Accessibility of Medicines Used in the Management of Substance Use Disorders in Selected Hospitals in Nairobi

Abstract

Background: Substance use disorder is a complex chronic disease that requires a multidisciplinary approach in treatment. Pharmacotherapy is one of the components in the treatment of this condition. This study sought to assess the accessibility of medicines used in the treatment of substance use disorders in both a public and a private health facility in Nairobi.

Methodology: This descriptive cross-sectional study with both qualitative and quantitative components was carried out in April and May 2015 at two hospitals in Nairobi, Mathare Mental Hospital (public) and Chiromo Lane Medical Centre (private).  Data on availability and affordability was collected from the two sites and the WHO performance indicators for health facilities used to assess availability. Affordability was determined using the daily wage of the lowest paid government worker. Interviews with the key informants were conducted to determine factors that influence the accessibility of the medicines.

Results: About 50% of medicines on the Kenya Essential Medicines List for management of substance use disorders were available in Mathare while Chiromo Lane had all of them. The mean stock out duration was 8 months and 0.5 months in Mathare and Chiromo Lane, respectively.  More than 67 % of the medicines required less than a single day’s wage to buy a month’s supply in Mathare while in Chiromo Lane all the medicines required more than a single day’s wage to purchase.  The cheapest medicine required 0.3 days wage to purchase while the most expensive drug required 50 days wage to purchase.

Conclusion: Medicines for the treatment of substance use disorders had limited availability but were relatively affordable in Mathare while their availability was better in Chiromo Lane but with limited affordability.  The Kenya Essential Medicines List for substance use disorders requires updating to include newer and more efficacious medicines. National guidelines for the treatment of substance use disorders should be developed and disseminated.