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Availability and affordability of antimalarial and antibiotic medicines in Malawi

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  • Felix Khuluza
  • Lutz Heide

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. We here present an analysis of availability and prices of antimalarial and antibiotic medicines in public, faith-based and private health facilities in Malawi. Medicines are provided free of charge in the public health care system of Malawi. In contrast, facilities of the Christian Health Association of Malawi (CHAM) usually charge their patients for medicines, as do private for-profit facilities. Methods: As part of a study on medicine quality, samples of six antimalarial and six antibiotic medicines were collected in 31 health facilities in four districts of southern Malawi. These included 15 public facilities (i.e. health centres, district hospitals and central hospitals), eight CHAM and eight private facilities. Random selection was used in choosing the included health facilities. The availability of medicines was recorded, including the number of units which could be collected of each medicine, as well as the prices of medicines which were charged in CHAM and private facilities. These data were analyzed using the standard methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Results: Availability of the antimalarials artemether/lumefantrine and sulfadoxine/pyrimethamine, which are provided with financial support from international donors, was high in public and CHAM facilities (93% and 100%, respectively). However, availability of antibiotics was much lower (e.g. 40% availability of amoxicillin tablets/capsules in public health centres). Medicine prices were lower than reported from many other countries. The median price ratio (MPR) to a wholesale international procurement price was 2.8 in CHAM facilities and even lower in the private sector (MPR 2.3). Nevertheless, for 10 of the 12 investigated medicines the cost for one course of treatment exceeded the daily wage of a low-paid government worker in Malawi and therefore had to be considered as unaffordable for a major part of the population. Conclusions: Continued efforts are required to improve the availability of essential medicines in Malawi. The free provision of medicines in the public health care system remains important in order to achieve universal health coverage, due to the low income in this country.

Suggested Citation

  • Felix Khuluza & Lutz Heide, 2017. "Availability and affordability of antimalarial and antibiotic medicines in Malawi," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-15, April.
    • Handle: RePEc:plo:pone00:0175399
    DOI: 10.1371/journal.pone.0175399
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    1. John H Amuasi & Graciela Diap & Samuel Blay Nguah & Patrick Karikari & Isaac Boakye & Amara Jambai & Wani Kumba Lahai & Karly S Louie & Jean-Rene Kiechel, 2012. "Access to Artemisinin-Combination Therapy (ACT) and other Anti-Malarials: National Policy and Markets in Sierra Leone," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-9, October.
    2. Zaheer-Ud-Din Babar & Charon Lessing & Cécile Mace & Karen Bissell, 2013. "The Availability, Pricing and Affordability of Three Essential Asthma Medicines in 52 Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 31(11), pages 1063-1082, November.
    3. Yaser T Bazargani & Margaret Ewen & Anthonius de Boer & Hubert G M Leufkens & Aukje K Mantel-Teeuwisse, 2014. "Essential Medicines Are More Available than Other Medicines around the Globe," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-7, February.
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    1. Meike Irene Nakovics & Stephan Brenner & Grace Bongololo & Jobiba Chinkhumba & Olivier Kalmus & Gerald Leppert & Manuela De Allegri, 2020. "Determinants of healthcare seeking and out-of-pocket expenditures in a “free” healthcare system: evidence from rural Malawi," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
    2. Thomas Bizimana & Pierre Claver Kayumba & Lutz Heide, 2020. "Prices, availability and affordability of medicines in Rwanda," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-14, August.

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