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Availability, pricing, and affordability of essential medicines for pediatric population in Malawi
Francis Kachidza Chiumia1, Cynthia Chithope-Mwale1, Felix Abikoloni1
1Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi.
Insights
Pediatric medicine availability is poor in Malawi, impacting child health. While some medicines are affordable, supply chain improvements are crucial for universal health coverage.
Area of Science:
- Global Health
- Health Systems Strengthening
- Pharmaceutical Policy
Background:
- Access to essential pediatric medicines is vital for healthcare quality, directly impacting child morbidity and mortality.
- Vulnerable pediatric populations are disproportionately affected by medicine shortages.
- Assessing pediatric medicine availability, pricing, and affordability is critical for improving healthcare outcomes.
Purpose of the Study:
- To evaluate the availability, pricing, and affordability of pediatric formulations in Malawi.
- To identify disparities in medicine access across different healthcare sectors in Malawi.
Main Methods:
- A cross-sectional study was conducted in 76 Malawian health facilities (public, faith-based, private) from March to May 2023.
- The WHO/HAI methodology was adapted to collect data on medicine availability from stock records and prices from pharmacy personnel.
- Medicine affordability was assessed by calculating the workdays required for a minimum wage earner to afford a treatment course.
Main Results:
- Overall pediatric medicine availability was low: 38.1% in public facilities, 53.7% in private retail, 49.5% in private clinics, and 48.3% in CHAM facilities.
- Prescription-only medicines were illegally available in up to 54% of medicine stores.
- While over 50% of medicines were affordable (requiring less than a day's wage), significant availability gaps persist across all sectors.
Conclusions:
- Poor availability of pediatric formulations in Malawi's public, CHAM, and private sectors poses a risk to child health, potentially increasing morbidity and mortality.
- Addressing supply chain challenges and prioritizing the needs of special populations like children are essential for achieving universal health coverage.
- Policy interventions are needed to improve the consistent availability and equitable access to essential pediatric medicines.
Objective:
Lack of access to essential medicines negatively impacts on the quality of healthcare delivery and increases morbidity and mortality, especially to the vulnerable pediatric population. We assessed the availability, pricing, and affordability of pediatric formulations in Malawi.
Methodology:
The study was conducted in 76 health facilities (public, faith-based and private pharmacies, and clinics) from the northern and southern regions of Malawi from March to May 2023. We adapted the WHO/HAI method for the assessment of both availability and pricing of medicines. Data on availability were collected from stock card records using a WHO/HAI template and medicine prices were provided by the pharmacy personnel who were managing the facilities. Availability of medicines was calculated as the percentage of facilities which had a stock of the respective medicine at the time of data collection while medicine prices was assessed by calculating the median prices of each medicine. To assess the affordability of the medicines, we calculated the number of days it takes for a person who is receiving the government-set minimum wage to work to pay for a treatment course of common indications. The study was approved by the KUHES ethics committee under the numbers U.12/22/3900 and U.12/22/3903.
Results And Conclusion:
The overall availability of pediatric medicines was 38.1% for public health facilities, 53.7% for private retail pharmacies and drug stores, 49.5% for private clinics and 48.3% for Christian Health Association of Malawi (CHAM) facilities. We found the illegal availability of prescription-only medicines of up to 54% in medicine stores. Medicine median prices were higher in the private clinics followed by retail pharmacies and drugs stores. CHAM had the lowest median prices for medicines of all the sectors. More than 50% of medicines were found to be affordable as less than a day's wage was required to purchase the treatment. We found poor availability of pediatric formulation among public, CHAM, and private sectors in Malawi. This may affect the quality of care among pediatric patients and therefore contribute to morbidity and mortality in Malawi. The supply of medicines and health commodities needs to consider needs of special populations such as children to achieve universal health coverage.
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