Availability, price and consumption patterns of medicines for non-communicable diseases in Kenya
Ashigbie, Paul Gamelie Kwame
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BACKGROUND: The Comprehensive Global Monitoring Framework on non-communicable diseases (NCDs) identifies availability and price of NCD medicines as critical indicators of access to treatment. This dissertation project conducted in eight counties in Kenya studies the: i) availability and prices of NCD medicines in public and non-profit health facilities and private drug outlets; ii) feasibility and validity of data collection on medicine availability and price through telephone interviews compared to in-person; and iii) effects Novartis Access, a NCD medicine pricing scheme, on medicine consumption patterns. METHODS: In 2016 medicine availability and price data were collected in-person through household and facility surveys. Between 2016 and 2018, monthly telephone surveillance data on medicines from health facilities and households were compared with data collected in-person. In-depth interviews (IDIs) were conducted with 25 respondents and data collectors to understand their perceptions on both modes of data collection. Sales data on Novartis Access medicines and their generic and therapeutic equivalents were collected from a major wholesaler. The effects of Novartis Access medicines on the consumption generic and therapeutic equivalents and on the consumption of medicines not listed in the national Essential Medicines List (EML) were estimated using segmented regression analysis. RESULTS AND DISCUSSION: Availability of NCD medicines was low, especially among primary care facilities in the public sector. Prices varied substantially by provider type and level of care, with prices generally lower in the public sector. Telephone interviews were cheaper than in-person interviews; demonstrated high response rates; showed statistically significant level of agreement and correlation with medicine availability and price data respectively from in-person interviews. Most IDI participants mentioned phone interviews were more convenient and yielded good data. Consumption of non-EML medicines was widespread. The introduction of Novartis Access had no statistically significant effect on the overall level and trend of consumption of generic equivalents and non-EML medicines. CONCLUSION: Interventions need to be implemented to address the poor availability of NCD medicines and large variation in prices and to ensure that access initiatives focus on priority medicines. Phone interviews are reliable and valid for collecting data on medicine availability and prices and should be routinely employed.