AVAILABILITY AND AFFORDABILITY OF ESSENTIAL MEDICINES: EXPLORING THE HEALTH SEEKING BEHAVIOURS AND HEALTH SERVICE UTILISATION FOR CHILDREN UNDER-5 YEARS LIVING IN SQUATTER SETTLEMENT OF KARACHI, PAKISTAN

Authors

  • Yasir Shafiq
  • Babar Tasneem Shaikh
  • Ramesh Kumar

Abstract

Background: Child health outcomes in the poor communities are largely affected by the nonavailability of essential medicines at government health facilities and non-affordability of prescribedmedicines at private retail pharmacies. This phenomenon largely defines health seeking behaviours andhealth service utilisation patterns of the families of the children. Methods: Using observational visits,we examined the shelf-availability of medicines for children less than 5 years of age at a rural healthcentre and conducted focus group discussions with the mothers to explore the effects of nonavailability and non-affordability of medicines. We also validated all information by interviewing thehealth care providers of the area. Results: We found that erratic and insufficient supply of essentialmedicines at the government health facility and a limited purchasing power to buy medicines from aretail pharmacy, led to considerable ‘financial burden’ on the poor people, non-compliance with thetreatment, health care seeking from informal health providers and healer shopping. This trend has aserious repercussion on the health seeking behaviours and of course the health outcomes, especiallyamong children. Conclusion: On the users’ side, health education and health promotion campaignmust be instituted to explain the adverse effects on child health ensure appropriate health care seekingbehaviours. For the supply side, the health care authorities must ensure the availability of essentialmedicines for the children at the government facilities. Local community representatives must beinvolved in the matters related to medicines stock management at the facility.Keywords: Essential Medicines, Health Seeking Behaviours, Health Service Utilization, Child Health,Developing Countries, Healthcare System

References

Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ.

Selected major risk factors and global and regional burden of

disease. Lancet 2002;360:1347–60.

Zahid GM. Mother’s health-seeking behavior and childhood

mortality in Pakistan. Pak Dev Rev 1996;35:719–31.

Bartlett S. Water, sanitation and urban children: the need to go

beyond “improved” provision. Environ Urba 2003;15:57–80.

UNICEF, WHO, the World Bank, UN Population Division.

Levels and trends in child mortality 2010: estimates developed by

the Inter-agency Group for Child Mortality Estimation. Report

Geneva: UN; 2010. Available from:

www.unicef.org/childsurvival/.../UNICEF_Child_mortality_for_

web_0831.pdf

Khan MS, Hussain I, Kazmi NR, Majid A, Javaid A. Morbidity

and mortality in children in rural community of district Peshawar.

Gomal J of Med Sci 2009;7:31–4.

United Nations Children's Fund. Unite for children. UNICEF:

Geneva; 2009. Available from:

http://www.unicef.org/infobycountry/pakistan_pakistan_backgro

und.html.

Atkinson S, Haran D. Individual and district scale determinants

of users’ satisfaction with primary health care in developing

countries. Soc Sci Med 2005;60:501–3.

World Health Organization. Declaration of Alma-Ata.

International Conference on Primary Health Care. Alma-Ata,

USSR, 6-12 September, 1978.

World Health Organization. Globalization, TRIPS and Access to

Pharmaceuticals: WHO Policy Perspectives on Medicines.

Geneva: 2001.

Banda M, Everard M, Logez S, Ombaka E. Multi-country study

of medicine supply and distribution activities of faith-based

organizations in sub-Saharan African countries. Geneva: WHO;

World Council of Churches. Essential medicines in primary

health care: where are we? Geneva. . [Accessed March 5, 2010].

Available from: www.oikoumene.org/fileadmin/files/wcc.../

contact/con-187.pdf

D’Souza RM. Role of health seeking behavior in child mortality

in the slums of Karachi, Pakistan. J Biosoc Sci 2003;35:131–44.

Butt ZA, Gilani AH, Nanan D, Sheikh AL, White F. Quality of

pharmacies in Pakistan: a cross-sectional survey. Int J Qual

Health Care 2005;17:307–13.

Siddiqui AR. Maternal characteristics in relation to income in a

semi-rural community in Pakistan. East Mediterr Health J

;13:1353–63.

International Union for Conservation of Nature (IUCN). Poverty

and Environment Nexus study: Rehri Goth, Main Korangi Creek

area. Islamabad: Asian Development Bank, IUCN–The World

Conservation Union Pakistan; 2003.

Shaikh BT, Haran D, Hatcher J, Azam SI. Studying healthseeking behaviors: collecting reliable data, conducting

comprehensive analysis. J Biosoc Sci 2008;40:53–68.

Glasser BG. The constant comparative method of qualitative

analysis. Social Problems 1965;12(4):436–38. Available at:

http://www.jstor.org/stable/798843

Bhutta ZA, Ali N, Hyder A, Wajid A. Maternal and child health

in Pakistan: Challenges and opportunities. Oxford University

Press; 2004. p19-46.

World Health Organization. Access indicators developed by the

World Health Organization. [Accessed on June 15, 2010].

Available from: http://www.un.org/esa/policy/mdggap/

appendix.pdf.

Saleh K, Ibrahim MIM. Are essential medicines in Malaysia

accessible, affordable and available? Pharm World Sci

;27:442–6.

England R. The dangers of disease specific aid programmes for

developing countries. BMJ 2007;335:565.

Mbugua KJ, Bloom GH, Segall MM. Impact of user fees on

vulnerable groups: The case of Kibwezi in rural Kenya. Soc Sci

Med 1995;41:828–35.

Nisar N, White F. Factors affecting utilization of antenatal care

among reproductive age group Women (15–49 years) in an urban

squatter settlement of Karachi. J Pak Med Assoc 2003;53:47–53.

Government of Pakistan. Utilization of public health facilities in

Pakistan. National Health Management Information System.

Islamabad: 2000

Harris Interactive. Out-of-pocket costs are a substantial barrier to

prescription drug compliance. Available at:

http://www.harrisinteractive.com/news/newsletters/healthnews/H

I_HealthCareNews2001Vol1_iss32.pdf.

Kardas P. Patient compliance with antibiotic treatment for

respiratory tract infections. J Antimicrob Chemother

;49:897–903.

Xu B, Fochsen G, Xiu Y, Thorson A, Kemp JR, Jiang QW.

Perception and experiences of health seeking and access to TB

care-a qualitative study in Rural Jiangsu Province, China. Health

Policy 2004;69:39–49.

Nonvignon J, Aikins MK, Chinbuah MA, Abbey M, Gyapong

M, Garshong BN, et al. Treatment choices for fevers in children

under-five years in a rural Ghanaian district. Malar J 2010;9:188.

Dzator J, Asafu-Adjaye J. A study of malaria care provider

choice in Ghana. Health Policy 2004;66:389–401.

Shaikh BT, Haran D, Hatcher J. Where do they go, whom do

they consult, and why? Health-seeking behaviors in the northern

areas of Pakistan. Qual Health Res 2008;18:747–55.

Published

2011-03-01

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