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
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 SystemReferences
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
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
