Availability and affordability of essential medicines during armed conflict in public hospitals of east Gojjam zone, Amhara region, Ethiopia: A mixed-method institutional-based cross-sectional study

Abstract

Access to essential medicines is a fundamental human right, with availability and affordability as crucial preconditions. However, war significantly disrupts healthcare systems, impacting access to these vital resources. The Amhara region in Ethiopia has been experiencing ongoing war, posing challenges to the availability and affordability of essential medicines. This study aimed to assess the availability and affordability of essential medicines and to identify the barriers to accessing them in public hospitals located in the East Gojjam Zone of the Amhara region during a period of war. A mixed-methods, cross-sectional survey was conducted in public hospitals in East Gojjam Zone, Ethiopia. Quantitative data on medicine availability and affordability were collected using WHO/HAI methodologies, with 50 medicines selected. Affordability was assessed by calculating the number of daily wages required to purchase a full course of treatment. Qualitative data were obtained through key-informant interviews with store managers to identify barriers to accessing medicines after the onset of armed conflict. Data were analyzed using SPSS 25 and NVIVO. The point availability of essential medicines averaged 64%, with some hospitals reporting levels as low as 20%. Period availability over the six months preceding the study was only 59%, far below the WHO-recommended minimum of 80%. Affordability analysis showed that only 6% of essential medicines were affordable for the poorest people. Furthermore, 34% of the medicines required between one- and five-days’ wages, and 60% required more than five days’ wages for a full course of treatment. Qualitative findings showed supply chain disruptions, security risks, budget shortages, and transportation costs as major contributors. Essential medicine availability and affordability were critically affected during the conflict, limiting access to life-saving treatments. Disruptions in supply chains, economic hardship, and security threats were key barriers. Urgent action is needed to restore access and strengthen health system resilience.