Abstract:
Background: Cancer is a rapidly growing global public health concern. Availability and affordability of cancer medicines remain among the challenges precluding its optimal care in developing and developed countries.
Objective: This study aimed at assessing the availability, stock-outs, prices, and affordability of cancer medicines in Rwanda and contributing factors.
Methods: A cross-sectional mixed-methods design was used to assess forty-nine cancer medicines listed in the 20th WHO EML. Data on medicine availability, stock-outs, procurement prices, and patients’ prices for the period from 1 st July 2018 to 30th June 2019 were collected from Butaro Cancer Center of Excellence, Centre Hospitalier Universitaire de Kigali, and King Faisal Hospital – the three tertiary facilities providing cancer care in Rwanda and two divisions of the central health implementation agency. Additionally, we used semi-structured interviews for qualitative data.
Results: Of the 49 medicines tracked, the alignment of Rwanda’s 2015 EML with WHO EML was 46.9%. In contrast, 77.6% of tracked cancer medicines were included in health facilities' formularies. Overall availability across facilities surveyed was 63.3% of the cancer medicines in the WHO EML and 78.9% of health facilities-based formulary cancer medicines. All health facilities experienced at least one stock-out and stock-outs were recorded for 86.8% of the medicines for the period from 1st July 2018 to 30th June 2019. Overall median and mean stock-outs duration were 365 (IQR: 1, 365) and 245 (SD +/-147) days respectively. Overall procurement prices for 50% of the medicines were >1 higher than the international buyer’s median prices. A majority (97.4%) of 38 medicines with price information were found to be unaffordable whereas 47.4% of medicines would require greater than hundreds of daily wages to purchase one course of treatment. Lack of coverage by the CBHI and inefficient procurement system were among the factors highlighted contributing to the non-affordability and high cost of cancer medicines in Rwanda.
Conclusion: This study showed low availability and frequent stock-outs of cancer medicines as major challenges for access to cancer medicines in Rwanda. This study suggests that strategic and affordable sourcing coupled with improvements in the health facility and national supply chain systems and processes would go a long way to increasing access, adequacy, and affordability for cancer medicines in Rwanda.
