Rockers Peter C, Laing Richard O, Wirtz Veronika J
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Glob Health. 2018 Jun 22;3(3):e000828. doi: 10.1136/bmjgh-2018-000828. eCollection 2018.
Wealth-based inequity in access to medicines is an impediment to achieving universal health coverage in many low-income and middle-income countries. We explored the relationship between household wealth and access to medicines for non-communicable diseases (NCDs) in Kenya.
We administered a cross-sectional survey to a sample of patients prescribed medicines for hypertension, diabetes or asthma. Data were collected on medicines available in the home, including the location and cost of purchase. Household asset information was used to construct an indicator of wealth. We analysed the relationship between household wealth and various aspects of access, including the probability of having NCD medicines at home and price paid.
Among 639 patients interviewed, hypertension was the most prevalent NCD (69.6%), followed by diabetes (22.2%) and asthma (20.2%). There was a positive and statistically significant association between wealth and having medicines for patients with hypertension (p=0.020) and asthma (p=0.016), but not for diabetes (p=0.160). Poorer patients lived farther from their nearest health facility (p=0.050). There was no relationship between household wealth and the probability that the nearest public or non-profit health facility had key NCD medicines in stock, though less poor patients were significantly more likely to purchase medicines at better stocked private outlets. The relationship between wealth and median price paid for metformin by patients with diabetes was strongly u-shaped, with the middle quintile paying the lowest prices and the poorest and least poor paying higher prices. Patients with asthma in the poorest wealth quintile paid more for salbutamol than those in all other quintiles.
The poorest in Kenya appear to face increased barriers to accessing NCD medicines as compared with the less poor. To achieve universal health coverage, the country will need to consider pro-poor policies for improving equity in access.
在许多低收入和中等收入国家，基于财富的药品获取不平等是实现全民健康覆盖的一个障碍。我们探讨了肯尼亚家庭财富与非传染性疾病（NCDs）药品获取之间的关系。
我们对开具高血压、糖尿病或哮喘药物处方的患者样本进行了横断面调查。收集了家中现有药品的数据，包括购买地点和成本。家庭资产信息用于构建财富指标。我们分析了家庭财富与获取药品的各个方面之间的关系，包括家中拥有非传染性疾病药品的概率和支付的价格。
在接受采访的639名患者中，高血压是最常见的非传染性疾病（69.6%），其次是糖尿病（22.2%）和哮喘（20.2%）。财富与高血压患者（p = 0.020）和哮喘患者（p = 0.016）拥有药品之间存在正相关且具有统计学意义，但与糖尿病患者无关（p = 0.160）。较贫困的患者居住的地方离最近的医疗机构更远（p = 0.050）。家庭财富与最近的公立或非营利性医疗机构库存关键非传染性疾病药品的概率之间没有关系，不过较不贫困的患者在库存更充足的私人药店购买药品的可能性显著更高。糖尿病患者财富与二甲双胍支付的中位数价格之间的关系呈强烈的U形，中间五分位数支付的价格最低，最贫困和最不贫困的人群支付的价格更高。最贫困财富五分位数的哮喘患者购买沙丁胺醇的费用高于所有其他五分位数的患者。
与较不贫困的人群相比，肯尼亚最贫困的人群在获取非传染性疾病药品方面似乎面临更多障碍。为了实现全民健康覆盖，该国需要考虑有利于穷人的政策，以改善获取药品的公平性。
