Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, US.
World Heart Federation, Salim Yusuf Emerging Leaders Progamme, Geneva, CH.
Glob Heart. 2021 May 18;16(1):38. doi: 10.5334/gh.927.
Universal access to essential medicines and routine diagnostics is required to combat the growing burden of cardiovascular disease (CVD) and diabetes. Evaluating health systems and various access dimensions availability, affordability, accessibility, acceptability, and quality is crucial yet rarely performed, especially in low- and middle-income countries.
To evaluate health system capacity and barriers in accessing diagnostics and essential medicines for CVD and diabetes in Nepal.
We conducted a WHO/HAI nationally-representative survey in 45 health-facilities (public-sector: 11; private-sector: 34) in Nepal to collect availability and price data for 21 essential medicines for treating CVD and diabetes, during MayJuly 2017. Data for 13 routine diagnostics was obtained in 12 health facilities. Medicines were considered unaffordable if the lowest paid worker spends >1 days wage to purchase a monthly supply. To evaluate accessibility, we conducted facility exit interviews among 636 CVD patients. Accessibility (e.g., private-public health facility mix, travel to hospital/pharmacy) and acceptability (i.e. Nepals adoption of WHO Essential Medicine List, and patient medication adherence) were summarized using descriptive statistics, and we conducted a systematic review of relevant literature. We did not evaluate medicine quality.
We found that mean availability of generic medicines is low (<50%) in both public and private sectors, and less than one-third medicines met WHOs availability target (80%). Mean (SD) availability of diagnostics was 73.1% (26.8%). Essential medicines appear locally unaffordable. On average, the lowest-paid worker would spend 1.03 (public-sector) and 1.26 (private-sector) days wages to purchase a monthly supply. For a person undergoing CVD secondary preventive-interventions in the private sector, the associated expenditure would be 7.511.2% of monthly household income. Exit-interviews suggest that a long/expensive commute to health-facilities and poor medicine affordability constrain access.
This study highlights critical gaps in Nepals health system capacity to offer basic health services to CVD and diabetes patients, owing to low availability, poor affordability and accessibility of essential medicines and diagnostics. Research and policy initiatives are needed to ensure uninterrupted supply of affordable essential medicines and diagnostics.
为了应对心血管疾病（CVD）和糖尿病日益加重的负担，需要普及基本药物和常规诊断。评估卫生系统和各种获取途径的供应、可负担性、可及性、可接受性和质量至关重要，但很少进行，尤其是在低收入和中等收入国家。
评估尼泊尔获取 CVD 和糖尿病诊断和基本药物的卫生系统能力和障碍。
我们于 2017 年 5 月至 7 月在尼泊尔的 45 家医疗机构（公立部门：11 家；私立部门：34 家）进行了一项世界卫生组织/卫生系统绩效评估工具（HAI）全国代表性调查，以收集 21 种治疗 CVD 和糖尿病的基本药物的供应和价格数据。在 12 家医疗机构中获得了 13 种常规诊断的数据。如果最低工资工人购买一个月的供应量需要花费超过 1 天的工资，则认为药物难以负担。为了评估可及性，我们对 636 名 CVD 患者进行了医疗机构出口访谈。使用描述性统计数据总结了可及性（例如公私医疗设施组合、前往医院/药房的旅行）和可接受性（即尼泊尔采用世界卫生组织基本药物清单和患者用药依从性），并对相关文献进行了系统回顾。我们没有评估药物质量。
我们发现，公立和私立部门的通用药物供应率均较低（<50%），不到三分之一的药物符合世卫组织的供应目标（80%）。诊断的平均（SD）供应率为 73.1%（26.8%）。基本药物似乎在当地难以负担。平均而言，最低工资工人购买一个月的供应量需要花费 1.03 天（公立部门）和 1.26 天（私立部门）的工资。对于在私立部门接受 CVD 二级预防干预的人来说，相关支出将占月家庭收入的 7.51%至 12.6%。出口访谈表明，前往医疗机构的路程长/昂贵且药物负担能力差，这限制了获得服务的机会。
本研究突出了尼泊尔卫生系统提供 CVD 和糖尿病患者基本卫生服务的能力存在重大差距，原因是基本药物和诊断的供应、可负担性和可及性较低。需要开展研究和政策举措，以确保基本药物和诊断的供应不受影响。
