Prices, Availability and Affordability of Essential Medicines in Public and Private Sectors of Kashmir Province

In low- and middle-income countries, large proportions of the population have limited access to medicines, either because of poor availability or because patients have to pay for their prescriptions which often they not able to do. The price and availability of medicines are key components in determining access to effective treatments. Data on prices and availability of common medicines in public and private sector in different Districts of Kashmir are scarce. Hence, a survey was undertaken in ten districts of Kashmir division to evaluate these metrics. This study used standard World Health Organization and Health Action International methodology in ten districts of Srinagar, Anantnag, Pulwama, Shopian, Ganderbal, Budgam, Baramulla, Kupwara, Bandipora and Kulgam.

 

Data was collected from the public as well as private sector pharmacies. Public sector consisted of a total of 51 district and divisional level govt health institutions whereas private sector comprised of 28 private retail pharmacies where people have to pay full cost of the medicines to the retailer. A core list of 31 drugs was prepared apart from a supplementary list of 16 drugs for the sake of assessment of accessibility and affordability. For each medicine, data was collected for the Innovator Brand (IB), Most Sold Generic (MSG), and Lowest Priced Generic (LPG) at randomly selected public and private facilities in each site surveyed. Prices were compared to an international reference price published by Management Sciences for Health, USA.

 

Study revealed that district hospitals, SDHs, PHCs, allopathic dispensaries and CHCs had the lowest average availability (7.13%) compared to the private sector (54.62%). In the private sector it was observed that, highest as well as lowest priced medicines were more expensive than their international reference price comparisons. Treatments were unaffordable, costing as much as 5 days wages’ of an unskilled worker to cure respiratory tract infections. The procurement price of medicines in the public sector was very low. Although a few innovator brands were more expensive, no difference was observed between the prices of the most sold generic (MSG) and the lowest priced generic (LPG) available at the facilities. The survey revealed low procurement prices and poor availability in the public sector. Thus, the majority of the population purchased medicines from private pharmacies, where generics were sometimes available although prices of certain medicines were high. Robust and specified policy measures could increase the availability and accessibility of medicines for the population.