Accessibility Of Essential Medicines For Non-Communicable Diseases In A Devolved System Of Government In Trans Nzoia County, Kenya

ABSTRACT

Access to medicines is a multidimensional concept said to exist when patients have

continuous availability of essential medicines at affordable prices and within a physical

location that is accessible. With devolution of health services, access to essential

medicines, including those for non-communicable disease is meant to improve. The study

sought to determine the accessibility to essential medicines for the four major non

communicable diseases in Trans-Nzoia County. The study was conducted in five

hospitals within Trans Nzoia County using both qualitative and quantitative methods.

Patients and key personnel within the health facilities were interviewed. Secondary

documents from the health facility were also reviewed. The design was a descriptive

cross sectional study carried out for three months among outpatients with noncommunicable

diseases. The sample size used was 320 participants attending the medical

outpatient clinic and 25 key personnel. The study participants were selected by use of

simple random sampling. Data obtained was analyzed using mean, percentages, standard

deviations as well as Chi and odds ratio. The study found that most of the noncommunicable

diseases medicines were unavailable at the health facilities at 23%.

Medicines for management of diabetes were found to be most available in all the

hospitals at 80%. Stock out rate for essential medicines for non-communicable diseases

was found to be high at 202 days per year, which was attributed to poor health care

financing by the county government of Trans Nzoia. Medicines for cancer treatment were

found to have the highest stock out days at 334 days per year. The study found the

essential medicines for non-communicable diseases to be affordable based on the

minimum daily wage calculation at 0.309 days’ wages. Affordability calculated was

based on individual drugs and not for a complete therapy. However, 78% of the

participants reported that the medicines were not affordable. Medicines for management

of chronic obstructive pulmonary disease were found to be most costly with affordability

of 0.449 days’ wages. Additionally, the study showed that health facilities where

participants received essential medicines for non-communicable diseases were

geographically accessible with most participants at 92% using 1 hour or less to get to the

facility. However, with the use of daily wages the affordability of the transport means

was found to be 0.52 days’ wages hence not accessible. There was a significant

association between the proportion of the prescribed drugs that the participants had

received and their health status, p=0.03. With an epidemiological change in the low and

medium income countries including Kenya from communicable diseases to noncommunicable

diseases, there is need for renewed focus on access to essential medicines

for these conditions as reflected by the formation of division of non-communicable

disease in the Ministry of Health. Based on the study findings, there is need to increase

healthcare funding by the county government for purchase of essential medicines for noncommunicable

diseases. This will greatly reduce stock out rates thereby increasing

availability.