Access to essential medicines in aspirational districts of India; A multi-site cross sectional study.

Abstract

Inequitable access to essential medicines (EMs) is a big challenge for optimal delivery of health care in a country like India. Baseline data is essential to develop effective public health policy to facilitate equitable access to EMs. The primary purpose of this research was to investigate the price, availability, and affordability EMs in the aspirational districts of Odisha using WHO/HAI methodology. The study was carried out in 25 public health facilities and 25 private pharmacies. Data on availability and price of EMs was collected from both public health facilities and private pharmacies. Prices were compared to an international reference price (expressed as median price ratio-MPR). Treatment affordability also was calculated for surveyed EMs. The overall percent availability of lowest price generics (LPGs) was 62% in the public health facilities and 58% in private pharmacies. The procurement price of surveyed medicines for public health facilities was 0.28 (IQR, 0.17, 0.50) times of IRP, whereas price charged to patients for the same in retail pharmacies was 1.34 (IQR, 0.71 to 2.4) of IRP. Most of the surveyed medicines in private pharmacies required for acute conditions were affordable except amoxicillin/clavulanic acid 625 mg tablet that was slightly unaffordable, with a single course of treatment costing up to 1.21 days of wages. This study revealed that overall availability of surveyed EMs in both public sector facilities and private pharmacies was optimal. Both procurement prices and prices charged to patients of surveyed medicines were reasonable in comparison to IRP. Availability of EMs has improved and many medicines are now affordable. These data have significant policy implications that could help in amending policies to further increase the access to EMs for patients residing in remote areas of the country.