Out of pocket payment, affordability and availability of essential medicines in Africa: systematic review

Abstract

Background: Availability and affordability of medicines are key determinants of universal health coverage, yet achieving them presents a major challenge especially in low-income countries. This study aims to overview the evidence on the accessibility of essential medicines in the African continent. Methods: A quantitative literature search published in English since 2014 was held from valid databases; such as, Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. The search was erperformed from September 16 to 20, 2019. Two authors (G.A and D.T) screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the literature. The third author (N.A) commented on the review. We have used the universal definition of OOP, availability, and affordability. Results: Of 34, 06 articles initially identified, 19 were eligible for inclusion. These were cross-sectional and case-control household and health facility studies published in 2014 in Africa. They demonstrated that the availability of some essential medicine (antibiotics) >80% met WHO’s target. However, drugs for non-communicable diseases show unavailable that range within 20.1% to 60.8%. Households access health services mainly through OOP. An item patients’ expense more for, was fees for drugs (62.3%) (Congo) and was an expensive component of expenditure in private and public health facilities with a mean of 16.7USD and 25.5USD, respectively (Burkina-Faso). Drugs for non-communicable diseases were the most expensive than drugs for infectious diseases (median = 0.62 USD) (Ethiopia). The majority of core essential medicines in private and public outlets are unaffordable. There was a considerable variation in the affordability of basic treatment for infectious and non-communicable diseases. Interestingly, the potential source of inadequate availability of essential medicines and the presence of unaffordability was not investigated in Africa. Conclusion: Evidence suggests that even though, African countries show progress in coverage and affordability for some core essential medicines, it tills needs an effort to convey the WHO’s goal particularly for drugs of non-communicable disease. Future studies need to explore reasons for the persistent unavailability, unaffordability as well as high OOPs for medicines.