Edessa Dumessa, Kumsa Fekede Asefa, Dinsa Girmaye, Oljira Lemessa
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P. O. Box 235, Harar, Ethiopia.
School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
BMC Health Serv Res. 2025 Jun 9;25(1):816. doi: 10.1186/s12913-025-12963-8.
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.
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.
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.
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.
The online version contains supplementary material available at 10.1186/s12913-025-12963-8.
由于经济和非经济方面的挑战，在较贫困国家，获取包括抗生素在内的可负担基本药物仍然是实现全民健康覆盖的障碍。尽管有证据表明埃塞俄比亚在医疗服务可及性方面存在差异以及由此导致的较差健康结果，但此前尚无研究全面调查过获取所需药物方面的不公平现象。因此，我们旨在评估埃塞俄比亚东部社区在获取所需药物方面的不公平情况。
我们对2256户家庭进行了横断面研究，这些家庭采用分层整群抽样策略从哈勒马亚和哈勒尔分区抽取。我们使用获取指标、社会经济地位指标及其他相关因素评估获取所需药物方面的不公平情况。采用纳入多个与公平相关因素的广义线性模型生成一个综合不公平指标，预测获取药物的概率。使用按该综合指标排序的集中指数来识别不公平情况。最后，我们使用RIF回归分解方法确定导致不公平的重要因素。
在过去六个月中最近需要用药的家庭成员中，204/1682（12.1%）有未满足的需求。集中指数为0.314（95%置信区间：0.309 - 0.320；标准误：0.0029；P < 0.001），表明较富裕个体比贫困个体更有可能获取药物。收入（32.6%）、教育程度（30.9%）、高收入与教育（8.9%）、家庭状况（6.3%）、信息来源（5.9%）、就业（5.0%）以及缺乏医疗保险（4.0%）对有利于富人的不公平情况有显著影响。相比之下，农村居民（7.5%）、有五岁以下儿童的家庭（3.0%）以及以女性为户主的家庭（2.9%）是最弱势群体。最富和最穷的20%人口之间的绝对公平差距为8.7个百分点。
我们的研究结果揭示了埃塞俄比亚东部在获取所需药物方面存在严重不公平现象，对低收入群体、农村居民、女性和五岁以下儿童的影响尤为严重。为使这些弱势群体更易获取且负担得起药物，在可行性研究之后，公平的医疗融资和有针对性的保险扩展可能会有所帮助。政府与制药公司之间的合作也可通过解决供应链问题来改善获取情况。此外，对社区进行如何获取药物的教育可解决与药品供应相关的认知问题。
在线版本包含可在10.1186/s12913 - 025 - 12963 - 8获取的补充材料。
