scholarly journals Medicine Prices, Availability, and Affordability in Private Health Facilities in Low-Income Settlements in Nairobi County, Kenya

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 40 ◽  
Author(s):  
Ongarora ◽  
Karumbi ◽  
Minnaard ◽  
Abuga ◽  
Okungu ◽  
...  
Keyword(s):  
Low Income ◽  
Healthcare Access ◽  
Health Facilities ◽  
Healthcare Facilities ◽  
International Reference ◽  
The Public ◽  
Reference Prices ◽  
Retail Prices ◽  
Medicine Prices ◽  
Electronic Questionnaires

Medicine prices are a major determinant of access to healthcare. Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities. In low-income settlements, high retail prices are likely to push the population further into poverty and ill health. This study assessed the retail pricing, availability, and affordability of medicines in private health facilities in low-income settlements within Nairobi County. Medicine prices and availability data were collected between September and December 2016 at 45 private healthcare facilities in 14 of Nairobi’s low-income settlements using electronic questionnaires. The International Medical Products Price Guide provided international medicine reference prices for comparison. Affordability and availability proxies were calculated according to existing methods. Innovator brands were 13.8 times more expensive than generic brands. The lowest priced generics and innovator brands were, on average, sold at 2.9 and 32.6 times the median international reference prices of corresponding medicines. Assuming a 100% disposable income, it would take 0.03 to 1.33 days’ wages for the lowest paid government employee to pay for treatment courses of selected single generic medicines. Medicine availability in the facilities ranged between 2% and 76% (mean 43%) for indicator medicines. Prices of selected medicines varied within the 14 study regions. Retail medicine prices in the low-income settlements studied were generally higher than corresponding international reference prices. Price variations were observed across different regions although the regions comprise similar socioeconomic populations. These factors are likely to impact negatively on healthcare access.

scholarly journals Medicine prices in 2017 and 2018 as a reflection of the effectiveness of government measures to ­ensure access to medicines

2020 ◽  
Vol 101 (2) ◽  
pp. 256-263
Author(s):  
C M Razzakova ◽  
L E Ziganshina
Keyword(s):  
Comparative Analysis ◽  
Public Sector ◽  
Private Sector ◽  
Price Ratio ◽  
Generic Medicines ◽  
Public And Private ◽  
International Reference ◽  
The Public ◽  
Reference Prices ◽  
Medicine Prices

Aim. To conduct a comparative analysis of medicine prices in 2017 and 2018 years in Kazan (The Republic of Tatarstan, The Russian Federation) to assess the effectiveness of government measures to ensure the accessibility of medicines. Methods. We conducted a comparative analysis of medicine prices according to methodology developed by Health Action International and World Health Organization (WHO/HAI). The analysis included 30 medicines at a preselected dosage form. We studied the accessibility and prices of original brands and lowest priced generic of each medicine in the public and private pharmacies of Kazan in 2017 and 2018, and analyzed the procurement prices of the same medicines in inpatient hospitals. Medicine prices were compared with international reference prices (The Management Sciences for Health (MSH) reference prices) and expressed as median price ratio (MPR). Results. Prices for originator and generic medicines in the public and private sectors tended to decrease in 2018 compared to 2017, but statistically significant price reduction occurred only for generic medicines in the private sector. For example, the median price ratio for originator products changed from 6.86 to 2.97 in the public sector and from 11.1 to 5.36 in the private sector in 2018 compared to 2017, but the changes were not statistically significant (p 0.05). Prices for generics medicines in the public sector did not change in the studied years and remained at the level of international reference prices (the median price ratio were 1.3 in 2017 and 1.27 in 2018). In the private sector, we found a twofold decrease in the prices of generics medicines in 2018 compared to 2017 [the median price ratio decreased from 3.25 to 1.44 (p 0.05)]. Procurement prices for generics medicines in public hospitals in 2017 and 2018 years did not show statistically significant changes with the median price ratio equal to 1.34 and 0.8, respectively. Conclusion. Government price control measures of medicines contributed to maintaining the price of generic medicines at the reference prices level in the public sector and to halving the price of generic medicines in the private sector in 2018 compared to 2017.

Baseline assessment of therapeutic injection practices in Pakistan in 2020: a cross-sectional study

2021 ◽  
pp. 16-21
Author(s):  
Syed Sharaf Ali Shah ◽  
Safdar Pasha ◽  
Nikhat Iftikar ◽  
Altaf Ahmed Soomro ◽  
Nazia Farrukh ◽  
...  
Keyword(s):  
Public Sector ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Cross Sectional ◽  
Injection Equipment ◽  
Public And Private ◽  
Healthcare Facilities ◽  
The Public ◽  
Injection Safety

Objective: To assess the magnitude of the problem of injection safety in public and private health facilities in two districts of Sindh and Punjab provinces of Pakistan. Methods: A cross-sectional observational study was conducted between October and December 2020 among public and private health facilities of two districts of Pakistan: Gujarat in Punjab and Larkana in Sindh provinces. A convenient sample size of 60 healthcare facilities (30 from each district) was taken due to time and resource constraint. Six data collection tools were used which included structured observations and interviews with injection prescribers and providers based on WHO Revised Tool C, which were finalised after piloting. Results: Reuse of injection equipment was not observed in any of the 60 health facilities. In exit interviews of 120 patients, it was found that 27 (22.5%) patients reported receiving an injection, while 11 (9.2%) were prescribed intravenous (IV) drips. More injections and drips were prescribed in the private sector (n=15; 25.0%) in comparison with the public sector (n=12; 20.0%). Slightly higher proportion of IV drips were prescribed by the private providers when compared to public sector healthcare providers: 6 (10.0%) vs 5 (8.3%) respectively. Most of the prescribers (n=58; 96.7%) reported that patients who attended public and private health facilities demanded injectable medicines. Used syringes and drips were noted to be visible in open containers and buckets for final disposal in 20 (33.3%) assessed health facilities. Continuou...

scholarly journals Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 167 ◽  
Author(s):  
Kennedy Abuga ◽  
Dennis Ongarora ◽  
Jamlick Karumbi ◽  
Millicent Olulo ◽  
Warnyta Minnaard ◽  
...  
Keyword(s):  
Low Income ◽  
Ethical Issues ◽  
Task Shifting ◽  
Pharmaceutical Services ◽  
Brand Preference ◽  
Ethical Guidelines ◽  
Drug Procurement ◽  
Healthcare Facilities ◽  
Private Healthcare ◽  
Electronic Questionnaires

Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.

scholarly journals The common concerns regarding the COVID-19 outbreak in Iran: Explored findings from a qualitative study

2020 ◽  
Author(s):  
Saeed Shahabi ◽  
Ahmad Kalateh Sadati ◽  
Leila Zarei ◽  
Masoome Noroozi ◽  
Reza Tabrizi ◽  
...  
Keyword(s):  
Content Analysis ◽  
Qualitative Study ◽  
Low Income ◽  
Snowball Sampling ◽  
Healthcare Facilities ◽  
The Public ◽  
Data Collection Process ◽  
Data Saturation ◽  
Low Income Groups ◽  
Current Concerns

Abstract Background The first cases of coronavirus disease 2019 (COVID-19) were reported in Iran on February 20, and then the virus spread rapidly in all parts of the country, so that over 95000 positive cases and approximately 6000 deaths have been confirmed in this region until May 1, 2020. Even if measures taken in this respect have had significant impacts on reducing the incidence rate of COVID-19, a large number of other problems have arisen. Following this situation, people have been also drawn against many concerns, especially Iranian population with their own previous socioeconomic and cultural problems. Therefore, this nation-wide project aimed to investigate common concerns regarding COVID-19 outbreak in Iran. Methods This qualitative study was conducted in Iran from February to March 2020 via an online open-ended questionnaire. The participants were also selected using convenience and snowball sampling methods. As well, the data collection process continued until data saturation was achieved. In addition, thematic content analysis was utilized to analysis the transcribed texts. Results The statements retrieved also represented the most challenging psychological stress experienced by the participants. Four themes were accordingly recognized based on the content analysis including stressful conditions, health concerns, social and political concerns, and economic concerns. Throughout the study, a major proportion of the participants commented that psychological disorders such as fear, anxiety, stress, and ennui were their main challenges regarding this pandemic. Furthermore, lack of social responsibility, worries about high-risk and susceptible groups, decreased economic power of the public, financial hardships for low-income groups, shortage of healthcare facilities, and adverse effects of disinfectants were expressed as the main concerns. Conclusions As a whole, it is evident that people have confronted with several challenges and need help together with effective policies and strategies during and after this pandemic to reduce their current concerns. The study findings provided a favorable ground to develop and adopt the required policies in Iran and other countries. It was concluded that creating local, national, and global solidarity in such epidemics is an inevitable necessity.

scholarly journals Monitoring Cardiovascular Medicine Prices as a Tool for Analyzing the Effectiveness of Government Intervetions to Ensure Access to Medicines at the Regional Level

2020 ◽  
Vol 16 (6) ◽  
pp. 916-924
Author(s):  
C. M. Razzakova ◽  
L. E. Ziganshina
Keyword(s):  
Comparative Analysis ◽  
Public Sector ◽  
Private Sector ◽  
Access To Medicines ◽  
Generic Medicines ◽  
Public And Private ◽  
The Public ◽  
Reference Prices ◽  
Medicine Prices ◽  
The City

Aim. The aim of our study was to continue a comparative analysis of availability and access to cardiovascular medicines in 2017 and 2018 in the city of Kazan according to the original WHO/HAI methodology to assess the effectiveness of government interventions to ensure access to medicines.Material and methods. We performed a comparative analysis of prices of cardiovascular medicines in 2017 and 2018 in Kazan using the World Health Organization and Health Action International (WHO/HAI) methodology, to assess medicines' availability and affordability to ensure their rational use. We studied availability and prices of 71 cardiovascular medicines in public and private pharmacies in the city of Kazan and analyzed procurement prices of these medicines in hospitals. Also we studied the affordability of medicines, as well as performed pharmacoeconomic cost-minimization analysis for arterial hypertension pharmacotherapy in 2018. For each name, we studied the prices for the original brand and its lowest-priced generic. We compared medicine prices with international reference, delivered by the Management Sciences for Health and by expressing them as median price ratio (MPR).Results. In the public sector, prices of generic medicines were at the level of reference prices with the indicators of MPR 1.14 [0.41-1.84] and 1.17 [0.49-2.21], in 2017 and 2018 respectively. In the private sector, prices of generics reduced 2 times in 2018 compared to 2017, with the decrease in MPR from 2.22 [1.12-3.91] to 1.25 [0.44-2.32], (p<0.05). In the public sector, the affordability indicators of generics were the same in the studied years (Me=0.24 in 2017 and Me=0.26 in 2018). However, in the private sector there was a 2.5 times reduction in the affordability of generics (reduction Me from 0.66 to 0.24, p<0.05) in 2018 compared to 2017. From 2017 to 2018 the affordability of original brands changed from 1.9 to 1.3 in the public sector and from 2.3 to 1.5 in the private sector, but this change was not statistically significant (p>0.05). In 2018, depending on the choice of the medicine the annual course of therapy of hypertension varied from 149 to 28835 rubles.Conclusions. In 2018, the prices of generic cardiovascular medicines, but not of originator brands, reached the level of reference prices in both the public and private sectors of Kazan. According to the WHO/HAI methodology, generic cardiovascular medicines became affordable. In the private sector, there was a reduction in the prices of generic medicines, but not of originator brands, with an improvement of affordability of generics in 2018 compared to 2017.

scholarly journals Evaluation of the Effectiveness of Brazilian Community Restaurants for the Dimension of Low-Income People Access to Food

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2671
Author(s):  
Mateus Santana Sousa ◽  
Camila Silveira Silva Teixeira ◽  
Jamacy Costa Souza ◽  
Priscila Ribas de Farias Costa ◽  
Renata Puppin Zandonadi ◽  
...  
Keyword(s):  
Low Income ◽  
Formal Education ◽  
Average Energy ◽  
Secondary Data ◽  
Target Population ◽  
Service Capacity ◽  
The Public ◽  
The Government ◽  
Access To Food

This study aimed to evaluate the effectiveness of community restaurants (CRs), managed by the Government of the State of Bahia/Brazil, for the dimension of access to food. The study used secondary data obtained from the public opinion survey Profile of users of community restaurants in Salvador. The nutritional information was accessed through the analysis of CRs’ menus. Adequate effectiveness of access to food was considered when the CR served meals to 50% to 70% of the users considered the target audience (individuals served by the two CRs located in the city of Salvador/Bahia/Brazil). The participants (n = 1464; 778 as low-income individuals) were adult CR users from Salvador/Brazil. Most of the respondents were male, 40 to 54 years old, not white, had up to 9 years of formal education, without a partner, and living in the municipality of Salvador. The evaluated CRs are effective in serving 53.1% of the target population in their total service capacity. Meal provision only reached an estimated 0.7% of the socially vulnerable community in the district. The average energy value of the meal served by the CR units was 853.05 kcal/meal, with a mean energy density composition classified as average (1.15 kcal/g). The effectiveness of the evaluated community restaurants showed that these instruments were minimally effective in promoting access to food for the low-income population within their total daily service capacity, and the current quantity of these facilities was insufficient. However, these instruments stand out in the fundamental role of promoting the daily distribution of meals to the Brazilian population with the highest social vulnerability levels.

scholarly journals Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045441
Author(s):  
Noemia Teixeira de Siqueira-Filha ◽  
Jinshuo Li ◽  
Eliud Kibuchi ◽  
Zahidul Quayyum ◽  
Penelope Phillips-Howard ◽  
...  
Keyword(s):  
Economic Impact ◽  
Scoping Review ◽  
Low Income ◽  
Purchase Power Parity ◽  
Healthcare Access ◽  
Well Being ◽  
Power Parity ◽  
Middle Income ◽  
Slum Dwellers ◽  
Scoping Reviews

IntroductionPeople living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents.Methods and analysisThis scoping review adopts the framework suggested by Arksey and O’Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported.Ethics and disseminationEthical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

scholarly journals Citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income

2021 ◽  
pp. 114015
Author(s):  
Lisanne S. Mulderij ◽  
José Ignacio Hernández ◽  
dr.mr. Niek Mouter ◽  
dr. Kirsten T. Verkooijen ◽  
dr.ir. Annemarie Wagemakers
Keyword(s):  
Body Weight ◽  
Low Income ◽  
Public Funding ◽  
The Public ◽  
Healthy Body Weight ◽  
Citizen Preferences ◽  
Healthy Body

Collaboration: A Strategy for Neighborhood Planning

1991 ◽  
Vol 13 (3) ◽  
pp. 13-14
Author(s):  
Ronald Register
Keyword(s):  
Low Income ◽  
Local Community ◽  
Planning Process ◽  
Ford Foundation ◽  
Neighborhood Planning ◽  
Public And Private ◽  
The Public ◽  
Strategic Plans ◽  
Income Neighborhood ◽  
Community Foundation

In 1990, the Ford Foundation launched the Neighborhood and Family Initiative Project (NFI) in four U.S. cities. A low-income neighborhood in each of the four cities is the target for the initiative, which is administered through a local community foundation in each city. The initiative relies on neighborhood leadership to develop strategic plans which reflect the goals and aspirations of neighborhood residents and institutions. A collaborative, or committee, composed of neighborhood leaders and key representatives from the public and private sectors is charged with overseeing the planning process.

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