Inequity in access to medications among communities in Eastern Ethiopia: a decomposition analysis.

BACKGROUND

Access to affordable essential medicines, including antibiotics, remains a barrier to achieving universal health coverage in poorer nations because of financial and nonfinancial challenges. Despite evidence of disparities in healthcare access and associated poorer health outcomes in Ethiopia, no previous study has thoroughly investigated inequity in access to needed medications. Hence, we aimed to assess inequity in access to needed medications among communities in eastern Ethiopia.

METHODS

We conducted a cross-sectional study among 2,256 households, which were sampled using a stratified cluster sampling strategy from Haramaya and Harar sub-districts. We assessed inequity in access to needed medications using access indicators, socioeconomic status indicators, and other relevant factors. A generalized linear model incorporating multiple equity-relevant factors was used to generate a composite unfair indicator, predicting the probability of access to medications. Inequity was identified using a concentration index ranked by this composite indicator. Finally, we used RIF’s regression decomposition method to identify the significant contributors to the inequity.

RESULTS

Of household members who needed medications the most recently in the past six months, 204/1,682 (12.1%) had an unmet need. The concentration index was 0.314 (95% CI: 0.309–0.320; SE: 0.0029;  < 0.001), showing that wealthier individuals were significantly more likely to have access to medications than poorer individuals. Income (32.6%), educational achievement (30.9%), education with high income (8.9%), home status (6.3%), information sources (5.9%), employment (5.0%), and lack of health insurance (4.0%) significantly contributed to pro-rich inequity. In contrast, rural residents (7.5%), families with children under five (3.0%), and female-represented households (2.9%) were the most disadvantaged groups. The absolute equity gap between the richest and poorest 20% of the population was 8.7%-point difference.

CONCLUSIONS

Our findings revealed substantial inequities in access to needed medications in eastern Ethiopia, disproportionately affecting low-income groups, rural residents, females, and children under five. To make medications more accessible and affordable for these disadvantaged groups, equitable healthcare financing and targeted insurance expansion could help, pending feasibility studies. Collaborations between the government and pharmaceutical companies can also improve access by addressing supply chain issues. Additionally, educating communities on how to access medicines can resolve awareness issues related to drug supplies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12913-025-12963-8.