Accessibility of medicines used in the management of substance use disorders in selected hospitals in Nairobi

Clarice A Ambale, Kipruto A Sinei, Beatrice K Amugune, Margaret N Oluka

Abstract


Background: Substance use disorder is a complex chronic disease that requires a multidisciplinary approach in treatment. Pharmacotherapy is one of the components in the treatment of this condition. This study sought to assess the accessibility of medicines used in the treatment of substance use disorders in both a public and a private health facility in Nairobi.

Methodology: This descriptive cross-sectional study with both qualitative and quantitative components was carried out in April and May 2015 at two hospitals in Nairobi, Mathare Mental Hospital (public) and Chiromo Lane Medical Centre (private).  Data on availability and affordability was collected from the two sites and the WHO performance indicators for health facilities used to assess availability. Affordability was determined using the daily wage of the lowest paid government worker. Interviews with the key informants were conducted to determine factors that influence the accessibility of the medicines.

Results: About 50% of medicines on the Kenya Essential Medicines List for management of substance use disorders were available in Mathare while Chiromo Lane had all of them. The mean stock out duration was 8 months and 0.5 months in Mathare and Chiromo Lane, respectively.  More than 67 % of the medicines required less than a single day’s wage to buy a month’s supply in Mathare while in Chiromo Lane all the medicines required more than a single day’s wage to purchase.  The cheapest medicine required 0.3 days wage to purchase while the most expensive drug required 50 days wage to purchase.

Conclusion: Medicines for the treatment of substance use disorders had limited availability but were relatively affordable in Mathare while their availability was better in Chiromo Lane but with limited affordability.  The Kenya Essential Medicines List for substance use disorders requires updating to include newer and more efficacious medicines. National guidelines for the treatment of substance use disorders should be developed and disseminated.

Key words: Substance use disorders, pharmacotherapy, accessibility and affordability


References


Beckerleg S, Telfer M, Hundt GL (2005). The rise of injecting drug use in east Africa: a case study from Kenya. Harm Reduct. J. 2:11-12.

Dabare P R, Chandanie A W, Beneragama BVS (2014). A national survey on availability, price and affordability of selected essential medicines for non-communicable diseases in Sri Lanka. BMC Public Health 14:817.

Fujii ET (1974). Public investment in the rehabilitation of heroin addicts. Soc Sci Q. 1974 55(1):39–51.

Hogerzeil HV, Liberman J, Wirtz VJ, Kishore SP, Selvaraj S, Kiddell-Monroe R (2013). Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. Lancet. 381: 680–9.

Kenya Economic Report (2013). Kenya Institute for Public Policy Research and Analysis (KIPPRA).

Kenya Service Provision Assessment Survey, 2010 (2011). National Coordinating Agency for Population and Development (NCAPD) (Kenya), Ministry of Medical Services (MOMS) (Kenya), Ministry of Public Health and Sanitation (MOPHS) (Kenya), Kenya National Bureau of Statistics (KNBS) (Kenya), ICF Macro. Nairobi, Kenya

Lingford-Hughes AR, Welch S, Peters L, Nutt DJ, British Association for Psychopharmacology, Expert Reviewers Group. (2012). BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol. 26 (7):899–952.

McCoy CB, Metsch LR, Chitwood DD, Miles C (2001). Drug Use and Barriers to Use of Health Care Services. Subst. Use Misuse. 36::789–804.

McLellan AT, Starrels JL, Tai B (2014). Can substance use disorders be managed using the chronic care model? Review and recommendations from a NIDA Consensus Group. Public Health Rev ; 35: http://www.journalindex.net/visit.php?j=6676

Mendis S, Fukino K, Cameron A, Laing R, Filipe Jr A, Khatib O (2007). The availability and affordability of selected essential medicines for chronic diseases in six low-and middle-income countries. Bull World Health Organ. 85:279–88.

Ministry of Medical Services and Ministry of Public Health & Sanitation (2009). Access to Essential Medicines in Kenya - A Health Facility Survey. (Accessed March 2015). Available at: http://apps.who.int/medicinedocs/documents/s18695en/s18695en.pdf

Ministry of Medical Services (2012). National Treatment Protocol for Substance Use in Kenya. (Accessed March 2015). Available at: http://nairobiparentingclinic.blogspot.co.ke/2015/10/national-treatment-protocol-for_97.html

National Authority for the Campaign against Alcohol and Drug Abuse (2012). Rapid situation assessment of the status of drug and substance abuse in Kenya.

Noeline L (2009). Addiction Medicine. Oxford University Press. UK.

National Institute on Drug Abuse (2012). Principles of drug addiction treatment. 3rd Edition. National Institutes of Health, US.

United Nations Office on Drugs and Crime (2012). World Drug Report. (Accessed March 2015). Available at: https://www.unodc.org/unodc/en/data-and-analysis/WDR-2012.html

World Health Organization (2014). Global status report on alcohol and health. (Accessed Marched 2015). Available at: http://apps.who.int/iris/handle/10665/112736

World Health Organization (2011). Guidelines for medicine donations. (Accessed Marched 2015). Available at: http://www.who.int/medicines/publications/med_donationsguide2011/en/


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