BMC Health Serv Res. 2026 Jun 6. doi: 10.1186/s12913-026-14792-9. Online ahead of print.
ABSTRACT
BACKGROUND: Ensuring equitable access to essential medicines is fundamental to universal health coverage, yet disparities in availability, pricing, and affordability persist in many low- and middle-income countries.
OBJECTIVES: This study assessed the availability, prices, and affordability of essential cardiovascular and antidiabetic medicines across public and private healthcare sectors in Pakistan using the WHO/Health Action International (WHO/HAI) methodology.
METHODS: A cross-sectional survey of 32 essential medicines was conducted across selected study areas (Rawalpindi, Muzaffargarh, Vehari, Gujranwala, Islamabad, and Azad Jammu & Kashmir). Medicine availability was measured as the percentage of facilities stocking medicines on the survey day. Prices were analyzed using median price ratios (MPRs) against international reference prices, and affordability was calculated as the number of days' wages required by the lowest-paid unskilled government worker to purchase a standard 30-day treatment. Sectoral and regional differences were evaluated using chi-square tests.
RESULTS: The availability of the 32 cardiovascular and antidiabetic medications was generally poor, especially in government facilities; originator brands (OBs) and lowest-priced generics (LPGs) were consistently more readily available in private pharmacies (χ²=180.6, p < 0.001). There were notable geographical differences, with rural areas exhibiting very poor access (χ²=202.8, p < 0.001) and Gujranwala exhibiting the greatest availability. While certain OBs, particularly insulin analogs, were noticeably more expensive than LPGs, prices and affordability favored LPGs across all medications. Public and private sectors continued to have insufficient supplies of insulin and emergency medications, falling short of WHO objectives.
CONCLUSION: This study reveals persistent inequities in the availability and affordability of essential medicines across the selected districts in Pakistan. While these findings specifically reflect the studied regions, they provide actionable evidence to strengthen Pakistan's public-sector supply systems, promote generic medicines, and inform national access policies.
PMID:42251409 | DOI:10.1186/s12913-026-14792-9