Access to medicines and out of pocket payments for primary care: evidence from family medicine users in rural Tajikistan.
BACKGROUND
In Tajikistan it is estimated that out of pocket payments constitute two-thirds of all health spending with high proportions of these contributions through informal payments. As a consequence, access to basic care is a major concern particularly among the most needy and vulnerable groups. This article evaluates accessibility of prescription medicines and patient expenditures for primary care services in two rural districts of Tajikistan.


METHODS
901 patients aged 18 years or above who had accessed primary care facilities were interviewed, using a questionnaire based on questions regarding patient's experience of visiting the health facility. To group respondents by socio-economic status, an asset index was created using principal component analysis of the information included in the questionnaires.


RESULTS
76.7% of patients were prescribed a medicine during the visits and more than 83% of them managed to obtain it. Patients spent on average US$ 9.3 on medicines, with wide variation among socio-economic groups. Around 45% of patients paid the Family Doctor. Additionally, over 41% of patients in the highest socioeconomic quintile were referred to a specialist, while only 29% of the poorest 40%.


CONCLUSIONS
This survey showed that there are financial barriers potentially inactivating utilization of basic services. These barriers can only be reduced by mobilizing more public resources to fund the health sector, providing incentives for family doctors to stop requiring payments from patients, and increasing the availability of prescription drugs in PHC facilities.
Tediosi
Fabrizio
F
Swiss Tropical Institute, Basel, Switzerland. fabrizio.tediosi@unibas.ch
Aye
Raffael
R
Ibodova
Shukufa
S
Thompson
Robin
R
Wyss
Kaspar
K
D000293:Adolescent; D000328:Adult; D016527:Drug Costs; D011307:Drug Prescriptions; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D004364:Pharmaceutical Preparations / Q000191:economics*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population; D012923:Social Class; D011795:Surveys and Questionnaires; D013620:Tajikistan
D004364:Pharmaceutical Preparations