Availability, Prices, Affordability, and Quality of Essential Medicines in Public Health Facilities in Mombasa County, Kenya

Abstract

Background: Access to essential medicines and vaccines can save 10 million lives a year globally with 4 million of these in Africa and South East Asia. A third of the global population lacks reliable access, with poor countries in Africa and Asia having 50% of their populations lacking access to essential medicines. Access to essential medicines relies on rational selection and use, affordable prices, sustainable financing, and reliable health and supply systems. Poor availability of essential medicines due to stock-outs, unreliable funding, unaffordable prices, and inefficient supply chains hinder access, especially for the poor who rely on public healthcare. Objective: To assess essential medicines availability, prices, affordability, quality, and predictors of medicines’ availability in public health facilities in Mombasa County. Methods: A cross-sectional descriptive survey was carried out through direct observation from 30 public healthcare facilities in Mombasa County. Data was collected from level II, III, IV, and V health facilities using a pre-tested and structured questionnaire. The survey collected data on availability, prices, affordability, and quality, and analyzed by calculating indicators derived from the WHO operational package for assessing, monitoring, and evaluating country pharmaceutical situations. The data were summarized using standard descriptive statistics. Regression analysis was carried out to determine predictors of medicine availability. The findings of the summary analysis were presented in tables and figures. Results: The average availability of essential medicines was 86.7%. The majority (76.6%) of facilities experienced an average stockout duration of 27 days. 57.7% of facilities did not have all stock records and 43.3% had expired medicines on the shelf. Storerooms and dispensing areas met 82.3% and 81.8% of the adequate storage and handling conditions. The patient prices were 3.7 times the procurement prices. Patient prices were 3.4 times the international reference prices (IRP) while procurement prices were 0.9 times the IRP. Treatment of moderate pneumonia, adult diabetes, and asthma in children costs less than a day’s wage. Stock records availability (p=0.017) was a statistically significant predictor of medicine availability. Conclusion: Essential medicines were fairly available, but their prices were high and public health facilities did not meet the expected storage and handling conditions with frequent stock-outs and expiries. Available stock records determine essential medicines' availability