EQUITY GAPS IN ACCESS TO ESSENTIAL CARDIOVASCULAR AND ANTIDIABETIC MEDICINES IN PAKISTAN: A MULTI-REGIONAL WHO/HAI SURVEY WITH MULTIVARIABLE ANALYSIS
Author(s)
Amjad Khan, PharmD, MPhil, PhD1, Muhammad Uzair ul Haq, PharmD2, Saima Mushtaq, PhD3, Arslan Khan, MSc, PharmD1, Yu Fang, PhD1.
1School of Pharmacy, Xi'an Jiaotong University, Xi'an, China, 2Quaid-i-Azam University, Islamabad, Pakistan, 3School of Pharmacy, Xi'an Jiaotong University, Xi’an, China.
1School of Pharmacy, Xi'an Jiaotong University, Xi'an, China, 2Quaid-i-Azam University, Islamabad, Pakistan, 3School of Pharmacy, Xi'an Jiaotong University, Xi’an, China.
OBJECTIVES: To assess availability, prices, affordability, and determinants of access to essential cardiovascular and antidiabetic medicines across public and private sectors in Pakistan.
METHODS: A cross-sectional WHO/Health Action International survey was conducted across six regions of Pakistan: Islamabad, Rawalpindi, Gujranwala, Muzaffargarh, Vehari, and Azad Jammu & Kashmir. Thirty-two essential medicines were assessed in 60 outlets, including public facilities and private pharmacies. Availability was measured on the survey day. Private-sector prices were evaluated using median price ratios against international reference prices, and affordability was estimated as days’ wages required by the lowest-paid unskilled government worker for a 30-day treatment. Multivariable logistic regression assessed factors associated with medicine availability, including sector, brand type, healthcare level, and district.
RESULTS: Medicine availability was suboptimal, particularly in the public sector, where no medicine achieved the WHO 80% availability benchmark. Private pharmacies had nearly threefold higher odds of medicine availability than public facilities (OR=2.90; 95% CI: 2.49-3.37; p<0.001). Brand type was not significantly associated with availability (OR=1.09; 95% CI: 0.94-1.26; p=0.260). Compared with primary care, availability was significantly lower in secondary (OR=0.43; 95% CI: 0.36-0.50; p<0.001) and tertiary facilities (OR=0.44; 95% CI: 0.36-0.54; p<0.001). Significant district-level inequities were observed, with Gujranwala showing higher availability than Islamabad (OR=3.03; 95% CI: 2.38-3.87; p<0.001), while Muzaffargarh and Kashmir had significantly lower availability. Lowest-priced generics were consistently more affordable than originator brands; however, insulin analogues remained poorly available and often unaffordable, requiring multiple days’ wages for monthly treatment.
CONCLUSIONS: Marked sectoral and geographic inequities persist in access to essential cardiovascular and antidiabetic medicines in Pakistan. Strengthening public-sector procurement, ensuring minimum stock requirements, promoting generic substitution, and including outpatient medicines in financial protection schemes are urgently needed to improve equitable access and support universal health coverage.
METHODS: A cross-sectional WHO/Health Action International survey was conducted across six regions of Pakistan: Islamabad, Rawalpindi, Gujranwala, Muzaffargarh, Vehari, and Azad Jammu & Kashmir. Thirty-two essential medicines were assessed in 60 outlets, including public facilities and private pharmacies. Availability was measured on the survey day. Private-sector prices were evaluated using median price ratios against international reference prices, and affordability was estimated as days’ wages required by the lowest-paid unskilled government worker for a 30-day treatment. Multivariable logistic regression assessed factors associated with medicine availability, including sector, brand type, healthcare level, and district.
RESULTS: Medicine availability was suboptimal, particularly in the public sector, where no medicine achieved the WHO 80% availability benchmark. Private pharmacies had nearly threefold higher odds of medicine availability than public facilities (OR=2.90; 95% CI: 2.49-3.37; p<0.001). Brand type was not significantly associated with availability (OR=1.09; 95% CI: 0.94-1.26; p=0.260). Compared with primary care, availability was significantly lower in secondary (OR=0.43; 95% CI: 0.36-0.50; p<0.001) and tertiary facilities (OR=0.44; 95% CI: 0.36-0.54; p<0.001). Significant district-level inequities were observed, with Gujranwala showing higher availability than Islamabad (OR=3.03; 95% CI: 2.38-3.87; p<0.001), while Muzaffargarh and Kashmir had significantly lower availability. Lowest-priced generics were consistently more affordable than originator brands; however, insulin analogues remained poorly available and often unaffordable, requiring multiple days’ wages for monthly treatment.
CONCLUSIONS: Marked sectoral and geographic inequities persist in access to essential cardiovascular and antidiabetic medicines in Pakistan. Strengthening public-sector procurement, ensuring minimum stock requirements, promoting generic substitution, and including outpatient medicines in financial protection schemes are urgently needed to improve equitable access and support universal health coverage.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR222
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Health Disparities & Equity, Pricing Policy & Schemes, Procurement Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas