SEARCHCROSS-SECTIONALpublic health, epidemiology

cross-sectional·public health, epidemiology, family medicine, internal medicine·PMC10583350

Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

International Journal for Equity in Health · 14 authors, 1 centre

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TL;DR

This cross-sectional study assessed 30 primary healthcare dispensaries and 630 patients in Khartoum state, finding essential medicine availability was 36.8% for adults and 6.7% for pediatric formulations, with median prices 16.4 times international references.

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This cross-sectional study evaluated essential medicine access at 30 primary healthcare facilities across three districts in Khartoum state, Sudan, using a standardized checklist for 21 medicines from Sudan's national essential medicines list and exit interviews with 630 patients. The overall availability of adult and pediatric essential medicines was 36.8% and 6.7%, respectively, markedly below the WHO standard of 80%. Cost of a single treatment course exceeded the daily wage of insured patients for 10 of 19 drugs and uninsured patients for 16 of 19 drugs, with a median price ratio of 16.4. Only 26.7% of participants reported full access, with patient-rated affordability at 1.5/4. Storerooms were non-functional in 40% of outlets, though dispensary conditions were acceptable.

STUDY TYPE

cross-sectional

SPECIALTY

public health

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ORIGINAL PAPER

PMC10583350

Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

International Journal for Equity in Health

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ABSTRACT

Abstract Background Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn’t well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients’ perceived affordability of essential medicines, and accommodation and acceptability of the public facility. Methods A cross-sectional study was carried out at 30 primary healthcare facilities’ drug dispensaries across three districts in Khartoum state. Within each Centre’s dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan’s national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. Results Participants’ ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. Conclusion Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients’ access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients’ satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-023-02009-y. Keywords: Essential medicines, Primary healthcare services, Affordability, Universal health coverage, Sudan’s healthcare

CITATION EXPORT

Lina Hemmeda, Abubaker E A Koko, Radia F Mohamed et al.. Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives. International Journal for Equity in Health. (2023). https://doi.org/10.1186/s12939-023-02009-y

AUTHORS

14 · 1 CENTRES

Lina Hemmeda, Abubaker E A Koko, Radia F Mohamed, Yousra Ibrahim Abdallah Mohammed, Abeer Osman Mukhtar Elabid, Alaa T Omer, Amna Abdel Rafea Al Hashemi Hamida, Aya M Haiba, Eithar M Ali, Istabraq I Abdelgadir, Reem M Al Fanob, Saja S Mohamed Almahadi, Sara Ali, Suzan A A Mahgoub

1Faculty of Medicine, University of Khartoum, Khartoum, Sudan