Limited access: What healthcare problems affect five countries and how these impact patient access

29 December 2017

09:00

Here, Maria Yasko, PR manager at phamax, lists five countries with limited access to healthcare, going into detail about how these countries are suffering from healthcare sector problems and how these are getting in the way of patient access.

access

We live in a modern age with incredible medical advances that hit our headlines on a daily basis.¹ As the years go by, we find quicker and more efficient ways to operate, diagnose and treat patients. Diseases are becoming more manageable and people are living longer than ever before.² Despite this, there are countries with serious pharmaceutical market access issues,³ which we should really address.

No two countries are alike and each country with limited access to healthcare will be experiencing unique and pressing issues. Below are five countries which suffer from healthcare sector problems. I’ll cover what these problems are and how they are getting in the way of patient access.

1. Liberia’s struggles with civil war, malaria and Ebola

One of the world’s poorest nations, Liberia is a country that is struggling to achieve better access to healthcare after years of civil war and prolonged regional instability.⁴ A great deal of clinics, hospitals and equipment were destroyed during Liberia’s 14-year civil conflict,⁵ and attempting to rectify the situation is wrought with financial roadblocks. On top of this, Liberia is suffering from a lack of qualified doctors. Figures suggest that there are only 14 physicians per million people in Liberia.⁶

Liberians are suffering in the face of malaria, the second leading cause of death in the country,⁷ which kills thousands of pregnant women and children each year. unfortunately, hospitals don’t always have access to antimalarials.⁸ The Ebola outbreak in 2014 also hit the country hard. But since this time, thanks to the government working on strategies to improve patient care and international aid, healthcare services have started to improve.

The healthcare system is now more decentralised, there are more medical supplies for health workers and extra training is being provided in infection prevention control. Healthcare in Liberia is also free,⁸ which helps struggling patients who would otherwise have no means of obtaining treatment.

There are also other exciting technological advances that could facilitate access to healthcare. Increasingly, mobile devices are being used for this purpose, and Julius SM Gilayeneh, a Liberian medical doctor, has said that he hopes investments in modern mobile technology could change the lives of those who live in rural areas.⁹ Where medical access is concerned, travelling is always an issue, but Gilayeneh believes that long trips to the hospital could be eliminated if individuals were able to call or text doctors for advice.

2. Malawi has to cope with regular ‘stock-outs’

Healthcare in Malawi faces a lot of problems, notably that of infant mortality, tuberculosis, HIV/AIDS and malaria. As with Liberia, Malawi has a dearth of physicians; there are only 19 doctors per million people and the World Health Organisation’s (WHO) report ranks Malawi’s health system as number 185 out of 190 due to lack of manpower, lack of skills and scarcity of appropriate equipment and technology.⁶

Only 46% of Malawi citizens live within 5 km of a health facility and, although most public health services are free, patients can rarely afford the associated costs that are involved when it comes to travelling to and from a facility.¹⁰ This means that despite how much they might need care, some patients refuse to, or are unable to, get the attention they deserve.

As we mentioned above, scarcity of equipment and drugs are an issue in Malawi — so much so that a phrase has been coined (stock-outs) to describe empty hospital and pharmacy shelves,¹¹ so even if patients manage to travel to the appropriate facility, they might not be able to receive the necessary drugs. The government acknowledges these problems and is making efforts to resolve the issues, but as it stands, the people of Malawi, especially in rural areas, are having to deal with long periods of drug shortages.

3. Somalia’s healthcare concerns are linked with political and environmental complications

Access to basic and essential healthcare services remains a challenge in Somalia. WHO argues that the reasons behind Somalia’s struggles with access to healthcare are numerous and complex, including environmental stress, ongoing armed conflict, political instability, recurring drought conditions, overcrowding and forced evictions.¹²

The lack of access to clean drinking water and malnutrition cause disease outbreaks, but with such limited healthcare and with only 35 doctors per million citizens,⁶ patients struggle and very often die without medical care. It is likely that with added investment in healthcare, along with improved water and hygiene practices, disease outbreaks will lessen and more patients will get appropriate care.

4. Nigeria has issues with health insurance

Despite the fact that Nigeria has ‘one of the largest stocks of human resources for health’,¹³ this African country still struggles with a deficit of midwives, nurses and doctors, meaning that delivering appropriate patient care is a challenge. On top of this, the healthcare providers tend to be concentrated in urban areas, causing rural areas to suffer. The country also deals with medical supply shortages.¹⁴

One of the biggest worries for Nigeria, however, is the issue of health insurance. According to one source, only approximately 3% of Nigerians have access to healthcare coverage under the National Health Insurance Scheme (NHIS).¹⁵ Professor Usman Yusef, executive secretary of NHIS, has expressed his sadness at this statistic and has said that they are determined to do better, with the aim of improving access to quality health care for all Nigerians.

5. India has great healthcare, but only some individuals can benefit

In many ways, Indian healthcare is globally acclaimed and provides a wide quality of care.¹⁶ In other areas, however, Indian hospitals and healthcare research are suffering, particularly due to the lack of reliable data with relation to certain diseases. On top of this, access to healthcare tends to depend very much on where you live. For example, it has been shown that 80% of doctors in India only serve 28% of the nation’s population.¹⁷ This could be explained by the fact that 70% of the Indian population lives rurally, in areas that have no or limited access to hospitals.

Research into healthcare issues in India shows that the country spends only 4.2% of its national GDP on healthcare goods and services,¹⁷ which can be compared to the USA, which spends 18% of its GDP on this area.

One area that is rarely discussed, but which causes a problem for Indian citizens, is the question of haemophilia. There are approximately 16,000 registered haemophiliacs in India,¹⁸ according to the Hemophilia Federation of India, but the actual estimated haemophiliac population is actually 54,000. This shows that not all Indians who suffer symptoms of haemophilia are seeking help, which might be because The Insurance Act in India doesn’t accommodate individuals with pre-existing genetic disorders. So, these sufferers never seek treatment.

This is a serious market access concern, as the only way we, as a modern society, will adequately address and treat rare bleeding disorders is if we get a full and accurate picture of how many sufferers there are in the world while collecting data on their symptoms and bleeds. Some sources suggest that the Indian government should implement an ‘Orphan disease’ policy to create drugs for diseases that don’t receive a lot of attention.¹⁹

No simple solution

All the countries above have their own unique sets of problems with relation to healthcare and, as such, the answer to improving access to healthcare will be different in each case. There is no simple way to resolve such complex issues, but with governmental support, technological evolution and a dedication to medical advancements, it’s likely that all the countries above will thrive long-term and provide patients with the support and care they need.

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