Availability and affordability of essential medicines for Non-Communicable Diseases across six Kenyan Counties

Mohamud, Ahmed Mire
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Strathmore University
The burden of Non-Communicable diseases (NCDs) is increasing in Kenya and other low-and middle-income countries. Evidence suggests that poorer groups are more affected as they have to incur lifelong costs of treatment associated with NCDs. Typically, out of pocket payment for NCD medicines consumes the largest share of treatment costs for NCDs, exposing households to the risk of catastrophic health spending. This study sought to assess the availability and affordability of three medicines used for management of diabetes, dyslipidemias (problems of poor cholesterol control) and hypertension in pregnancy at public and private hospitals in Kenya, and assess the risk of incurring catastrophic health expenditure due to out of pocket purchase of the medicines. This study used a quantitative approach, analyzing data using the WHO/HAI methodology to determine availability and affordability of Atovarstatin 20mg, Metformin 500mg, Methyldopa 250mg. The study found out that atorvastatin’s availability was 32% and 70% in public and private facilities respectively; Metformin (94% and 84% in public and private respectively) and Methyldopa 75 and 82% for public and private facilities respectively. The lowest paid government worker would require a day’s wages to purchase a monthly dose of Atorvastatin in public facilities, and three days’ wages to purchase at a private facility. However, price differences were minimal for the other two medicines. The medicine price ratio (MPR) for Atorvastatin was nearly four times that of the international reference price list, the ratio was higher in private facilities as compared to public facilities (4.75 vs 1.19). The MPR for Methyldopa was 1.18 times the international reference price for both public and private facilities. The MPR for Metformin was three times the international reference price with the ratio being higher in private facilities. Finally, the study found that the risk of incurring catastrophic health expenditure due to out of pocket purchase of medicines for households was 1.5%, 6.8%, 15.1% and 28.8% for Metformin, Atorvastatin, a combination of two medicines (Atovarstatin and Metformin) and Methyldopa respectively. The study concluded that NCD medicines had low availability, were unaffordable and had a considerable risk of catastrophic health expenditure, especially among the poor.
A Dissertation submitted in partial fulfillment of the requirements for the award of the Degree of Master of Business Administration in Healthcare Management at Strathmore University
Non-Communicable Diseases (NCDs), Kenyan Counties, Treatment