PDF(Pubmed)
Abstract：
Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia\'s public and private medicine outlets with respect to availability and affordability parameters.
A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days\' wages required by the lowest paid government worker (LPGW) to purchase a one month\'s supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices.
Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO\'s target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month\'s supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively.
There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.
A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days\' wages required by the lowest paid government worker (LPGW) to purchase a one month\'s supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices.
Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO\'s target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month\'s supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively.
There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.
摘要：
背景：糖尿病是全球主要的公共卫生负担。有效的糖尿病管理在很大程度上取决于能否获得负担得起且有质量保证的基本药物，这是一个挑战，尤其是在埃塞俄比亚等中低收入国家。这项研究旨在评估埃塞俄比亚中部公共和私人医疗机构在可获得性和可负担性参数方面用于糖尿病护理的EM的可及性。
方法：2022年1月至2月，在埃塞俄比亚中部的60家选定的公共和私人医疗机构进行了一项横断面研究，使用世界卫生组织/国际卫生行动组织（WHO/HAI）标准工具评估获得EMs的情况。我们包括降低血糖的EMs，血压,和胆固醇，因为这些都是糖尿病治疗的关键。可用性确定为每个行业的调查网点的百分比，其中找到了选定的价格最低的通用（LPG）和原始品牌（OB）产品。最低工资政府工作人员（LPGW）购买一个月药品所需的工资天数用于衡量可负担性，而确定中位数价格用于评估患者价格和公共采购之间的价格加成差异和零售价格。
结果：在所有设施中，LPG和OB药物的可获得性分别为34.6%和2.5%。只有两种降糖药物（格列本脲5mg和二甲双胍500mg）和两种降血压药物（硝苯地平20mg和氢氯噻嗪25mg）超过了WHO的80%可获得性目标。基于LPG糖尿病EMs的最小可测量单位的中位数价格在公共场所为1.6ETB（0.033美元），在私人商店为4.65ETB（0.095美元）。一个月供应糖尿病新兴市场的费用相当于公众的0.3至3.1天工资和私人营业点的1.0至11.0天工资，分别,对于典型的LPGW。因此，包括在价格分析中的液化石油气糖尿病EMs的58.8%和84.6%在私人和公共渠道中负担不起，分别。
结论：在埃塞俄比亚中部用于糖尿病的EMs的可获得性和可负担性方面存在很大差距。政策制定者应努力改善获得糖尿病EMs的机会。建议政府更多地关注利用负担得起的EMs进行糖尿病护理，包括在大多数人口更容易获得的初级医疗保健水平。还建议在埃塞俄比亚不同地区进行类似的研究。
方法：2022年1月至2月，在埃塞俄比亚中部的60家选定的公共和私人医疗机构进行了一项横断面研究，使用世界卫生组织/国际卫生行动组织（WHO/HAI）标准工具评估获得EMs的情况。我们包括降低血糖的EMs，血压,和胆固醇，因为这些都是糖尿病治疗的关键。可用性确定为每个行业的调查网点的百分比，其中找到了选定的价格最低的通用（LPG）和原始品牌（OB）产品。最低工资政府工作人员（LPGW）购买一个月药品所需的工资天数用于衡量可负担性，而确定中位数价格用于评估患者价格和公共采购之间的价格加成差异和零售价格。
结果：在所有设施中，LPG和OB药物的可获得性分别为34.6%和2.5%。只有两种降糖药物（格列本脲5mg和二甲双胍500mg）和两种降血压药物（硝苯地平20mg和氢氯噻嗪25mg）超过了WHO的80%可获得性目标。基于LPG糖尿病EMs的最小可测量单位的中位数价格在公共场所为1.6ETB（0.033美元），在私人商店为4.65ETB（0.095美元）。一个月供应糖尿病新兴市场的费用相当于公众的0.3至3.1天工资和私人营业点的1.0至11.0天工资，分别,对于典型的LPGW。因此，包括在价格分析中的液化石油气糖尿病EMs的58.8%和84.6%在私人和公共渠道中负担不起，分别。
结论：在埃塞俄比亚中部用于糖尿病的EMs的可获得性和可负担性方面存在很大差距。政策制定者应努力改善获得糖尿病EMs的机会。建议政府更多地关注利用负担得起的EMs进行糖尿病护理，包括在大多数人口更容易获得的初级医疗保健水平。还建议在埃塞俄比亚不同地区进行类似的研究。
