Availability and affordability of essential medicines during the COVID-19 pandemic among drug retail outlets in Addis Ababa, Ethiopia—a mixed methods study

Background Accessing essential medicines that satisfy the priority healthcare needs of the population is the backbone of the healthcare system. During the COVID-19 pandemic, accessing essential medications has become more challenging than ever before. This study aimed to assess the availability and affordability of essential medicines among public and private drug retail outlets (DROs) in Addis Ababa, Ethiopia, during the COVID-19 pandemic. Methods An explanatory sequential mixed methods approach that utilized a quantitative survey followed by a qualitative interview was employed from July 1, 2021, to March 30, 2022. Public and private DROs that fulfilled the study criteria were selected from among 11 sub-cities of Addis Ababa. For the quantitative part, data entry and analysis were carried out via the WHO/HAI workbook and SPSS version 26, whereas for the qualitative part, thematic analysis was used. Results The overall availability of essential medicines in Addis Ababa was 5.78% and 53.5% for originator brands and lowest-priced generics, respectively, with the mean availability of originator brands being greater in private DROs, whereas that of lowest-priced generics was greater in public sector outlets. The Mann–Whitney U test indicated that 94.7% of LPGs show a statistically significant (p < 0.05) median unit price difference between public and private DROs. The cost of standard treatment varied from 0.14–6.9 days’ wages in public and 0.74–25.9 days in private DROs. The identified contributing factors that were explained by the qualitative findings were related to the data reporting trend of public health facilities (PHFs), issues related to pharmaceutical logistics, changes in the demand pattern for pharmaceuticals, and global pharmaceutical supply chain disruption due to the COVID-19 pandemic. Conclusion The current study revealed that essential medicines were poorly available with unaffordable prices in Addis Ababa for various reasons related to demand and supply imbalances related to the COVID-19 pandemic and other factors. The various stakeholders in the pharmaceutical supply chain of the country should work together to improve availability and make the price of medicines affordable.