cross-sectional study design was employed to assess 33 representative private pharmacies, public health facilities, NGO and private hospitals providing maternal health care and dispensing medicines from January 12 to 27, 2021 in Addis Ababa, the capital city of Ethiopia. WHO and Health Action International procedures were followed to determine sample size, sampling of health facilities, and data collection. WHO and UNFPA priority lifesaving maternal health medicines included in the Ethiopia essential medicine list were included in the study. Data were cleaned and entered into SPSS version 25 for analysis.

Result

The overall mean availability of maternal health medicines was fairly high, 59% (range 6%-94%), as per the WHO availability index. Among the four sectors, the private pharmacy had the lowest availability (40%), while the mean availability in private hospitals, public and NGO/mission sector facilities were 70%, 72% and 72% respectively. Medicines used only for the management of maternal health conditions had lower availability (47%) compared to commodities used for the broader indication (65%). Compared based on source, the average availability of maternal health medicines which could be sourced locally was (68%) higher than imported medicines (55%). Affordability was not an issue in the public sector, public facilities offered maternal health medicines at no cost to the client. On the other hand, the private hospitals dispensed only 13% of the medicines at affordable prices followed by the private pharmacies (17%) and NGO/Mission facilities (29%). Furthermore, key challenges to access maternal health medicines were frequent stockouts in the public sector and the high cost of medicines in the private sector.

Conclusion

Even though it was below the recommended 80% availability, fairly high availability with variabilities across sectors was observed. Except in the public sector, maternal health medicines were unaffordable in Addis Ababa.

Available only for authorised users

Droti B, Neill KPO, Mathai M, Yao D, Dovlo T, Robertson J. Poor availability of essential medicines for women and children threatens progress towards Sustainable Development Goal 3 in Africa. BMJ Glob Heal. 2019;4 Suppl 9(e001306):1–10.

JSI Research & Training Institute I. 2014. A Commodity Security Framework for Maternal Health [Internet]. Arlington. Available from: https://www.rhsupplies.org/uploads/tx_rhscpublications/CommSecuFramMateHeal_01.pdf

CSA, ICF. 2016. Ethiopia Demographic and Health Survey 2016. [Internet]. Addis Ababa, Ethiopia, and Rockville, Maryland, USA. Available from: https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf

WHO. 2010. Monitoring the building blocks of health systems : a handbook of indicators and their measurement strategies. [Internet]. Geneva, Switzerland. Available from: https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

Schöpperle A. 2013. Analysis of challenges of medical supply chains in sub-Saharan Africa regarding inventory management and transport and distribution [Internet]. University of Westminster. Available from: https://iaphl.org/wp-content/uploads/2016/05/Medical-Supply-Chain-Challenges.Masterthesis.ASchoepperle.pdf

WHO. 2011. Priority medicines for mothers and children [Internet]. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi1mKnG0ZLxAhWJRkEAHURDD78QFjABegQIAxAE&url=https%3A%2F%2Fwww.who.int%2Fmedicines%2Fpublications%2Femp_mar2011.1%2Fen%2F&usg=AOvVaw32f5610-ptOVsoK0sCbLDc

WHO. 2012. Priority life-saving medicines for women and children [Internet]. Available from: https://www.who.int/reproductivehealth/publications/general/emp_mar2012.1/en/

Bahl K, Lee C, Palmer A, Rosenberg T. 2016. Increasing Access to Essential Maternal Health Supplies [Internet]. Available from: https://www.rhsupplies.org/uploads/tx_rhscpublications/Increasing_Access_to_Essential_Maternal_Health_Supplies_-_A_scoping_of_market-based.pdf

Assefa Y, Tesfaye D, Van Damme W, Hill PS. Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in Ethiopia. Lancet. 2018;392(10156):1473–81. https://doi.org/10.1016/S0140-6736(18)32215-3.CrossRefPubMed

10.

Ali EE, Gilani A, Gedif T. Pharmaceutical Pricing in Ethiopia. In: Pharmaceuticals Prices in 21st Century. Springer International Publishing Switzerland; 2015. https://doi.org/10.1007/978-3-319-12169-7_5.

11.

EPSA. About Us- Ethiopian pharmaceuticals supply Agnecy [Internet]. [cited 2021 Nov 16]. Available from: https://epsa.gov.et/about-us-2/

12.

HPR E. Drug fund and Pharmaceuticals supply agency establishment proclamation. proclamation Number 553/2007. federal negarit Gazeta of federal Democratic republic of Ethiopia. 2007 Sep;

13.

WHO, HAI. 2008. Measuring medicine prices, availability, affordability and price components, 2nd Edition [Internet]. Switherland. Available from: https://www.who.int/medicines/areas/access/OMS_Medicine_prices.pdf

14.

Muiruri CW, Mugambi DMM. Factors Influencing Availability of Essential Medicines in Public Health Facilities in Kenya: a Case of Embu County. IAJISPM [Internet]. 2017;2(2):43–57. Available from: https://www.iajournals.org/articles/iajispm_v2_i2_43_57.pdf.

15.

Briggs J, Embrey M, Maliqi B, Hedman L, Requejo J. How to assure access of essential RMNCH medicines by looking at policy and systems factors : an analysis of countdown to 2015 countries. BMC Heal Serv Res. 2018;18:952.CrossRef

16.

PATH. 2015. Scaling Up Commodities for Women , Children , and Newborns; An Advocacy Toolkit [Internet]. Washngton, DC. Available from: https://path.azureedge.net/media/documents/APP_advocacy_toolkit.pdf

17.

HAI. 2019. Report sexual and reproductive health commodities : prices , availability and affordability report sexual and reproductive health commodities : prices , availability and affordability [Internet]. Overtoom 60 (2) | 1054 HK Amsterdam, The Netherlands. Available from: https://www.heps.or.ug/publications/sexual-and-reproductive-health-commodities-prices-availability-and-affordability

18.

Ewen M, Kaplan W, Gedif T, Mirza Z, Regeer B, Zweekhorst M, et al. Prices and availability of locally produced and imported medicines in Ethiopia and Tanzania. J Pharm Policy Pract [Internet]. 2017;1–9. Available from: http://dx.doi.org/https://doi.org/10.1186/s40545-016-0095-1

19.

Nnorom CE. Health System Predictors of Access to Maternal Health Medicines in Low and Middle Income Countries. Ann Glob Heal. 2017;83(1):122.CrossRef

20.

Gutema G, Engidawork E. Affordability of commonly prescribed antibiotics in a large tertiary teaching hospital in Ethiopia : a challenge for the national drug policy objective. BMC Res Notes [Internet]. 2018;4–9. Available from: https://doi.org/10.1186/s13104-018-4021-2

21.

Damtew D, Worku F, Tesfaye Y, Jemal A. Availability of Lifesaving Maternal and Child Health Commodities and Associated Factors in Public and Private Health Facilities of Addis Ababa. Ethiopia Heal Serv Res Manag Epidemiol. 2019;6:1–9.

22.

Sani SA. 2017. Outbound logistics of medicines in private pharmacies in addis ababa [Internet]. Addis Ababa University. Available from: http://etd.aau.edu.et/handle/123456789/13909

23.

ESA. Primary Hospital - Requirements [Internet]. Addis Ababa, Ethiopia; 2012. Report No.: ES3617:2012. Available from: http://repository.iifphc.org/bitstream/handle/123456789/557/Ethiopian standard Primary Hospital 2012.pdf?sequence=1&isAllowed=y

24.

ESA. Health Center - Requirements [Internet]. Addis Ababa, Ethiopia; 2012. Available from: http://repository.iifphc.org/bitstream/handle/123456789/556/Ethiopian standard health centers.pdf?sequence=1&isAllowed=y

25.

United Nations Population Fund. 2012. UN commission on life-saving commodities for women and children Commissioners’ Report [Internet]. New York, NY. Available from: https://www.unfpa.org/publications/un-commission-life-saving-commodities-women-and-children

26.

FMHACA. 2015. National Essential Medicine List Fifth Edition [Internet]. Addis Ababa, Ethiopia. Available from: https://www.who.int/selection_medicines/country_lists/EML_5th_edition_2015.pdf

27.

MOH. OBSTETRICS MANAGEMENT PROTOCOL For Health Centers. Ministry of Health- Ethiopia. Addis Ababa: OBSTETRICS MANAGEMENT PROTOCOL; 2021. https://moh.gov.et.

28.

MOH. OBSTETRICS MANAGEMENT PROTOCOL FOR HOSPITALS. Ministry of Health- Ethiopia. Addis Ababa: OBSTETRICS MANAGEMENT PROTOCOL FOR HOSPITALS; 2021. https://moh.gov.et.

29.

MOH. First Trimester Comprehensive Abortion Care, Participant’s Manual, Second Edition. Addis Ababa: Ministry of Health- Ethiopia; 2018.

30.

MOH. 2015. National guidelines for the management of sexually transmitted infections using syndromic approach [Internet]. Federal Ministry of Health. Addis Ababa, Ethiopia.. Available from: http://apps.who.int/medicinedocs/en/m/abstract/Js22268en/

31.

EFDA. 2021. Registered products [Internet]. Registered Products. [Cited 2021 Jan 23]. Available from: https://www.eris.efda.gov.et/public/products

32.

NBE. 2021. Transaction exchange rates for major currencies against birr-national bank [Internet]. [cited 2021 Jan 20]. Available from: https://nbebank.com/transaction-exchange-rates-for-major-currencies-against-birr/

33.

Ministers of Council. Federal civil servants position rating, grading and salary scale council of ministers regulation number 455/2019. Federal negarit Gazette. 2019 Oct 2;11862 and 11863.

34.

UNFPA. 2016. 2015 Health Facility Assessment for Reproductive Health Commodities and Services. [Internet]. Available from: http://library1.nida.ac.th/termpaper6/sd/2554/19755.pdf

35.

Bizimana T, Kayumba PC, Heide L. Prices, availability and affordability of medicines in Rwanda. PLoS One [Internet]. 2020;15:1–14. Available from: https://doi.org/10.1371/journal.pone.0236411.CrossRef

36.

Fentie M, Fenta A, Moges F, Oumer H, Belay S, Sebhat Y, et al. Availability of Essential Medicines and Inventory Management Practice in Availability of Essential Medicines and Inventory Management Practice in Primary Public Health Facilities of Gondar Town, North West Ethiopia. J PharmaSciTech. 2015;4(2):54-56.

37.

Pronyk PM, Nemser B, Maliqi B, Springstubb N, Sera D, Karimov R, et al. The UN Commission on Life Saving Commodities 3 years on : global progress update and results of a multicountry. Lancet Glob Heal [Internet]. 2016;4(4):e276-86. Available from: https://doi.org/10.1016/S2214-109X(16)00046-2.CrossRef

38.

Tesfaye G, Loxton D, Chojenta C, Assefa N, Smith R. Magnitude, trends and causes of maternal mortality among reproductive aged women in Kersa health and demographic surveillance system, eastern Ethiopia. BMC Womens Health. 2018;18(1):1–10.CrossRef

39.

Sado E, Sufa A. Availability and affordability of essential medicines for children in the Western part of Ethiopia : implication for access. BMC Pediatr [Internet]. 2016;1–8. Available from: http://dx.doi.org/https://doi.org/10.1186/s12887-016-0572-3

40.

Ewen M, International HA, Kaplan W. 2016. Prices and availability of locally produced and imported medicines in Ethiopia [Internet]. Available from: https://haiweb.org/wp-content/uploads/2016/12/Price-Availability-Local-vs-Imported-Meds-in-Ethiopia.pdf

41.

Debalke F, Belayneh K. Explore the Challenge in Medicines Registration Process in Ethiopia : Qualitative Phenomenological Study Acta Scientific Pharmaceutical Sciences ( ISSN : 2581–5423) Explore the Challenge in Medicines Registration Process in Ethiopia : Qualitative Phenome. Acta Sci Pharm Sci. 2020;4(1):44–51.

42.

Hailu AD, Mohammed SA. Availability, Price and Affordability of WHO Priority Maternal and Child Health Medicine in Public Health Facilities of Dessie, North-East Ethiopia. BMC Med Inf Decis Mak. 2020;20(221):1–23.

Title: Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia
Authors: Fantaye Teka Dinkashe
Kinfe Haile
Fatimetu Mohammed Adem
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Misoprostol
Published in: BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-022-07793-x

2024 ASCO Annual Meeting

Springer Medicine

Availability and affordability of priority lifesaving maternal health medicines in Addis Ababa, Ethiopia

Abstract

Background

Methods

Result

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

The implementation of value-based healthcare: a scoping review

Over-the-counter sale of antibiotics during COVID-19 outbreak by community pharmacies in Saudi Arabia: a simulated client study

A real-world economic analysis of biologic therapies for psoriatic arthritis in Italy: results of the CHRONOS observational longitudinal study

Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

Being a member of a novel transitional case management team for patients with unstable housing: an ethnographic study

Trust-based service innovation of municipal home care: a longitudinal mixed methods study