ACCESS TO MEDICINES FOR HYPERTENSIVE DISORDER OF PREGNANCY IN SOMALIA: A WHO/HAI EVALUATION OF AVAILABILITY, PRICES, AND AFFORDABILITY
Author(s)
Najwa Ali Yasin, MSc1, Amna Saeed, PhD1, Jin Peng, MSc1, Yifan Wu, MSc1, Marian Osman, MD2, Ahmed Mohamed, MD3, Elias Mossialos, PhD4, Zaheer-Ud-Din Babar, PhD5, Yu Fang, PhD1, Minghuan Jiang, PhD1.
1Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China, 2Research Department, Somali National Institute of Health, Mogadishu, Somalia, 3Faculty of Medicine and Health Science, Darul Hikmah University, Mogadishu, Somalia, 4London School of Economics -LSE Health, London, United Kingdom, 5Qatar University, Doha, Qatar.
1Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China, 2Research Department, Somali National Institute of Health, Mogadishu, Somalia, 3Faculty of Medicine and Health Science, Darul Hikmah University, Mogadishu, Somalia, 4London School of Economics -LSE Health, London, United Kingdom, 5Qatar University, Doha, Qatar.
OBJECTIVES: Hypertensive disorders of pregnancy (HDPs), common and potentially life-threatening pregnancy complications, are among the leading causes of maternal death in Somalia. Yet, evidence on access to medicines indicated for managing these conditions remains limited. We evaluated the availability, prices, and affordability of medicines for HDPs in Somalia.
METHODS: A cross-sectional survey using an adapted WHO/Health Action International methodology assessed retail price and availability data for nine HDP medicine formulations across public (n=40), private (n=30), and private not-for-profit (PNFP) facilities (n=8) in six urban regions. Data were collected using a standardized survey form hosted on REDCap. Availability was calculated as the proportion of facilities stocking each medicine on the survey day. Prices were expressed as median price ratios (MPRs) relative to international reference prices. Affordability was assessed as the number of days' wages required for the lowest-paid government worker (LPGW) and using the catastrophic medicine expenditure (CME) method, whereby treatment costs exceeding 5% of daily consumption expenditure among population groups living on US$0.87-4.29 per day were considered catastrophic.
RESULTS: Overall availability of HDP medicines was very low, with only 24%, 25%, and 27% of private, public, and PNFP facilities stocking all nine formulations, respectively. Medicines were provided free of charge in the public and PNFP sectors, whereas private sector prices were moderately above international reference prices (median MPR 1.5). Affordability in the private sector was poor, requiring 2.36 days’ wages for the LPGW to purchase complete treatment. CME incidence was high, with an estimated 34% to 100% of population groups likely to spend more than 5% of their daily living expenditure on medicines.
CONCLUSIONS: Access to medicines for HDPs in Somalia is constrained by critically low availability across all sectors and affordability barriers in the private sector, highlighting the urgent need for targeted pricing and procurement policies.
METHODS: A cross-sectional survey using an adapted WHO/Health Action International methodology assessed retail price and availability data for nine HDP medicine formulations across public (n=40), private (n=30), and private not-for-profit (PNFP) facilities (n=8) in six urban regions. Data were collected using a standardized survey form hosted on REDCap. Availability was calculated as the proportion of facilities stocking each medicine on the survey day. Prices were expressed as median price ratios (MPRs) relative to international reference prices. Affordability was assessed as the number of days' wages required for the lowest-paid government worker (LPGW) and using the catastrophic medicine expenditure (CME) method, whereby treatment costs exceeding 5% of daily consumption expenditure among population groups living on US$0.87-4.29 per day were considered catastrophic.
RESULTS: Overall availability of HDP medicines was very low, with only 24%, 25%, and 27% of private, public, and PNFP facilities stocking all nine formulations, respectively. Medicines were provided free of charge in the public and PNFP sectors, whereas private sector prices were moderately above international reference prices (median MPR 1.5). Affordability in the private sector was poor, requiring 2.36 days’ wages for the LPGW to purchase complete treatment. CME incidence was high, with an estimated 34% to 100% of population groups likely to spend more than 5% of their daily living expenditure on medicines.
CONCLUSIONS: Access to medicines for HDPs in Somalia is constrained by critically low availability across all sectors and affordability barriers in the private sector, highlighting the urgent need for targeted pricing and procurement policies.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HPR45
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Procurement Systems, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Reproductive & Sexual Health