User Evaluation of Availability of Medicines in Nigerian Public Hospitals: Why do Urban Dwellers Purchase Medicines from For-Profit Pharmacies?

Non-availability of medicines in Nigerian Public Health Facilities (PHFs), which constitute the best option for the common man, undermines the global health reforms to improve access to health for all, especially the... [ view full abstract ]

Non-availability of medicines in Nigerian Public Health Facilities (PHFs), which constitute the best option for the common man, undermines the global health reforms to improve access to health for all, especially the chronically ill and poor. Thus, healthcare users, irrespective of purchasing power, buy medicines at exorbitant prices from for-profit pharmacies. We examined user evaluation of medicine availability in public facilities and how this influences their choice of where to buy medicines in three states- Cross River, Enugu and Oyo- of Southern Nigeria. We approached and interviewed 1711 healthcare users, with an interviewer-administered questionnaire, as they visited for-profit pharmacies to purchase medicines. This allowed both buyers who had presented at health facilities (private/public) and those who did not, to be included. Information was collected on why respondents could not buy medicines at the hospitals they attended, their views of medicine availability and whether non-availability influences their choice of for-profit pharmacies and/or self-medication. Mean age of participants was 37.58±14.9 years; 52% were males, 59% were married, 82% earned ≥NGN18,000 (US$90) per/month, the national minimum wage, and 72% were not enrolled in the National Health Insurance Scheme. Majority (66%) had presented in a hospital, and had prescriptions; of this, 70% were from PHFs. Eighteen percent of all respondents felt that all their medicines were usually available at the PHFs, most were available (29%), some were available (44%) and not always available (10%). Reasons for using for-profit pharmacies included: health workers attitudes (43%), referral by providers (43%); inadequate money to purchase all prescribed drugs (42%) and cumbersome processes for obtaining medicines. Lower availability of medicines has serious implications for healthcare behavior, especially in the context of poverty. It is crucial for government to fulfill its mandate of providing access to care for all by ensuring medicines are available and cheap in all PHFs.