Assessing the Availability, Service Quality, and Price of Essential Medicines in Private Pharmacies in Afghanistan
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Background: Globally, medicines remain inaccessible and unaffordable in low and middle-income countries, where national medicines regulatory authorities are often weak. In Afghanistan, the Ministry of Public Health strives to develop pharmaceutical systems to ensure people's access to health care. However, the private pharmacy sector is largely uncontrolled, and its role is unknown in terms of guaranteeing accessibility, availability, and affordability of essential medicines. Objectives: The dissertation aimed to estimate the prevalence and types of private pharmacies--licensed and unlicensed--and to assess the relationships among pharmacy licensure status, the availability of essential medicines, pharmacy service quality, and essential medicine prices. Methods: A national-level, interview survey of 879 pharmacies was conducted to examine characteristics of private pharmacies in 10 representative provinces in Afghanistan and to obtain information of staff characteristics, licensure status, service quality, availability of essential medicines, and price. Regression models were estimated to assess relationships between the availability of essential medicines as a proportion of a basket of 30 essential medicines, licensure status, service quality, and price of essential medicines. Results: Of 30 sampled essential medicines, national-level availability at private pharmacies was estimated to be 63.7%. In terms of licensure, 54.5% were licensed, 10.5% were unlicensed, and the rest unverifiable. There was a consistent trend to slightly lower availability in unlicensed pharmacies. In addition, associations between licensure status, service quality, and price were weak, despite considerable price variation. Conclusion: Private pharmacies have an important role to play in improving access to care by making essential medicines available for the population in need in Afghanistan. Licensure status does not explain the variations in the availability of essential medicines. Essential medicine prices showed considerable variability, indicating that that regulation is unsuccessful at controlling the price of essential medicines in the private market. The private licensure system as a regulatory intervention does not effectively guarantee the availability of essential medicines in Afghanistan. Further research is needed to identify the appropriate changes in regulatory policy to improve access to pharmacy services in terms of the availability and affordability of essential medicines.