Introduction

Essential medicines (EM) are those that meet the population’s healthcare needs and are intended to be available at all times in the context of a functioning healthcare system in adequate quantities, in the appropriate dosage forms, and at a price that the community can afford [1]. Preparing a comprehensive national essential medicines list is recommended by WHO for all countries to improve access to safe, effective, and high-quality medicines [2]. National essential medicine lists are government approved lists of medicines, often adapted and implemented as local medicine formularies [3]. Based on WHO directions, Ethiopia developed its own national essential medicine list for use in healthcare financing and medicines supply budgeting; procurement, and encouraging the appropriate use of medicines [4].

The WHO estimated that health interventions based on the delivery of EMs could prevent over 10 million deaths each year [2]. Developing an essential medicines policy (EMP) can help countries rationalize the purchase and distribution of medicines, thereby reducing the expenditures in public and private health systems, improving their accessibility, and enhancing their rational use [5]. Consumers frequently cite the availability of essential medicines as the most important aspect of quality healthcare services, and a shortage of medicines is a major factor in the underutilization of government health services [6]. The continual availability of essential medicines can provide patients with value-added services [7].

The provision of quality health services can be adversely affected by a stock-out of even a small number of essential medicines. Health service readiness is impacted by stock-outs, since clinics without consistent and adequate availability of essential medicines cannot provide quality care [8]. It is essential to understand the degree, reasons for, and implication of stock-outs of essential medicines at different healthcare levels in order to optimize quality of care. Approximately one-third of the world’s population lacks regular access to full and effective treatment with the necessary medicine [9, 10]. More than 33% of the world’s population and 50% of people in the poorest countries in Africa and Asia lack access to essential medicines [11]. An effective healthcare system should ensure equitable access to essential medicines, vaccines, and healthcare technologies that are of guaranteed quality, safety, efficacy, and cost-effectiveness profile [12].

Healthcare policy and system flaws lead to inequities in access to medicines [1]. There are several factors that can contribute to the stockout of EMs, including limited budget allocation, inefficient budget utilization, irrational demand estimation, poor distribution systems, supplying medicines with short shelf lives, and purchasing unnecessary medicines [13]. The ability and practice of the store clerk also affect the stock status [12, 14, 15]. Public procurement inefficiency, limited budgets, and fluctuating currency exchange rates are some of the factors that contribute to a shortage of medicines in Ethiopia. Besides, Medicine availability in Ethiopia is hindered by a lack of transportation infrastructure and long distances from suppliers, especially in rural areas where medicines are sometimes transported by humans [14–17]. The lack of resources or information can create barriers to accessing essential medicines in many developing countries, contributing to higher rates of death and illness [18].

The Pharmaceutical Fund and Supply Agency (PFSA) was established in Ethiopia in order to ensure that medicines were available, fix price variations, and eliminate interruptions in supply. To supply pharmaceuticals to Ethiopia’s public health facilities, PFSA designed and implemented an integrated pharmaceutical logistics system [17, 19]. to Even with significant progress since the introduction of the EMs concept, access to essential medicines remains a serious public health issue [20]. When medicine shortage happen in the public sector, patients are forced to purchase medicines from private outlets, where generic medicines cost many times more than the international reference price, and originators are often even more expensive [13]. Lack of EMs and high spending on low-quality medicines result in resource wastage and, in the worst-case scenario, death [21]. Our study’s goal was to assess the availability and stock-out duration of essential medicines in selected public healthcare facilities.

Materials and methods

Result

General characteristics of health facilities

The health facilities included in the study were a general hospital and a health center. Each facility had an average lead time of one month. There were 9 and 6 medicine dispensing units in the hospital and health center, respectively. There were 12 pharmacy staff members at the hospital and 4 at the health center. The pharmacist was in charge of the hospital’s medicine store. The health center’s medicine store, on the other hand, was run by a druggist. (Table 1).

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Table 1. General characteristics of health facilities.

https://doi.org/10.1371/journal.pone.0274776.t001

Availability and stock out of essential medicines in Shegaw Motta general hospital and Motta Health Centre

On the day of the survey, only 80% (12) of the 15 essential medicines were available at the Shegaw Motta general hospital and 93.3% (14) were available at the Motta health center. During the last six months, 60% (9) of essential medicines were stocked out at Shegaw Motta general hospital while only three (20%) were stocked out at Motta health center. (Table 2)

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Table 2. Availability of essential medicines on the day of the survey and in the last 6-month before data collection.

https://doi.org/10.1371/journal.pone.0274776.t002

During our survey day, in Shegaw Motta general hospital, three essential medicines were unavailable, including Amoxicillin 500mg, Cotrimoxazole 240mg/5ml, and Ferrous salt + folic acid 150mg + 0.5mg. Furthermore, every essential medicine except Medroxy progesterone injection was available in the Motta health center. (Table 3)

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Table 3. Availability of each medicine in Shegaw Motta general hospital and Motta Health center at the date of the survey.

https://doi.org/10.1371/journal.pone.0274776.t003

Stock-out duration of essential medicines in Shegaw Motta general hospital and Motta Health Centre

The average number of stock-out days at Shegaw Motta general hospital was 38.5 days. Over the last six months, Ferrous salt + folic acid 150 mg + 0.5 mg was the medicine with the most stocked out days (157 days), followed by Tetracycline 1%, and Oral Rehydration Salt with 127 days, and 104 days, respectively. In Motta health center, only three medicines were not available during the last six months and the average stock-out days was 11.2 days. In terms of stockout days among these medicines, Medroxy progesterone injection ranked highest with 150 days. And it was followed by Ferrous salt + folic acid 150mg + 0.5mg which was stocked out for 12 days in the last 6-months. (Table 4)

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Table 4. Stock-out duration of essential medicines in the last 6-months in Shegaw Motta general hospital and Motta health center.

https://doi.org/10.1371/journal.pone.0274776.t004

Discussion

On the day of the survey, The availability of selected EMs in both hospital and health center was 80% and 93.3% respectively. At both health facilities, availability was below the WHO recommendation of 100%, but at the health center, it was above the minimum requirement of WHO (80%). The availability at Shegaw Motta general hospital was comparable to that of a study in Tanzania, while the availability at Motta health center was less than that of the Tanzanian study [25]. The availability found in this study was much higher than what was reported in a study conducted in developing and middle-income countries [26]. It may be because the findings of the latter study were based on the findings of many health facilities, whereas this study reported findings from two separate health facilities. In addition, the report in this study was higher than the report in Gondar [27]. A study conducted in Jimma reported 55.65% availablity of essential medicines, which was much lower than availability at both Shegaw Motta general hospital and Motta health center [17]. As the studies were done on different period, this disparity may reflect an improvement in access to essential medicines in Ethiopia compared to past years.

At the hospital and health center, respectively, 60% and 20% of essential medicines were stocked out during the last six months. As compared to a study conducted in Gondar, the findings of the Shegaw Motta general hospital were significantly higher, whereas those of Motta health center were equivalent [27]. The provision of essential medications is crucial for meeting the most basic needs of the people, as well as promoting the rational use of medicines to improve the effectiveness of health resources [28]. As part of activities to increase the availability of EMs, the government should promote competition for lower-cost generics, purchase generics at lower prices that are of high quality, negotiate prices with suppliers, eliminate stockouts by forecasting adequately, and secure adequate funding [29].

Over the last six months, the average stock-out duration at Shegaw Motta general hospital and Motta health center was 38.5 days and 11.2 days, respectively. Furthermore, the average stockout period in Shegaw Motta general hospital during the last six months was slightly longer than what was found in the Gondar study. However, the average stockout period in Motta health center was shorter than that in the Gondar study [27]. Among the medicines in the Shegaw Motta general hospital, ferrous salt + folic acid 150 mg + 0.5mg had the longest stockout period, with 157 days. In Motta health center, the medicine with the longest stockout days was Medroxy progesterone injectable, which was unavailable for 150 days. The shortage of essential medicines can increase the workload of already stressed healthcare workers, since patients are faced with additional visits and referrals. This frequent stockout is likely due to long-distance transportation from its suppliers during the procurement process, as well as the unavailability of pharmaceuticals from suppliers [8, 30]. It is possible that the COVID-19 pandemic may compromise access to essential medicines and medical supplies, which may impact prevention, diagnosis, care, and treatment [22]. In addition, the government’s limited funds for medicine procurement and inadequate pharmaceutical management in these facilities may contribute to frequent medicines stockouts [31].

Conclusion

In general, the hospital tends to have lower drug availability and a higher history of stockouts than the health center. Besides, at least one of the essential medicines was not available in both health facilities on the day of the survey. Similarly, in the six months before the survey, majority of essential medicines were out of stock in the hospital. The average stock-out duration at Shegaw Motta general hospital was longer than that og the helth center.

Supporting information