title: Pharmaceutical availability across levels of care: evidence from facility surveys in Ghana, Kenya, and Uganda.
abstract: OBJECTIVE
  In this study we use facility-level data from nationally representative surveys conducted in Ghana, Kenya, and Uganda to understand pharmaceutical availability within the three countries.
  
  
  METHODS
  In 2012, we conducted a survey to capture information on pharmaceuticals and other facility indicators from over 200 facilities in each country. We analyze data on the availability of pharmaceuticals and quantify its association with various facility-level indicators. We analyze both availability of essential medicines, as defined by the various essential medicine lists (EMLs) of each respective country, and availability of all surveyed pharmaceuticals deemed important for treatment of various high-burden diseases, including those on the EMLs.
  
  
  RESULTS
  We find that there is heterogeneity with respect to availability across the three countries with Ghana generally having better availability than Uganda and Kenya. To analyze the relationship between facility-level factors and pharmaceutical stock-out we use a binomial regression model. We find that the factors associated with stock-out vary by country, but across all countries both presence of a laboratory at the facility and presence of a vehicle at the facility are significantly associated with reduced stock-out.
  
  
  CONCLUSIONS
  The results of this study highlight the poor availability of essential medicines across these three countries and suggest more needs to be done to strengthen the supply system so that stock remains uninterrupted.
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Masters
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
authors.forename: Roy
authors.initials: R
authors.lastname: Burstein
authors.affiliation: RTI International, Durham, North Carolina, United States of America.
authors.forename: Brendan
authors.initials: B
authors.lastname: DeCenso
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Moore
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
authors.forename: Annie
authors.initials: A
authors.lastname: Haakenstad
authors.affiliation: Infectious Disease Research Collaboration, Kampala, Uganda.
authors.forename: Gloria
authors.initials: G
authors.lastname: Ikilezi
authors.affiliation: Infectious Disease Research Collaboration, Kampala, Uganda.
authors.forename: Jane
authors.initials: J
authors.lastname: Achan
authors.affiliation: Ghana Health Service, Accra, Ghana.
authors.forename: Ivy
authors.initials: I
authors.lastname: Osei
authors.affiliation: Ghana Health Service, Accra, Ghana.
authors.forename: Bertha
authors.initials: B
authors.lastname: Garshong
authors.affiliation: Action Africa Help International, Nairobi, Kenya.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kisia
authors.affiliation: Action Africa Help International, Nairobi, Kenya.
authors.forename: Pamela
authors.initials: P
authors.lastname: Njuguna
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Joseph
authors.initials: J
authors.lastname: Babigumira
authors.affiliation: Department of Economics & International Business, Sam Houston State University, Huntsville, Texas, United States of America.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Hanlon
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
mesh_terms: D018954:Drugs, Essential / Q000600:supply & distribution* / Q000627:therapeutic use; D005869:Ghana; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007630:Kenya; D011795:Surveys and Questionnaires; D014454:Uganda
chemical_list: D018954:Drugs, Essential