Addressing access barriers to medicines in the Republic of Moldova

Abstract

Introduction. In middle-income and low-income countries, average availability of medicines is 35% in public facilities and 66% in the private sector. The prices are often unaffordable, for the majority of population. Up to 50% of medicines are inappropriately prescribed or dispensed, and up to 50% are used incorrectly by patients. This leads to significant wasted resources, the potential to drive the development of drug resistance and to poor health outcomes. Many patients, especially the poor, rely on the informal sector for their health care needs including medicines, while respective vendors have little or no pharmacy training. Aim of the study. Evaluation and addressing barriers of population from Republic of Moldova to medicines trough health system perspective. Materials and methods. Has been conducted a descriptive cross-sectional study of international practice on strengthen policy framework on access to medicines; secondly has been initiated a quantitative study on the population of Republic of Moldova regarding the access to medicines. Results. According to UNDP, global access to medicines is: having drugs continuously available and affordable at public and private health facilities or drug outlets that are within one hour's walk of the population. Addressing access barriers to medicine has four dimensions: availability, geographic accessibility, affordability and acceptability. Availability: medicines supply-type and quantity and medicines demand type and quantity; affordability: prices of drug products and services, user income and ability to pay; acceptability: characteristics of products and services, user attitudes, expectations of products and services; accessibility: medicines supply location and user location. Another concept assume that access is defined by rational use: rational therapeutic choices and improved medicines’ use by consumers; affordable prices: medicines pricing policies; sustainable financing: resource mobilization, pooling, reduction of out-of-pocket expenditures; reliable health and supply systems: medicines procurement and supply, regulation, human resources. Conclusions. According with latest studies, the main health expenditure of population from Republic of Moldova are medicines – 73,5%. In case of hospitalisation 44% of population had to by supplementary medicines. To address barriers health system should ensure health equity, funds, universal health coverage, health insurance, provision of essential health care services, pay for performance, regulatory approaches, needs-based financing, integrated outreach services, abolishment of user fees, staffed peripheral health facilities, sensitive health care delivery.