Ethiopian hospitals must do more to provide medicines to patients

Researchers say patients need better access to medicines at Ethiopian hospitals. Their study found patients often didn’t know enough about their medications, and some didn’t have access to all the drugs they needed. Their medicines were also very expensive, and hospitals were not managing the resources and staff needed to dispense medications well enough.

Many Ethiopians suffer from tuberculosis, HIV/AIDS, pneumonia, diabetes, cancer and high blood pressure. Unfortunately, medicines are often not available or are not taken properly by patients, and pharmaceutical services are generally poor.

The government wanted to improve the situation using a system called the “Auditable Pharmaceutical Transactions and Services” (APTS). In this 2017 study, researchers wanted to know if the system indeed improved medicine access for patients.

They looked specifically at how the system was applied at 2 public hospitals in southern Ethiopia.

They surveyed pharmacy staff and interviewed 400 patients. They used statistical methods to analyse their answers so that they could draw conclusions about any differences between the 2 hospitals.

Unfortunately, they determined that the ATPS system was of a low quality at both hospitals. They said patients showed little knowledge of medications, medication was expensive, and patients did not have access to all medications needed. There was also pharmaceutical mismanagement, and resources, staff, and facilities required for dispensing medications were not satisfactory.

Most Ethiopians live below the poverty line, so having access to affordable medicines is key to making healthcare accessible and equitable to citizens. Researchers say this study shows which challenges hospitals need to address to improve access, and they recommend administrative training for those who dispense medicines.

They caution however that their study was done on only a small group of people, so may not represent the situation in the general population, and some patient responses could have reflected their feelings about other healthcare departments. 

But the researchers did compare their results to work done in other African and lower-income countries such as Ghana and Haiti, and found many similarities.

Abstract

Background: Availability of essential medicines is necessary to maintain health of the community. In Ethiopia, availability of medicines was low (65%), with high expiry rate (8.24%), low patient knowledge on correct dosage (50.5%) and satisfaction on pharmacy services (74.5%). To avert these problems, the government had endorsed legislation on a system called “Auditable Pharmaceutical Transactions and Services (APTS)”. However, the outcomes and challenges in implementation of this system were not assessed.

Objective: To assess the implementation status of APTS and its challenges at public hospitals in Gamo Gofa Zone Southern Ethiopia, April 2017.

Methods: Facility based Cross sectional study was conducted in two APTS implementing hospitals in Gamo Gofa zone. Semi structured Self-administered questionnaire was distributed to all pharmacy staffs in selected hospitals. APTS reports of 12 months (with different characteristics) were reviewed. Four hundred patients were interviewed by data collectors about patient knowledge and satisfaction using WHO questionnaire. The data were entered and analyzed using Statistical package for social science students/SPSS version 20. T-test and linear regression was used to evaluate significant differences between two hospitals with level of significance pre-set at p-value ≤0.05.

Results: All dispensing units in primary hospital had six (75%) out of the eight essential equipment for dispensing practice. it was found that respondents in general hospital stated higher scores in general setting of outpatient pharmacy (4.58 Versus 4.25; P <0.001), but lower scores for availability and cost of medicines (4.24 vs 4.43; P<0.05) when compared with those in primary level hospital. There was no significant difference in instruction of medicine provided by dispenser (2.58 vs 2.59; P>0.05), dispenser client interaction (3.09 vs 4.08; P>0.05) and total satisfaction score (2.09 vs 2.02; P>0.05).

Conclusion and recommendations: In our study Quality of Auditable Pharmaceutical Transactions and Service was low, especially regarding patient knowledge about medicines, unaffordability of medicines, less availability of prescribed drugs, poor transparency of pharmaceutical transactions, insufficient counselling practice and limited facilities for dispensing such as, key medicines, formularies and standard guidelines. We therefore recommend the following measures responsible bodies to improve these gaps by taking administrative actions and providing continued education and training for dispensers.

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