Overdependence on For-Profit Pharmacies: A Descriptive Survey of User Evaluation of Medicines Availability in Public Hospitals in Selected Nigerian States

ObjectiveLower availability of medicines in Nigerian public health facilities—the most affordable option for the masses—undermines global health reforms to improve access to health for all, especially the chronically ill and poor. Thus, a sizeable proportion of healthcare users, irrespective of purchasing power, buy medicines at higher costs from for-profit pharmacies. We examined user evaluation of medicine availability in public facilities and how this influences their choice of where to buy medicines in selected states—Cross River, Enugu and Oyo—in Nigeria.MethodsWe approached and interviewed 1711 healthcare users using a semi-structured, interviewer-administered questionnaire as they exited for-profit pharmacies after purchasing medicines. This ensured that both clients who had presented at health facilities (private/public) and those who did not were included. Information was collected on why respondents could not buy medicines at the hospitals they attended, their views of medicine availability and whether their choice of where to buy medicines is influenced by non-availability.Principal FindingsRespondents’ mean age was 37.7±14.4 years; 52% were males, 59% were married, 82% earned ≥NGN18, 000 (US$57.19) per month, and 72% were not insured. Majority (66%) had prescriptions; of this, 70% were from public facilities. Eighteen percent of all respondents indicated that all their medicines were usually available at the public facilities, most (29%), some (44%) and not always available (10%). Reasons for using for-profit pharmacies included: health workers attitudes (43%), referral by providers (43%); inadequate money to purchase all prescribed drugs (42%) and cumbersome processes for obtaining medicines.ConclusionsLower availability of medicines has serious implications for healthcare behavior, especially because of poverty. It is crucial for government to fulfill its mandate of equitable access to care for all by making medicines available and cheap through reviving and sustaining the drug revolving fund scheme and encouraging the prescription of generic drugs in all public health facilities.

研究背景与目的：尼日利亚公立医疗机构作为民众最可负担的医疗选项，其药品可及性偏低，这一现状削弱了旨在实现全民健康可及的全球卫生改革成效，尤其对慢性病患者与低收入群体影响更为显著。为此，无论购买力如何，仍有相当比例的医疗服务使用者需自营利性药店以更高成本购药。本研究针对尼日利亚克罗斯河州（Cross River）、埃努古州（Enugu）及奥约州（Oyo）的相关群体，调查医疗使用者对公立医疗机构药品可及性的评价，并分析该评价如何影响其购药地点选择。

研究方法：本研究在医疗服务使用者于营利性药店购药离店时，采用半结构化访谈式问卷对1711名受访者进行调查。该招募方式确保样本同时涵盖曾就诊于医疗机构（含公立与私立）及未就诊人群。调查内容包括：受访者无法在就诊医院购药的原因、对药品可及性的看法，以及购药地点选择是否受药品缺货影响。

主要研究结果：受访者平均年龄为37.7±14.4岁；其中52%为男性，59%已婚，82%的月收入不低于18000奈拉（NGN，约合57.19美元），72%未参保。多数受访者（66%）持有处方，其中70%的处方来自公立医疗机构。18%的受访者表示，其所需药品在公立医疗机构通常均可获取；29%认为多数药品可及，44%认为部分药品可及，仅10%表示药品始终缺货。受访者选择营利性药店购药的原因包括：医护人员服务态度问题（43%）、医疗机构转诊（43%）、无力承担全部处方药品费用（42%），以及购药流程繁琐。

研究结论：药品可及性偏低对医疗服务行为存在显著负面影响，这一问题在贫困群体中尤为突出。政府应切实履行保障全民公平享有医疗服务的职责，通过恢复并持续实施药品周转金制度，以及鼓励所有公立医疗机构开具仿制药处方，确保药品供应充足且价格亲民。