RESUMEN
BACKGROUND: To assess the effect of policies supporting local medicine production to improve access to medicines. METHODS: We adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in stock for medicines on a country-specific list. Government procurement prices were also collected. Prices were compared to an international reference and expressed as median price ratios (MPR). RESULTS: The Ethiopian government paid more for local products (median MPR = 1.20) than for imports (median MPR = 0.84). Eight of nine medicines procured as both local and imported products were cheaper when imported. Availability was better for local products compared to imports, in the public (48% vs. 19%, respectively) and private (54% vs. 35%, respectively) sectors. Patient prices were lower for imports in the public sector (median MPR = 1.18[imported] vs. 1.44[local]) and higher in the private sector (median MPR = 5.42[imported] vs. 1.85[local]). In the public sector, patients paid 17% and 53% more than the government procurement price for local and imported products, respectively. The Tanzanian government paid less for local products (median MPR = 0.69) than imports (median MPR = 1.34). In the public sector, availability of local and imported products was 21% and 32% respectively, with patients paying slightly more for local products (median MPR = 1.35[imported] vs. 1.44[local]). In the private sector, local products were less available (21%) than imports (70%) but prices were similar (median MPR = 2.29[imported] vs. 2.27[local]). In the public sector, patients paid 135% and 65% more than the government procurement price for local and imported products, respectively. CONCLUSIONS: Our results show how local production can affect availability and prices, and how it can be influenced by preferential purchasing and mark-ups in the public sector. Governments need to evaluate the impact of local production policies, and adjust policies to protect patients from paying more for local products.
RESUMEN
Though important in the development of educational materials for the public, community drug use studies are rare in Ethiopia. This community based cross-sectional study was conducted in Addis Ababa between November 1995 and January 1996 to describe community's perception on drugs, identify people's various sources of modern drugs and determine factors associated with drug use. The study results show that out of the 903 persons who reported an illness in the four weeks recall period, 231 (26%) did not take any action for their illness. The reasons being mainly the perception that the illness was minor and economic inaccessibility. Regarding sources of modern drugs, the majority 398 (63%) of those who used modern drugs obtained their medications from government health institutions. Drug sharing was practiced by 156 (17%) of the respondents. In addition, 39 (6%) prematurely discontinued their treatment course and the majority did so either due to inability to comprehend the instructions or having some social entertainment. It was also found that 178 (20%) of the studied households were found hoarding drugs and the most common ones were oral antibiotics and antipyretic analgesics. In addition, gender and education were found to have an association with drug hoarding. The study also identified factors associated with household drug hoarding and drug sharing among family members or neighbours; in this respect, the former was found associated with education and gender but the latter was associated with sex, age, education and marital status. In conclusion, drug sharing among families, friends or relatives are commonly practiced in Addis Ababa community. In addition, many patients stopped taking their prescribed drugs once they started to feel better.