Availability and affordability of essential medicines : exploring the effects on health seeking behaviours and health services utilization for children under-5 years, living in a settlement of Karachi

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Background: Health status and outcomes pertaining to child health in the poor communities and urban slums is determined by variety of factors; provision of health care is found to be most important. Non-availability of essential medicines at government health facilities and non-affordability of prescribed medicines at private retail pharmacies is one of the major problem in health care system of developing countries, effecting health seeking behavior and thereon health service utilization for children under-5, especially among the urban squatter settlements. To learn this complex phenomenon, the study was conducted in Rehri Goth, a squatter settlement in the metropolitan city of Karachi. Objectives: The study objectives were: (i) To authenticate the shelf-availability of medicines at primary health care facility (Rural health center) of Rehri Goth for children under-5 year of age during the month of July, 2010 and (ii) to explore the effects of nonavailability and non-affordability of medicines on health seeking behavior and health service utilization for children under-5 year of age. Study design: The approach used was Qualitative comprised of Focus Group discussions with mothers of children under-5 and in-depth interviews with health care providers of the area. 'The observational visits' were also carried out at Rural Health center (RHC) in Rehri Goth to confirm availability of selected essential medicine for acute childhood illnesses. Results: It was found that 'erratic and poor supply' of essential medicines at government health facility and 'limited purchasing power' to purchase medicines from retail pharmacy, led to 'financial burden' on people. Considering non-availability of essential medicines as poor quality service and out-of-pocket purchase as a burden on the families; `non-compliance'; 'inappropriate treatment action', 'lost of trust' on the government health facility i.e. RHC, inappropriate health care seeking and more so 'healer shopping' were found to be the major outcomes. It was also found that 'healer shopping in search of free treatment' was a common practice in this community. These effects create a phenomenon of "disease poverty trap' where financial burden of the cost of treatment lead to improper actions and behaviors which have negative impact on the health outcomes, especially among children. Health care authorities must ensure the availability of essential medicines for children under-5 at the government facility. Programs and interventions targeting poor communities need to incorporate the strategies which improve the access to essential medicines and resultantly an improved health seeking behavior and health service utilization for children under-5. Conclusion: Addressing the issues related to the availability and affordability of essential medicines is imperative. A multitude of interventions would be required to improve upon the situation at various levels: local health authorities, health care providers (public and private) and at community level to address the issue of access to essential medicine for children so as to promote appropriate health seeking behavior and health service utilization. This would also be a pathway to improve the child health outcomes with in the country, which is generally, travail from the vicious circle of poverty and illness.

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