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Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India
Author(s) -
Satheesh Gautam,
Sharma Abhishek,
Puthean Sandra,
Ansil T.P. Muhammed,
E. Jereena,
Raj Mishra Shiva,
Unnikrishnan M. K.
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13494
Subject(s) - pharmacy , private sector , government (linguistics) , business , essential medicines , medicine , environmental health , finance , socioeconomics , agricultural economics , public health , economic growth , economics , family medicine , linguistics , philosophy , nursing
Objective Limited access to essential medicines (EMs) for cardiovascular disease (CVD) and diabetes is a major concern in low‐ and middle‐income countries. We aimed to generate data on availability, price and affordability of EMs for CVD and diabetes in India. Methods Using WHO/HAI survey methodology, we evaluated availability and prices of 23 EMs in 30 public sector facilities (government hospitals and semi‐public/government‐subsidised‐discount‐pharmacies (GSDPs)) and 60 private retail pharmacies across six districts in Kerala state, India (November 2018 ‐ May 2019). Median Price Ratios (MPRs) were calculated by comparing consumer prices with international reference prices. We also analysed data (collected in July 2020) on six anti‐hypertensive fixed‐dose‐combinations (FDCs) that were designated as ‘essential’ by the WHO in 2019. Results Mean availability of surveyed generic EMs was 45.7% in government hospitals, 64.7% in GSDPs and 72.0% in private retail pharmacies. On average, the most‐sold and highest‐priced generics, respectively, were 6.6% and 8.9% costlier than the lowest‐priced generics (LPG). Median MPR for LPG was 2.71 in private retail and 2.25 in GSDPs. Monthly supply of LPG would cost the lowest‐paid worker 1.11 and 0.79 days’ wages in private retail and GSDPs, respectively. Mean availability of the surveyed FDCs was poor (private retail: 15–85%; GSDPs: 8.3–66.7%), and the private retail prices of FDCs were comparable to the sum of corresponding constituent monotherapies. Conclusion Availability of CVD and diabetes EMs fall short of WHO’s 80% target in both sectors. Although availability in the private retail pharmacies was near‐optimal, prices appear unaffordable compared to GSDPs. Initiatives such as mandating generic prescribing, adding the WHO‐approved FDCs in local EM lists, improving price transparency, and streamlining medicine supply to ensure equitable access to EMs, especially in the public sector, are crucial in tackling Kerala’s ever‐increasing CVD burden.