Household access to non-communicable disease medicines during universal health care roll-out in Kenya: A time series analysis

Zana Wangari Kiragu; Peter C Rockers; Monica A Onyango; John Mungai; John Mboya; Richard Laing; Veronika J Wirtz

doi:10.1371/journal.pone.0266715

Household access to non-communicable disease medicines during universal health care roll-out in Kenya: A time series analysis

PLoS One. 2022 Apr 20;17(4):e0266715. doi: 10.1371/journal.pone.0266715. eCollection 2022.

Authors

Zana Wangari Kiragu¹, Peter C Rockers¹, Monica A Onyango¹, John Mungai², John Mboya², Richard Laing^{1

3}, Veronika J Wirtz¹

Affiliations

¹ Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.
² Innovation for Poverty Action, Nairobi, Kenya.
³ School of Public Health, University of Western Cape, Bellville, South Africa.

Abstract

Objectives: This study aims to describe trends and estimate impact of county-level universal health coverage expansion in Kenya on household availability of non-communicable disease medicines, medicine obtainment at public hospitals and proportion of medicines obtained free of charge.

Methods: Data from phone surveillance of households in eight Kenyan counties between December 2016 and September 2019 were used. Three primary outcomes related to access were assessed based on patient report: availability of non-communicable disease medicines at the household; non-communicable disease medicine obtainment at a public hospital versus a different outlet; and non-communicable disease medicine obtainment free of cost versus at a non-zero price. Mixed models adjusting for fixed and random effects were used to estimate associations between outcomes of interest and UHC exposure.

Results: The 197 respondents with universal health coverage were similar on all demographic factors to the 415 respondents with no universal health coverage. Private chemists were the most popular place of purchase throughout the study. Adjusting for demographic factors, county and time fixed effects, there was a significant increase in free medicines (aOR 2.55, 95% CI 1.73, 3.76), significant decrease in medicine obtainment at public hospitals (aOR 0.68, 95% CI 0.47, 0.97), and no impact on the availability of non-communicable disease medicines in households (aβ -0.004, 95% CI -0.058, 0.050) with universal health coverage.

Conclusions: Access to universal health coverage caused a significant increase in free non-communicable disease medicines, indicating financial risk protection. Interestingly, this is not accompanied with increases in public hospitals purchases or household availability of non-communicable disease medicines, with public health centers playing a greater role in supply of free medicines. This raises the question as to the status of supply-side investments at the public hospitals, to facilitate availability of quality-assured medicines.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Drugs, Essential*
Health Services Accessibility
Humans
Kenya
Noncommunicable Diseases* / drug therapy
Noncommunicable Diseases* / epidemiology
Time Factors
Universal Health Care

Substances

Drugs, Essential

Grants and funding

The authors have read the journal's policy and have the following competing interests: This work was supported by commercial funder Sandoz International GmBH, a subsidiary of Novartis International AG. Peter C. Rockers received grants from Access Accelerated, Gilead Sciences, F. Hoffmann-La Roche, and Amgen outside the submitted work. Richard O. Laing received non-financial support from Novartis International AG, Gilead Sciences, and F. Hoffmann-La Roche outside the submitted work. Veronika J. Wirtz received grants from Access Accelerated, Gilead Sciences, F. Hoffmann-La Roche, and Amgen outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.