Investigating medicines availability for selected non-communicable diseases at Raleigh Fitkin Memorial Hospital, Manzini, Swaziland and the impact on patient out-of-pocket payments.

Abstract

Background: The burden of non- communicable diseases (NCDs) in low and middle -income countries is greatly increasing and posing both financial and public health concerns. Increased morbidity has significantly reduced quality of life in these populations and Swaziland is no exception. Patients with NCD’s often have to pay for their medicines out-of-pocket. The extent of this practice is not known. Methods: The study was conducted at a regional hospital in Manzini that serves majority of NCD patients in the central part of the country. Exit interviews were conducted with 300 patients diagnosed with diabetes, hypertension and asthma. Patients were asked how often they experienced stock-outs of essential medicines at the facility and how much they paid at private pharmacies to access the medicines. Responses were triangulated with Central Medical Stores’ (CMS) 2012 annual stock records to ascertain availability of the selected medicines and their turnaround time which was the time taken for medicines to be issued to the facility on receipt after they had been out of stock at CMS. Results were analyzed using the Statistical Package for Social Sciences (SPSS). Results: Majority of patients (n=213; 71%) confirmed not receiving the complete package of their prescribed medicines at each visit to the hospital in the past six months. On average patients spent 10-50 times more for their medicines in private pharmacies than they would when accessing them from the health facility. Stock-outs at CMS ranged from minimum of 30 days to over 217 days in the course of the assessment period (12 months) were recorded and found to be the cause of stock-outs in the health facility. The turnaround time of medicines from CMS to the facility was not found to have influence on shortages recorded in facility. Conclusion: Out-of-pocket expenditure is very common for patients with NCDs using this health facility which increases of the possibility of default on treatment because they cannot afford the commercial fees charged at private pharmacies. Patients were paying 10 to 50 times more to access medicines for their conditions in private pharmacies than when accessing them from the health facility in the event they were out-of-stock.