Assessment of Essential Medicines Affordability in Primary Health Care Facilities in Southern Nigeria: “Effect of Drug Revolving Fund Performance

Background Essential medicines save lives and improve health, when they are available, affordable, of assured quality and used rationally. High cost of medicines is a major barrier to accessing medicines and achieving better health outcomes. This study assessed the effect of Drug Revolving Fund performance on affordability of essential medicines in the primary health care facilities in Esan Southeast local government in southern Nigeria. Method The study was a descriptive cross-sectional study that employed both quantitative and qualitative approaches, following the standardized World Health Organization and Health Action International (WHO/HAI) methodology. Prices of 27 key essential medicines (EDs) for treatment of common diseases and 12 key essential medicines used in reproductive health were assessed in 22 primary health care facilities in Esan Southeast. The operation of Drug Revolving Fund was also explored with the use of researcher administered questionnaire to determine its performance and effect on affordability of EDs. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of essential medicines. Results The results showed that on the average the lowest paid worker would require 0.34 (representing 34%) of a day’s wage for the treatment of malaria in adults using artemisinin combination therapy (ACT), while with quinine it required 0.5 (representing 50%) of a day’s wage. Also for the treatment of childhood diseases, malaria treatment required 0.07 days wage (representing 7% of a day’s wage) using ACT while treatment with quinine required 0.43 day’s wage (representing 43% of a day’s wage). According to this study one comprehensive health centre (representing 33.3% of the total CHC) out of the three CHC had a good performance of DRF, and then two out of seventeen PHC (representing 11.8% of the total PHCs) had a good performance of DRF. None of the HP had a working DRF. Majority of the health facility had a poor performance of DRF. Health facilities with good performance of DRF also had good affordability of EDs for treatment of common diseases and vice versa. The same was true for EDs used in reproductive health. Conclusion Essential medicines for treatment of adults and child’s disease conditions were largely affordable. Alternative health financing options together with the performance of DRF had effects on affordability of essential medicines for treatment of common diseases and for reproductive health. A working Drug Revolving Fund Scheme is critical to affordable access to essential medicines in primary health care facilities.