A new study that evaluated the availability, prices, and affordability of essential medicines for cardiovascular diseases (CVD) and diabetes in Kerala has found that the state has fallen short of the World Health Organisation’s 80 per cent target, in both public and private sector.
Kerala has one of the highest burdens of cardiovascular diseases and diabetes in the country, while the health system in the state is considered among the better-performing ones. Recently, the Kerala government’s efforts to prevent and control non-communicable diseases were recognised by the United Nations.
But there is always an opportunity to improve healthcare services and in Kerala, improving medicine availability in government health facilities, popularising government discount pharmacies (such as Karunya, Jan Aushadhi and Neethi), and regularly updating the essential medicine list would be a good start, researchers from the Boston University, National College of Pharmacy, Kozhikode, and World Heart Federation have said in a new study published in the Tropical Medicine and International Health journal.
Although medicines are provided free of cost in government hospitals, the study found only 46 per cent of surveyed medicines in government hospitals, 65 per cent in government-subsidised discount pharmacies (GSDPs), and 72 per cent in private retail pharmacies.
“We found that, on an average, the lowest paid government worker in Kerala would have to spend 1.1 days’ wage to purchase monthly supply of essential medicines in the private sector, compared to only 0.8 days’ wages in GSDPs such as Karunya and Jan Aushadhi. We also found that higher-priced branded generics were more likely to be ‘most selling’ medicine versions, despite much cheaper alternatives available in the same pharmacies,” said Abhishek Sharma from the Boston University School of Public Health.
Although retail pharmacies have higher availability, poor affordability of medicines poses a major constraint to access. According to WHO, a medicine is unaffordable if a lowest paid government worker has to spend more than a day’s wage to afford monthly supply. Given the need to ensure affordable medicine prices, the WHO has set a target that no patient should pay more than four times the international reference prices.
Dr Gautam Satheesh and Abhishek Sharma (Boston University), in collaboration with Dr Sandra Puthean and Dr M K Unnikrishnan (National College of Pharmacy, Kozhikode, India) and Shiva Raj Mishra (World Heart Federation, Switzerland) wanted to generate data on availability, price and affordability of essential medicines in 30 public sector facilities and 60 private retail pharmacies.
They used a World Health Organisation/Health Action International methodology to survey government healthcare facilities, GSDPs and private retail pharmacies across six districts in Kerala —Thiruvananthapuram, Ernakulam, Kozhikode, Malappuram, Thrissur and Kottayam — from November 2018 to May 2019
WHO surveys in various low and middle-income countries from 2008 to 2015 reported that the majority of the essential NCD medicines did not meet WHO’s 80 per cent availability target. However, these surveys studied a mixed basket of medicines and there is limited evidence on access to CVD and diabetes medicines in particular.
Cardiovascular diseases account for 31 per cent of all deaths and 44 per cent of deaths from all non-communicable diseases globally. To combat the rapidly increasing global NCD burden, the United Nations member-states have pledged to reduce premature NCD mortality by a third by 2030.
In India, CVD is the leading cause of mortality, with nearly 1.7 million deaths annually. India also has the world’s second-largest population living with diabetes. “More research is needed to further our understanding of the supply and demand side barriers to healthcare access for all,” said Sharma.
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