RESUMEN
The objective of this study was to assess the availability of 42 children’s essential medicines contained in the Standard Treatment Guidelines (STG) of Ghana in the 27 districts of Ashanti Region. Five hundred medicine outlets comprising of hospitals/health centers/clinics, community pharmacies and chemical shops were surveyed using a validated structured questionnaire. The results were analysed and the availability of the 42 medicines in each district was determined. The average availability of children’s medicines across the region was 41.3% (range: 26.4-52%), with the Kumasi Metropolis (KM) and Bosome Freho (BF) district having the highest and lowest availabilities, respectively. Six (14.3%) of the medicines, omeprazole, tinidazole, furosemide and spironolactone suspensions, and praziquantel and thiabendazole syrups had zero availability in the Region while ferrous sulphate syrup (95%), albendazole suspension (90%) and paracetamol syrup (88.8%) had the highest availabilities. Three hundred and twenty three different formulations of the 42 medicines were identified with foreign and local manufacturers accounting for 198 (61.3%) and 125 (38.7%) formulations, respectively. India (38.7%) and United Kingdom (35.5%) were the major foreign manufacturers. The duration of stock-outs was shorter for private than public/government facilities and generally ranged from up to one week (68.4 %) to over one month (3%). Reasons for the low or non-availability of children’s medicines included the lack of funds, non-prescription by physicians, unavailability of medicines at wholesalers and lack of awareness of medicine outlets staff.
RESUMEN
India has outlined its commitment to achieving universal health coverage and several states in India are rolling out strategies to support this aim. In 2011, Rajasthan implemented an ambitious universal access to medicines programme based on a centralized procurement and decentralized distribution model. In terms of the three dimensions of universal health coverage, the scheme has made significant positive strides within a short period of implementation. The key objectives of this paper are to assess the likely implications of providing universal access to essential medicines in Rajasthan, which has a population of 70 million. Primary field-level data were obtained from 112 public health-care facilities using multistage random sampling. National Sample Survey Organization data and health system data were also analysed. The per capita health expenditure during the pre-reform period was estimated to be `5.7 and is now close to `50. Availability of essential medicines was encouraging and utilization of public facilities had increased. With additional per capita annual investment of `43, the scheme has brought about several improvements in the delivery of essential services and increased utilization of public facilities in the state and, as a result, enhanced efficiency of the system. Although there was an attempt to convert the scheme into a targeted one with the change in government, strong resistance from the civil society resulted in such efforts being defeated and the universality of the scheme has been retained.