Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia.

BACKGROUND: Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia's public and private medicine outlets with respect to availability and affordability parameters. METHODS: A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. RESULTS: Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. CONCLUSIONS: There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Access to Essential Medicines for Diabetes Care: Availability, Price, and Affordability in Central Ethiopia.

Background: Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. Methods: A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. Results: Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5mg, metformin 500mg) and two blood pressure-lowering medications (nifedipine 20mg and hydrochlorothiazide 25mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets, respectively. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. Conclusion: There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Relevant stakeholders should work to improve access to EMs.

Assessment of Knowledge, Practices, and Challenges of Pharmaceuticals Inventory Control Among Pharmacy Professionals Working in Selected Public Health Facilities of West Arsi Zone, Oromia, Ethiopia.

BACKGROUND: Good pharmaceutical inventory control enables health facilities (HFs) to provide complete health care by ensuring the availability of safe, effective, and affordable pharmaceuticals and related supplies of the required quality, inadequate quantity, at the required place and at all times. It boosts patients' trust in the HFs and motivates working staff. However, it needs well-trained and skilled professionals. The aim of the current study was, therefore, assessing knowledge, practice, and challenges of pharmacy professionals conducting inventory control in selected public health facilities of West Arsi Zone, Oromia regional state for the year 2016 to 2018. METHOD: A mixed-methods study design was used to assess pharmacy professionals' knowledge, skills, and challenges in applying inventory management methods. A semi-structured questionnaire was implemented for quantitative, whereas an open-ended question was employed for key informants (KIs) to explore qualitative data. RESULT: Ninety percent of pharmacy professionals knew about VEN analysis concepts and 70% about ABC analysis. However, none of them had a concept of FSN and XYZ analysis. Among the respondents who knew the concept, 75% had gained knowledge through formal training and 10% of them learned from on-job training. When they asked about the methods of inventory control, 60% responded as they did not hear about it. Of those who said "Yes" on being asked to mention at least 1 method of it, 80% could not able to correctly mention the methods used in inventory control. However, 44%, 62.5%, and 75% of respondents had practiced ABC, VED, and ABC-VED matrix analysis respectively. The challenges that prevented these professionals from practicing pharmaceutical inventory control in their HFs were grouped into price-related, training-related, human resource-related, and managerial-related factors. CONCLUSION: Inventory control is the heart of the pharmaceutical supply system. Without its healthy action, HFs' goal attainment will not be viable. Problems of sick pharmaceutical inventory control are directly related to a lack of knowledge and appreciation of it by the concerned bodies. The current finding revealed almost all pharmacy professionals included in the study had little knowledge about how to manage their inventories. Managers' unwillingness to cooperate and facilitate necessary resources prevented the professionals from doing inventory control.

Availability and affordability of children essential medicines in health facilities of southern nations, nationalities, and people region, Ethiopia: key determinants for access.

BACKGROUND: Children in resource-limited countries are more likely to die from treatable conditions than those in higher resource settings due to a lack of the right essential medicine at the right time. Globally millions of children die every year from conditions that could be treatable with existing medicines before they reach their fifth birthday. This study aimed in assessing the availability and affordability of essential medicine for children in selected health facilities of southern nations, nationalities, and peoples' regions (SNNPR), Ethiopia. METHOD: A medicine outlets-based cross-sectional study was conducted to assess the availability, affordability, and prices of the 30 selected essential medicines (EMs) for children in 30 public and 30 private medicine outlets in SNNPR from March 29 to May 5, 2019, applying WHO and Health Action International (HAI) tools. Availability was expressed as the percentage of sampled medicine outlets per sector that the surveyed medicine was found on the day of data collection. The amount of daily wages required for the lowest-paid government unskilled worker (LPGW) to buy one standard treatment of an acute condition or treatment for a chronic condition for a month was used to measure affordability and median price ratio for the price of EMs. THE RESULTS: Availability varied by sector, type of medication, and level of health facilities. The average availability of EM was 57.67% for the public sector and 53.67% for the private sector. Ceftriaxone, SOR, zinc sulfate, and cotrimoxazole were the most widely available types of medications in the two sectors. The median price ratios (MPR) for the cheapest drugs LP were 1.26 and 2.24 times higher than their International Reference Price (IRP) in the public and private sectors respectively. Eighty-two percent of LP medicines in the public and 91 % of LP medicines in the private sectors used in the treatments of prevalent common conditions in the region were unaffordable as they cost a day's or more wages for the LPGW. CONCLUSION: Availability, affordability, and price are determinant pre-requisite for EMs access. According to the current work, although fair availability was achieved, the observed high price affected affordability and hence access to EMs.

In Vitro Comparative Quality Assessment of Different Brands of Doxycycline Hyclate Finished Dosage Forms: Capsule and Tablet in Jimma Town, South-West Ethiopia.

BACKGROUND: Persistent postmarket quality evaluation helps produce clear information on the current quality status of the different brands of a given drug and hence introduces a biopharmaceutical and therapeutically equivalent list of the products to the prescribers and users of it. This in turn facilitates access to essential medicines by breaking the high-cost barrier imposed by a few expensive brands of the product. This study was aimed at determining the quality and evaluating the equivalence of doxycycline hyclate capsules and tablets in Jimma, Ethiopia. METHODS: Ten brands of doxycycline hyclate capsules and tablets were tested for product identity, dosage uniformity, assay, and in vitro dissolution; and tablets were tested for friability and hardness. RESULTS: All investigated brands of doxycycline complied with the USP for dosage uniformity, an assay of the active ingredient, and single-point dissolution tests. One brand, D09, failed both hardness and friability tests. Comparisons of dissolution profiles applying fit factors confirmed that only brands D04, D06, and D07 had similarities with the innovator. Ratio test approaches also showed that significant variability exists between test products and comparators. Weibull model was found to provide the best adjustment curve for all brands, from model-dependent approaches employed for explaining the overall release of drug from the dosage forms. CONCLUSIONS: Doxycycline is a biowaiver product. Hence, in vitro dissolution evaluation suffices its market approval. In this quality assessment study, however, the samples passed quality control tests, except D09 brand which failed friability; it has been revealed that five out of eight brands had problems with interchangeability. Only three doxycycline hyclate brands were found to be equivalent to the comparators.

Evaluation of Pharmaceuticals Inventory Management in Selected Health Facilities of West Arsi Zone, Oromia, Ethiopia.

BACKGROUND: Effective inventory management ensures an uninterrupted supply of safe, effective, and affordable pharmaceuticals which could be achieved through developing ABC-VEN (Always, Better, Control-Vital, Essential, Desirable) and FSN-XYZ (Fast, Slow, Non-moving-High, Medium, Low Value) matrix analysis. ABC-VEN matrix analysis is used to control inventory according to their annual consumption and on their functional importance whereas, FSN-XYZ matrix analysis is applied to control inventory by identifying the items to be discarded and the amount saved during the closing of annual accounts. OBJECTIVE: To evaluate inventory management in selected health facilities of West Arsi zone, Oromia regional state for the year 2016-2018. METHODS: Facility-based cross-sectional descriptive study complemented with a qualitative study was conducted in fourteen health facilities. Data were collected from goods issuing vouchers for the year 2016-2018 to perform ABC-VEN matrix analysis. The frequency of issue was collected to perform FSN analysis and the value of each closing stock was taken to get XYZ analysis. RESULTS: From the ABC-VEN matrix analysis, 26.6% of items were Category I of which the highest proportion were taken by class A and V items consuming 84.7% of annual drug expenditure (ADE). The remaining 49.2% and 24.2% of the drugs accounted for only 13.2% and 2.1% of the ADE being category II and III, respectively. Based on FSN-XYZ matrix analysis findings, category I with 41.% item share account for the highest budget (average 86.5% of values). Of this category, the XN group-non-moving and high-cost drugs had the high value (20%) which need managerial measure. In category III, the ZN group items, being 25% of drugs, only had 2.2% of value-that may increase wastage, inventory holding cost, and shortage of storage space. CONCLUSION: The matrix analysis for inventory control is a strong tool that enables one to identify items requiring close monitoring. The coupled ABC-VEN matrix analysis, combining their individual advantages - inventory's cost and its functional importance help in achieving a meaningful inventory management. However, to control the stock at an appropriate level with minimum shortage and oversupply, it has to be supported by XYZ-FSN matrix analysis. The XYZ-FSN matrix benefits the health facilities to determine the level of inventory with high value in dead-stock, and to take measures like transferring to others, discarding, or saving.

Effect of Auditable Pharmaceutical Services and Transaction System on Pharmaceutical Service Outcomes in Public Hospitals of SNNPR, Ethiopia.

BACKGROUND: Auditable pharmaceuticals service and transaction system (APTS) is unique in its systems strengthening approach. It is a data-driven package of interventions designed to establish accountable, transparent, and responsible pharmacy practice. The objective of this study was to assess the outcome performance of pharmaceuticals services among selected hospitals with and without the APTS system in SNNPR, Ethiopia. METHODS: A cross-sectional comparative facility-based study was conducted at public hospitals by using an intervention and control approach to estimate the significance of the difference between average performances of APTS and non-APTS hospitals. A case-to-control ratio was applied to decide the number of sites and a simple random lottery sampling technique was employed to select control sites. The sample size formula was used to determine the proposed population for patient care indicator assessment. Epidata version 3.1 and SPSS version 23 were used for analysis. The study was conducted from March 1 to 30, 2019. RESULTS: APTS implemented hospitals attained 92.3% patient satisfaction on the overall pharmacy services compared to 47.5% for non-APTS hospitals. They have improved essential drugs (EDs) availability, minimum stock-outs, and reduced wastage rates, unlike control groups. They undertook workload analysis to assess human power sufficiency; generate reliable information from accurate recording culture for decision making; practiced transparency and accountability through conducting physical inventory and daily sales tracking/management system; and made budget utilization rationale applying ABC analysis, VEN analysis, ABC/VEN reconciliation, and stock status analysis (SSA) that non-APTS hospitals did less/not. CONCLUSION: In general, higher performances were observed in APTS implemented hospitals than non-APTS hospitals regarding patient knowledge, satisfaction, and medicine availability at stores. In all cases, it needs improvement to achieve target values.

Physicochemical Quality Assessment of Antimalarial Medicines: Chloroquine Phosphate and Quinine Sulfate Tablets from Drug Retail Outlets of South-West Ethiopia.

BACKGROUND: Malaria is a complex disease and main community health problem in Africa and the top leading cause of outpatient visits, admissions, and deaths in Ethiopia. Its effective management is possible through early diagnosis and immediate treatment employing antimalarials. The quality of these drugs has to be good enough to attain their intended purpose. However, there are treatment failures resulted from the consumption of falsified and substandard antimalarials. Therefore, the current study was undertaken to evaluate the quality of two commonly used antimalarial drugs [chloroquine phosphate and quinine sulfate tablets] and to determine whether the quality of these drugs was affected by the origin, brand and sample collection sites in South-West Ethiopia. METHODS: Random sampling based on Ethiopian malaria eco-epidemiological strata map, with different levels of medicines outlets, was applied to select sampling sites. RESULTS: Sixty samples were bought from 43 drug retails (pharmacy, drug store, and drug vendor) in twelve different geographical locations of South-West Ethiopia between June and July 2016. Visual inspection was done for all samples before the lab experiment. A 28.3%, 31.7%, and 6.8% of samples failed to comply with the Pharmacopoeial quality standards for visual inspection, hardness and weight variation tests, respectively. Statistical analysis revealed that origin and geography from which samples were collected significantly affects the active pharmaceutical content of both drugs at P < 0.05 level. Significant variation was observed for chloroquine samples within batches of the same manufacturing and between origins. CONCLUSION: This study indicated that all the chloroquine and quinine tablets met the quality specification concerning friability, dissolution and assay. Out-of-specification results for weight variation, hardness and visual inspection tests for the chloroquine tablets are signs of substandard/spurious/falsely labeled/falsified/counterfeit actions that may compromise the quality of these drugs. Besides, within the acceptance limit, the origin of drugs and collection sites have found to determine the quality which raises good manufacturing practice and storage (drug supply chain system) issues to be evaluated.