Abstract
Background: A key element of universal health care is equitable access to Essential medicines (EMs). Disparities in medicine availability, cost, and affordability, however, continue to be a global problem, especially in decentralized health systems like Indonesia. A standardized World Health Organization/health action international (WHO/HAI)-based evaluation of these indicators has never been carried out in Gunungsitoli City.
Methods: The study employed a descriptive sequential mixed-method approach. Using WHO/HAI sample guidelines, quantitative secondary data on the accessibility, cost, and affordability of 50 basic medications were retrieved retroactively from 2023 records from eight Puskesmas and two hospitals. To contextualize procurement difficulties, in-depth interviews with pharmaceutical staff were used to gather primary qualitative data. Descriptive analysis and benchmarking against WHO/HAI indicators were performed on the data.
Results: The majority of necessary medications in Puskesmas showed 100% availability. While program medications (Albendazole, DHP, and anti TB drugs) were unavailable at hospitals because of procurement laws connected to BPJS and centralized supply at the City Pharmacy Installation, stock-outs for ranitidine and retinol injections were noted at Puskesmas. At Puskesmas, all medications were reasonably priced, costing less than a day's minimum salary (Rp 93,633). According to a median price ratio (MPR) research, Puskesmas prices fell within the affordable range.
Conclusions: At the primary care level, access of EMs in Gunungsitoli is usually sufficient; nevertheless, stock-outs of certain injectables and program medications suggest systemic procurement limitations. Price fluctuations at the hospital level point to the necessity of better forecasting, more robust regulatory alignment, and more efficient procurement procedures to guarantee fair and long-term access to necessary medications.