Table 1
Drugs recommended for health facilities for cardiovascular disease care.
| Therapeutic class | Drug name | Essential drug for HCs | Available in any of the study HCs in 2017? | Essential drug for DHs in 2017 | Available in any of the study DHs in 2017? |
|---|---|---|---|---|---|
| ACE inhibitors | Captopril 12.5 mg, 25 mg tablets | Yes | Yes, *12.5 mg | Yes | Yes, *12.5 mg |
| Lisinopril 5 mg tablets | No | Yes | Yes | ||
| Alpha-blockers | Methyldopa 250 mg | Yes | Yes | Yes | Yes |
| Angiotensin II receptor antagonist | Losartan 50 mg tablets | No | Yes | Yes | |
| Antiplatelet | Acetylsalicylic Acid 100 mg tablets | Yes | Yes | Yes | Yes |
| Anticoagulants | Enoxaparin 40 mg/0.4 ml injection | No | _ | Yes | Yes |
| Heparin 5,000; 10,000 units/ml injection | No | _ | Yes | Yes, *10,000 units/ml | |
| Warfarin 1 mg, 5 mg tablets | No | _ | Yes | Yes | |
| Clopidogrel 75 mg, 300 mg tablets | No | _ | Yes | No | |
| Beta blockers | Atenolol 25 mg, 50 mg, 100 mg tablets | No | _ | Yes | Yes, *25 mg |
| Carvedilol 6.25 mg, 12.5 mg, 25 mg tablets | No | _ | Yes | Yes | |
| Calcium channel blockers | Amlodipine 5 mg, 10 mg tablets | Yes | Yes | Yes | Yes |
| Nifedipine 10 mg, 20 mg tablets | No | _ | Yes | Yes | |
| Cardiac glycosides | Digoxin 250 μg/ml injection; 50 μg/ml oral liquid; 250 μg tablets | No | _ | Yes | Yes, *50 μg/ml |
| Diuretics | Furosemide 20 mg, 40 mg; 10 mg/ml injection | Yes | Yes, *10 mg/ml | Yes | Yes, *20 mg |
| Hydrochlorothiazide 25 mg tablets | Yes | Yes | Yes | Yes | |
| Mannitol 10%, 20% injection solution | No | _ | Yes | Yes | |
| Spironolactone 25 mg tablets | Yes | Yes | Yes | Yes | |
| Nitrate | Isosorbide dinitrate 5 mg, 20 mg sublingual tablets | No | _ | Yes | Yes, *20 mg |
| Sympathomimetic | Dopamine 40 mg/ml injection | No | _ | Yes | Yes |
| Adrenaline 100 mg/ml (0.1%) injection | No | _ | Yes | No | |
| Vasodilator | Hydralazine 20 mg/ml injection | No | _ | Yes | Yes |
[i] * Refers to the formulation/strength of the drug that was unavailable in the facility; HCs: Health centers; DHs: District hospitals.
Table 2
Drugs recommended for health facilities for diabetes and asthma care.
| Therapeutic group | Drug name | Essential drug for HCs? | Available in any of the study HCs in 2017? | Essential drug for DHs? | Available in any of the study DHs in 2017? |
|---|---|---|---|---|---|
| Diabetes medicines | Glibenclamide 5 mg tablets | Yes | Yes | Yes | Yes |
| Metformin 500 mg, 800 mg tablets | Yes | Yes, *800 mg | Yes | Yes, *800 mg | |
| Long-acting insulins 100 IU/ml injection | Yes | No | Yes | Yes | |
| Intermediate-acting insulins 30/70, 100 IU/ml injection | Yes | No | Yes | Yes | |
| Rapid-acting insulins 100 IU/ml injection | Yes | No | Yes | Yes | |
| Gliclazide 30 mg modified-release tablets | No | – | Yes | No | |
| Asthma medicines | Aminophylline 250 mg/10 ml injection | Yes | Yes | Yes | Yes |
| Beclomethasone inhaler 50 µg, 250 µg/metered dose | Yes | Yes | Yes | Yes | |
| Salbutamol inhaler 100 mcg/metered dose | Yes | Yes | Yes | Yes | |
| Salbutamol 5 mg/ml nebulizer solution | No | – | Yes | Yes |
[i] * Refers to the formulation/strength of the drug that was unavailable in the facility.
Table 3
Non-communicable disease patients active in study facilities as of January 2017.
| Non-communicable disease Type | Patients in health centers n (%) | Drugs from the essential list available in the health center n (%) | Patients in district hospitals n (%) | Drugs from the essential list available in district hospitals n (%) |
|---|---|---|---|---|
| Cardiovascular | 1121 (56.8) | 9 (81.8) | 880 (64.0) | 29 (76.3) |
| Heart failure | 9 (0.8) | 393 (44.7) | ||
| Hypertension | 1112 (99.2) | 487 (55.3) | ||
| Diabetes | 202 (10.2) | 2 (33.3) | 338 (24.6) | 5 (71.4) |
| Type 1 | – | 67 (19.8) | ||
| Type 2 | 131 (64.9) | 240 (71.0) | ||
| Missing | 71 (35.1) | 31 (9.2) | ||
| Asthma | 649 (32.9) | 4 (100.0) | 156 (11.4) | 5 (100.0) |
| Total | 1972 (58.9) | 15 (71.4) | 1374 (41.1) | 39 (78.0) |
Table 4
Availability, consumption, costs, stock-out trends, and replacement of essential cardiovascular drugs at health centers.
| Therapeutic class | Type of drugs | HCs with drug available (n, %) (N = 17) | Median monthly consumption (IQR) | Median cost (US $) to the health facility (IQR)* | HCs with any stock-out (n, %) | Stock-outs per facility (n) | Average of stock-outs across facilities n (SD) | Median length of stock-out in days (IQR) | Stock-outs replaced by PIH (n, %) | Stock-outs replaced by MOH (n, %) |
|---|---|---|---|---|---|---|---|---|---|---|
| ACE inhibitors | Captopril 25 mg tablets | 17 (100.0) | 700 (191, 1495) | 3.12 (2.56, 3.12) | 12 (70.6) | 33 | 2.8 (2.0) | 17 (9, 27) | 26 (78.8) | 7 (21.2) |
| Alpha-blockers | Methyldopa 250 mg tablets | 12 (70.6) | 200 (0, 1000) | 2.50 (2.50, 3.12) | 8 (66.7) | 25 | 3.1 (2.6) | 18 (14, 34) | 24 (95.8) | 1 (4.2) |
| Antiplatelets | Acetylsalicylic acid 100 mg tablets† | 14 (82.4) | 0 (0, 1000) | 0.45 (0.44, 0.54) | 4 (28.6) | 6 | 1.5 (0.5) | 43 (23, 82) | 0 (0.0) | 5 (83.3) |
| Calcium channel blockers | Amlodipine 5 mg tablets | 15 (88.2) | 106 (0, 700) | 4.20 (4.20, 6.97) | 13 (86.7) | 29 | 2.2 (1.0) | 33 (12, 81) | 22 (75.9) | 7 (20.7) |
| Amlodipine 10 mg tablets | 12 (70.6) | 210 (0, 1000) | 3.21 (3.21, 11.06) | 8 (66.7) | 17 | 2.1 (1.1) | 27 (9, 87) | 12 (70.6) | 5 (29.4) | |
| Diuretics | Furosemide 20 mg tablets | 2 (11.8) | 0 (0, 45) | 0.41 (0.41, 0.49) | 0 (0.0) | 0 | N/A | N/A | N/A | N/A |
| Furosemide 40 mg tablets†† | 9 (52.9) | 0 (0, 1000) | 0.49 (0.42, 1.00) | 6 (66.7) | 17 | 2.8 (2.1) | 34 (9, 70) | 14 (82.3) | 1 (5.7) | |
| Hydrochlorothiazide 25 mg tablets† | 17 (100.0) | 728 (0, 1091) | 1.18 (0.53, 3.00) | 12 (70.6) | 43 | 3.6 (1.8) | 23 (14, 45) | 36 (83.7) | 6 (14.0) | |
| Spironolactone 25 mg tablets† | 3 (17.6) | 0 (0, 15) | 5.20 (5.10, 5.70) | 1 (33.3) | 1 | 1.0 (0.0) | 360 (360, 360) | 0 (0.0) | 0 (0.0) |
[i] * For tablets, we reported the cost for 100 tablets.
** One of the stock-outs was replaced from another source/supplier different from PIH or MOH.
† Missing information on restock-details (supplier and restock-date) for one of the observed stock-outs in the facilities.
†† Missing information on restock-details (supplier and restock-date) for two of the observed stock-outs in the facilities.
HCs: Health centers; IQR: Interquartile range; US $: United States Dollars; SD: Standard Deviation; PIH: Partners In Health; MOH: Ministry of Health; N/A: Not applicable.
Table 5
Availability, consumption, costs, stock-out trends, and replacement of essential diabetes and asthma drugs at health centers.
| Type of drugs | HCs with drug available n (%) (N = 17) | Median monthly consumption (IQR) | Median cost (US $) to the health facility (IQR)* | HCs with any stock-out n (%) | Stock-outs per facility (n) | Average of stock-outs across facilities n (SD) | Median length of stock-out in days (IQR) | Stock-outs replaced by PIH (n, %) | Stock-outs replaced by MOH (n, %) |
|---|---|---|---|---|---|---|---|---|---|
| Anti-diabetes | |||||||||
| Glibenclamide 5 mg tablets†, ** | 15 (88.2) | 124 (0, 1000) | 0.43 (0.43, 0.6) | 11 (73.3) | 34 | 3.1 (1.9) | 29.5 (13, 60) | 30 (90.9) | 2 (6.1) |
| Metformin 500 mg tablets† | 17 (100.0) | 800 (0, 1000) | 1.18 (1.17, 1.65) | 13 (76.5) | 34 | 2.6 (1.6) | 17.5 (9, 35) | 26 (76.5) | 7 (20.6) |
| Anti-asthma | |||||||||
| Aminophylline 250 mg/10 ml injection | 1 (5.9) | 0 (0, 1) | – | – | – | – | – | – | – |
| Beclomethasone inhaler 50 mcg/metered dose | 2 (11.8) | 2 (0, 6) | 3.00 (3.00, 3.00) | 0 (0.0) | 0 | 0.0 | N/A | N/A | N/A |
| Beclomethasone inhaler 250 mcg/metered dose | 13 (76.5) | 24 (10, 44) | 3.00 (3.00, 3.00) | 2 (15.4) | 2 | 1.0 (0.0) | 11 (1, 21) | 2 (100) | 0 (0.0) |
| Salbutamol inhaler 100 mcg/metered dose | 16 (94.1) | 14 (5, 35) | 1.44 (1.44, 1.85) | 11 (68.8) | 30 | 2.7 (1.9) | 9 (5, 22) | 20 (66.7) | 10 (33.3) |
[i] * For tablets, we reported the cost for 100 tablets.
** One of the stock-outs was replaced from another source/supplier different from PIH or MOH.
† Missing information on restock-details (supplier and restock-date) for one of the observed stock-outs in the facilities.
†† Missing information on restock-details (supplier and restock-date) for two of the observed stock-outs in the facilities.
HCs: Health centers; IQR: Interquartile range; US $: United States Dollars; SD: Standard Deviation; PIH: Partners In Health; MOH: Ministry of Health; N/A: Not applicable.
Table 6
Availability, consumption, costs, stock-out trends, and replacement of essential cardiovascular drugs at district hospitals.
| Type of drugs | DHs with drug available (n) (N = 3) | Median monthly consumption (IQR) | Median cost (US $) to the health facility (IQR)* | DHs with any stock-out (n) | Stock-outs per facility (n) | Average of stock-outs across facilities n (SD) | Median length of stock-out in days (IQR) | Stock-outs replaced by PIH (n, %) | Stock-outs replaced by MOH (n, %) | |
|---|---|---|---|---|---|---|---|---|---|---|
| ACE inhibitors | Captopril 25 mg tablets | 3 | 13000 (4750, 16000) | 2.40 (1.99, 2.54) | 2 | 10 | 5.0 (3.0) | 13 (7, 18) | 0 (0.0) | 10 (100.0) |
| Lisinopril 5 mg tablets† | 3 | 0 (0, 1500) | – | 2 | 6 | 3.0 (1.) | 30 (10, 52) | 0 (0.0) | 5 (83.3) | |
| Alpha-blocker | Methyldopa 250 mg tablets | 3 | 2000 (1000, 30000) | 3.25 (3.11, 3.45) | 3 | 5 | 1.7 (0.9) | 22 (12, 22) | 0 (0.0) | 5 (100.0) |
| Angiotensin II receptor antagonist | Losartan 50 mg tablets | 1 | 0 (0, 50) | 12.6 (12.6, 12.6) | 1 | 2 | 2.0 (0.0) | 157 (28, 286) | 0 (0.0) | 2 (100.0) |
| Antiplatelet | Acetylsalicylic acid 100 mg tablets | 3 | 1500 (1000, 2000) | 0.45 (0.40, 0.61) | 3 | 9 | 3.0 (0.0) | 20 (8, 35) | 0 (0.0) | 9 (100.0) |
| Anticoagulants | Enoxaparin 40 mg/0.4ml injection | 1 | 0 (0, 7) | 2.95 (2.95, 2.95) | 0 | – | – | – | – | – |
| Heparin 5,000 units/ml injection | 3 | 0 (0, 10) | 5.97 (5.60, 7.52) | 2 | 2 | 1.0 (0.0) | 228 (245, 325) | 0 (0.0) | 1(100.0) | |
| Warfarin 1 mg tablets | 3 | 200 (0, 500) | 29.69 (28.35, 31.04) | 3 | 7 | 2.3 (1.2) | 40 (23, 159) | 2 (28.6) | 5 (71.4) | |
| Warfarin 5 mg tablets | 3 | 500 (300, 722) | 57.00 (53.71, 57.00) | 3 | 11 | 3.7 (1.9) | 14 (7, 40) | 3 (27.3) | 8 (72.7) | |
| Beta-blockers | Atenolol 50 mg tablets | 2 | 100 (0, 700) | 1.87 (1.80, 2.25) | 2 | 2 | 1.0 (0.0) | 76 (14, 138) | 0 (0.0) | 2 (100.0) |
| Atenolol 100 mg tablets† | 3 | 500 (0, 650) | 2.57 (2.25, 3.85) | 3 | 7 | 2.3 (1.9) | 4 (2, 14) | 0 (0.0) | 6 (85.7) | |
| Carvedilol 6.25 mg tablets | 3 | 500 (0, 1600) | 20.85 (1.43, 40.28) | 3 | 4 | 1.3 (0.5) | 32 (8, 89) | 0 (0.0) | 4 (100.0) | |
| Carvedilol 12.5 mg tablets | 3 | 200 (0, 400) | 10.15 (10.15, 10.15) | 2 | 6 | 3.0 (2.0) | 60 (15, 132) | 0 (0.0) | 6 (100.0) | |
| Carvedilol 25 mg tablets | 2 | 0 (0, 500) | 6.06 (1.62, 10.5) | 1 | 1 | 1.0 (0.0) | 60 (60, 60) | 0 (0.0) | 1 (100.0) | |
| Calcium channel blocker | Amlodipine 5 mg tablets | 3 | 1000 (200, 1000) | 4.20 (1.69, 8.90) | 2 | 8 | 4.0 (2.0) | 15 (6, 36) | 0 (0.0) | 8 (100.0) |
| Amlodipine 10 mg tablets | 1 | 2000 (1900, 2350) | 11.06 (11.06, 11.06) | 1 | 1 | 1.0 (0.0) | 21 (21, 21) | 0 (0.0) | 1 (100.0) | |
| Nifedipine 10 mg tablets | 2 | 0 (0, 250) | 2.1 (1.8, 2.5) | 1 | 5 | 5.0 (0.0) | 37 (15, 41) | 0 (0.0) | 5 (100.0) | |
| Nifedipine 20 mg tablets | 3 | 5950 (2140, 13050) | 1.89 (1.58, 2.43) | 3 | 8 | 2.6 (1.2) | 12 (7, 28) | 0 (0.0) | 8 (100.0) | |
| Cardiac glycosidase | Digoxin 250 μg/ml injection | 2 | 0 (0, 2) | 0.52 (0.33, 4.48) | 1 | 1 | 1.0 (0.0) | 156 (156, 156) | 0 (0.0) | 1 (100.0) |
| Digoxin 250 μg tablets† | 3 | 0 (0, 0) | 0.02 (0.01, 0.10) | 3 | 6 | 2.0 (0.0) | 40 (21, 121) | 0 (0.0) | 5 (83.3) | |
| Diuretics | Furosemide 40 mg tablets | 3 | 6000 (5000, 9000) | 0.46 (0.42, 0.49) | 3 | 12 | 4.0 (2.2) | 4 (2, 11) | 3 (25.0) | 9 (75.0) |
| Furosemide 10mg/ml injection | 2 | 675 (494, 1050) | 0.11 (0.07, 0.14) | 1 | 9 | 9.0 (0.0) | 4 (2, 9) | 1 (11.1) | 8 (88.9) | |
| Hydrochlorothiazide 25 mg tablets | 1 | 1500 (0, 4500) | 1.17 (1.17, 1.17) | 1 | 2 | 2.0 (0.0) | 90 (19, 161) | 0 (0.0) | 2 (100.0) | |
| Mannitol 10% injection solution† | 2 | 1 (0, 5) | 2.62 (1.65, 6.26) | 2 | 3 | 1.5 (0.5) | 27 (9, 205) | 0 (0.0) | 2 (66.7) | |
| Mannitol 20% injection solution | 1 | 0 (0, 5) | 2.06 (2.06, 2.06) | 1 | 3 | 3.0 (0.0) | 80 (3, 157) | 0 (0.0) | 3 (100.0) | |
| Spironolactone 25 mg tablets | 3 | 2000 (2000, 2985) | 5.1 (5.0, 5.6) | 3 | 9 | 3.0 (1.6) | 27 (7, 41) | 0 (0.0) | 9 (100.0) | |
| Nitrate | Isosorbide dinitrate 5 mg sublingual tablets | 2 | 1080 (300, 1980) | 3.75 (3.75, 3.75) | 2 | 6 | 3.0 (0.0) | 12 (9, 17) | 3 (50.0) | 3 (50.0) |
| Sympathomimetic | Dopamine 40 mg/ml injection | 3 | 0 (0, 1.5) | 2.65 (1.47, 2.70) | 2 | 3 | 1.5 (0.5) | 59 (45, 103) | 2 (66.7) | 1 (33.3) |
| Vasodilator | Hydralazine 20 mg/ml injection | 3 | 20 (2.5, 30) | 7.41 (4.73, 7.53) | 2 | 6 | 3.0 (1.0) | 15 (9, 44) | 1 (16.7) | 5 (83.3) |
[i] * For Tabs, we reported the cost for 100 tablets.
* For tablets, we reported the cost for 100 tablets.
** One of the stock-outs was replaced from another source/supplier different from PIH or MOH.
† Missing information on restock-details (supplier and restock-date) for one of the observed stock-outs in the facilities.
†† Missing information on restock-details (supplier and restock-date) for two of the observed stock-outs in the facilities.
HCs: Health centers; IQR: Interquartile range; US $: United States Dollars; SD: Standard Deviation; PIH: Partners In Health; MOH: Ministry of Health; N/A: Not applicable.
Table 7
Availability, consumption, costs, stock-out trends, and replacement of essential diabetes and asthma drugs at district hospitals.
| Type of drugs | DHs with drug available (n) (N = 3) | Median monthly consumption (IQR) | Median cost (US $) to the health facility (IQR)* | DHs with any stock-out (n) | Stock-outs per facility (n) | Average of stock-outs across facilities n (SD) | Median length of stock-out in days (IQR) | Stock-outs replaced by PIH (n, %) | Stock-outs replaced by MOH (n, %) |
|---|---|---|---|---|---|---|---|---|---|
| Anti-diabetes | |||||||||
| Glibenclamide 5 mg tablets | 3 | 2500 (2000, 40000) | 0.59 (0.42, 0.76) | 3 | 8 | 2.7 (0.9) | 7 (4, 11) | 0 (0.0) | 8 (100.0) |
| Intermediate-acting insulins 30/70, 100 IU/ml injection | 2 | 22 (10, 41) | 5.45 (4.94, 7.36) | 2 | 9 | 4.5 (0.5) | 10 (6, 15) | 2 (22.2) | 7 (77.8) |
| Long-acting insulins 100 IU/ml injection** | 3 | 43 (30, 50) | 4.90 (4.65, 5.47) | 2 | 8 | 4.0 (1.0) | 8 (2, 13) | 3 (37.5) | 4 (50.0) |
| Metformin 500 mg tablets | 3 | 5000 (4000, 5300) | 1.70 (1.61, 1.81) | 0 | – | – | – | – | – |
| Rapid-acting insulins 100 IU/ml injection** | 3 | 30 (20, 43) | 4.65 (4.62, 5.48) | 2 | 2 | 1.0 (0.0) | 27 (0, 54) | 1 (50.0) | 0 (0.0) |
| Anti-asthma | |||||||||
| Aminophylline 250 mg/10 ml injection | 3 | 2.5 (0, 26.5) | 0.23 (0.18, 0.24) | 3 | 5 | 1.7 (0.5) | 37 (13, 46) | 0 (0.0) | 5 (100.0) |
| Beclomethasone inhaler 50 mcg/metered dose† | 1 | 0 (0, 31) | 3.00 (3.00, 3.00) | 1 | 1 | 1.0 (0.0) | 61 (61, 61) | 0 (0.0) | 0 (0.0) |
| Beclomethasone inhaler 250 mcg/metered dose | 3 | 20 (12, 33) | 9.35 (3.00, 13.20) | 1 | 2 | 2.0 (0.0) | 19 (15, 23) | 2 (100.0) | 0 (0.0) |
| Salbutamol inhaler 100 mcg/metered dose | 3 | 56 (39, 60) | 2.56 (2.30, 2.58) | 2 | 4 | 2.0 (1.0) | 11 (7, 15) | 1 (25.0) | 3 (75.0) |
| Salbutamol 5 mg/ml nebulizer solution | 1 | 25 (5, 40) | 5.60 (5.60, 5.65) | 1 | 3 | 3.0 (0.0) | 26 (10, 35) | 3 (100.0) | 0 (0.0) |
[i] * For Tabs, we reported the cost for 100 tablets.
* For tablets, we reported the cost for 100 tablets.
** One of the stock-outs was replaced from another source/supplier different from PIH or MOH.
† Missing information on restock-details (supplier and restock-date) for one of the observed stock-outs in the facilities.
†† Missing information on restock-details (supplier and restock-date) for two of the observed stock-outs in the facilities.
HCs: Health centers; IQR: Interquartile range; US $: United States Dollars; SD: Standard Deviation; PIH: Partners In Health; MOH: Ministry of Health; N/A: Not applicable.