Availability, price, and affordability of medicines for chronic care: A cross-sectional study of anti-hypertensives in Kampala City

Abstract

Introduction: In Uganda, NCDs are estimated to account for 33% of all deaths while cardiovascular complications of hypertension account for 10% of total deaths (WHO, 2018b). The prevalence of hypertension in Uganda among adults is 26.4% (Guwatudde et al, 2015) which highlights the high need to ensure optimum access to anti-hypertensive medicines. While health services are free in public facilities in Uganda, the public system is characterised by stock-outs of essential medicines and supplies which constrains access to essential NCD medicines. The alternative is the private sector through pharmacies. A number of patients go to the public sector and get prescriptions but are referred to the private sector to access the drugs. Given that medicines are critical for the survival of patients with NCDs, we are not sure where they are sent, are the medicines available, at what price, and are they affordable? This study therefore intended to determine the availability, price and affordability of anti-hypertensive medicines in pharmacies in Kampala. Methods: A survey was conducted in the five divisions of Kampala city to collect quantitative data on availability and price of selected anti-hypertensive medicines in independent retail pharmacies and pharmacies found inside health facilities (PFP and PNFP facilities). Affordability was then calculated with regards to the daily wage of the lowest-paid government employee. Medicines were considered available if they were found present in the pharmacy on the day of the survey and affordable if the monthly dosage cost of the least priced generic is less than the daily wage of the lowest paid government employee. Availability and affordability were determined across private for profit and private not for profit pharmacies. Results: In Independent pharmacies, only 2 out of the ten medicines surveyed had availability of less than 80% compared with 3 and 5 medicines having availability of less than 80% in private-for-profit (PFP) and private-not-for-profit (PNFP) facilities respectively. Median price ratios (MPR) indicated that all medicines in all facilities were more expensive in Uganda compared to international reference prices. Five medicines (Atenolol, Bendroflumethiazide, Captopril, Nifedipine and Propranolol) were affordable in Independent pharmacies, only three (Atenolol, Bendroflumethiazide and Propranolol) in PNFP facilities and none in PFP facilities showing that Independent pharmacies charged the least prices followed by PNFP and PFP facilities. Conclusion: The results indicate that most anti-hypertensive medicines are not affordable to low income patients across the private sector. Access in terms of availability, price and affordability was better for independent retail pharmacies compared to pharmacies situated in PFP and PNFP facilities. Recommendations: There is a need for a pricing policy to improve the affordability of anti-hypertensive medicines in Uganda. There is also a need for incentives like the NHIS to improve affordability and hence accessibility. Generic substitution of high-priced anti-hypertensives for relatively cheaper therapeutic alternatives can also enable low-income patients to afford the medicine.