Evaluating the availability and affordability of essential drugs for the treatment of epilepsy in Rwanda

Abstract

Epilepsy is one of non-communicable diseases that has received little attention in developing countries health development agendas. Globally, around 50 million of people suffer from epilepsy with 80 % of them living in lower and middle income countries. While there is such a considerable number of cases, some conducted studies found that the availability and affordability of Anti-epileptic drugs were still a problem with a big extent in developing countries. The objective of this study was to assess the availability and affordability of antiepileptic drugs in Rwanda. Methods: A quantitative cross-sectional study was conducted in all Rwanda Medical Supply branches and secondary data were collected using an elaborated excel tool. Stock cards for Anti-epileptic drugs were checked to record information including quantity of Anti-epileptic available at visit, drug distribution, days and frequencies of stock outs, selling prices. The data collected were first cleaned in Excel and SPSS software was used to generate graphs. The Antiepileptic drugs available at the day of visit, days and frequencies of stock outs were expressed using mean and percentages. The stock status were also determined using maximum and minimum stocks as well as stocks according to plan. The affordability was assessed by adapting the WHO/HAI tool used in assessing prices, availability and affordability of drugs. Results: This study revealed that 70.21% of essential antiepileptic drugs were available in Rwanda Medical Supply branches. Valproic Acid syrup 200mg/5ml and Phenobarbital 100mg/ml inj. were expensive but affordability was good and community-based health insurance played a big part. Only 12 (40%) of Rwanda Medical Supply branches (n=30) were in stock out of Phenobarbital 100mg while 10 (33.3 %) of RMS branches experienced stock out of Phenobarbital 30mg. The median length of stock-out ranged from 34.4 to 147.3 days. This study found that 63% (n=30) of branches had under minimum stock of Phenobarbital Tab 100mg while 73.3% (n=30) of branches were in overstock for Carbamazepine Tab 200mg.

Conclusion With 70.21 % of availability, this study revealed that there are still some stock outs on Antiepileptic drugs susceptible to hinder the uninterrupted availability of these drugs. Not only stock outs, but also stocks below minimum and beyond maximum levels were found for Antiepileptic drugs in this study which informed about desired efforts in inventory management. The affordability is better in Rwanda compared to many other African counties thanks to the community-based health insurance.