Review of facility-level data from all surveys for internal purposes. NOT FOR CIRCULATION.
(initial publication: February 16, 2023. last update: 2023-02-21 19:00:48)
Problem: the list of medicines is too long to use in a rapid assessment with remote data collection
Motivation to ask about availability of various medicines is
not necessarily to know availability of individual
drugs. Rather, we want to know:
* on average how many are available among the select medicines (e.g.,
percent maximum score) - knowing that often facilities do not have all
medicines assessed, or
* where do facilities fall in terms of broad categorization (quintiles)
to see if a cluster of facilities need more intensive support (e.g.,
geographic clustering, type of facilities)
For the last two objectives, we do not need to have a long list of medicines. Our goal is to find a “sweet spot” that reasonably satisfy all objectives. i.e., the shorter the list, the better - if the analytical value is similar.
In this exercise, we create and compare various scores and
quintiles, using different set of medicines. Selection of
medicines can based on:
* typical availability of different medicines (include those with wide
ranges)
* medicines distribution paths, if different (include childhood vaccines
vs. contraceptives).
1. List of medicines for considertation
Data: A total of 15 CEHS surveys conducted in 13 countries - that were included in the facility-level dataset (i.e.,
HSA unit/4 Databases, analyses & dashboards/2 HFAs for COVID-19/1 Database/**cehs_facility.dta**).
Further two surveys (Ghana Round 2 & Suriname Round 1) were excluded since the select standard med variables are all missing.
A total of 37 medicines were included in one or more surveys.
Among the 37 medicines, 17 medicines were asked in a half of the surveys. This analysis uses only those medicines that were relatively commonly asked across surveys. See below table.
| medicine | n.surveys | mean | median | range |
|---|---|---|---|---|
| amoxicillin_tabs | 12 | 82 | 92 | (17-97) |
| ivfluids | 12 | 87 | 90 | (65-100) |
| paracetamol_susp | 13 | 82 | 88 | (20-100) |
| artemether | 10 | 70 | 86 | (3-92) |
| hydrocortisone | 11 | 83 | 85 | (54-99) |
| oxytocin | 13 | 70 | 81 | (24-91) |
| magnesiumsulphate | 12 | 71 | 77 | (14-100) |
| salbutamol | 10 | 69 | 77 | (33-100) |
| metformin | 12 | 57 | 69 | (12-94) |
| oxygen | 12 | 57 | 66 | (4-96) |
| isoniazid | 12 | 53 | 56 | (13-88) |
| oralcontracept | 12 | 56 | 56 | (14-89) |
| epinephrine | 11 | 54 | 54 | (6-95) |
| hydrochlorothiazide | 12 | 48 | 47 | (9-83) |
| carbamazapine | 11 | 48 | 46 | (14-88) |
| efavirenz | 10 | 39 | 31 | (9-85) |
| heparin | 11 | 32 | 19 | (3-88) |
2. Explorary analysis: range/distribution of medicine availability
Overall
By facility level
- Footnote: estimates based on a small number of facilities (i.e., <25) are excluded in the figure. There are 3
3. Explorary analysis results by facility type
Hospitals
| medicine | mean |
|---|---|
| xdrug__ivfluids | 94.2 |
| xdrug__oxygen | 92.2 |
| xdrug__hydrocortisone | 90.2 |
| xdrug__salbutamol | 87.8 |
| xdrug__metformin | 82.2 |
| xdrug__isoniazid | 80.4 |
| xdrug__epinephrine | 79.8 |
| xdrug__paracetamol_susp | 76.9 |
| xdrug__amoxicillin_tabs | 76.8 |
| xdrug__magnesiumsulphate | 72.7 |
| xdrug__oxytocin | 72.4 |
| xdrug__carbamazapine | 59.6 |
| xdrug__artemether | 58.5 |
| xdrug__oralcontracept | 57.5 |
| xdrug__hydrochlorothiazide | 57.0 |
| xdrug__heparin | 49.3 |
| xdrug__efavirenz | 38.5 |
Non-hospitals
| medicine | mean |
|---|---|
| xdrug__ivfluids | 87.5 |
| xdrug__hydrocortisone | 83.9 |
| xdrug__artemether | 80.8 |
| xdrug__amoxicillin_tabs | 78.1 |
| xdrug__paracetamol_susp | 77.7 |
| xdrug__magnesiumsulphate | 71.7 |
| xdrug__oxytocin | 66.5 |
| xdrug__salbutamol | 61.7 |
| xdrug__oralcontracept | 49.2 |
| xdrug__efavirenz | 48.0 |
| xdrug__metformin | 46.1 |
| xdrug__hydrochlorothiazide | 45.8 |
| xdrug__isoniazid | 45.8 |
| xdrug__epinephrine | 43.8 |
| xdrug__carbamazapine | 40.4 |
| xdrug__oxygen | 35.2 |
| xdrug__heparin | 26.4 |
4. Explorary analysis results by country
PCA, using all non-missing medicines in the country#### Kenya, R1
| medicine | mean |
|---|---|
| xdrug__ivfluids | 96.7 |
| xdrug__amoxicillin_tabs | 93.4 |
| xdrug__artemether | 92.3 |
| xdrug__oralcontracept | 89.0 |
| xdrug__paracetamol_susp | 87.9 |
| xdrug__hydrocortisone | 82.4 |
| xdrug__oxytocin | 82.4 |
| xdrug__isoniazid | 75.8 |
| xdrug__magnesiumsulphate | 75.8 |
| xdrug__hydrochlorothiazide | 72.5 |
| xdrug__metformin | 72.5 |
| xdrug__epinephrine | 69.2 |
| xdrug__oxygen | 68.1 |
| xdrug__carbamazapine | 63.7 |
| xdrug__heparin | 46.2 |
Kenya, R2
| medicine | mean |
|---|---|
| xdrug__ivfluids | 93.3 |
| xdrug__artemether | 86.5 |
| xdrug__isoniazid | 74.0 |
| xdrug__metformin | 72.1 |
| xdrug__hydrocortisone | 71.2 |
| xdrug__oxygen | 66.3 |
| xdrug__epinephrine | 53.8 |
| xdrug__hydrochlorothiazide | 49.5 |
| xdrug__oxytocin | 33.0 |
| xdrug__oralcontracept | 26.4 |
| xdrug__carbamazapine | 24.2 |
| xdrug__paracetamol_susp | 19.6 |
| xdrug__amoxicillin_tabs | 16.7 |
| xdrug__heparin | 16.2 |
| xdrug__magnesiumsulphate | 14.1 |
Ghana, R1
| medicine | mean |
|---|---|
| xdrug__artemether | 85.3 |
| xdrug__paracetamol_susp | 83.9 |
| xdrug__amoxicillin_tabs | 76.9 |
| xdrug__ivfluids | 72.0 |
| xdrug__oxytocin | 72.0 |
| xdrug__oralcontracept | 62.9 |
| xdrug__magnesiumsulphate | 56.6 |
| xdrug__hydrocortisone | 53.8 |
| xdrug__metformin | 40.6 |
| xdrug__oxygen | 40.6 |
| xdrug__salbutamol | 38.5 |
| xdrug__carbamazapine | 30.8 |
| xdrug__epinephrine | 28.7 |
| xdrug__isoniazid | 28.0 |
| xdrug__efavirenz | 25.9 |
| xdrug__hydrochlorothiazide | 25.9 |
| xdrug__heparin | 17.5 |
Zambia
| medicine | mean |
|---|---|
| xdrug__ivfluids | 95.9 |
| xdrug__artemether | 91.7 |
| xdrug__oxytocin | 86.0 |
| xdrug__efavirenz | 82.2 |
| xdrug__isoniazid | 81.8 |
| xdrug__amoxicillin_tabs | 81.4 |
| xdrug__magnesiumsulphate | 78.9 |
| xdrug__oralcontracept | 71.5 |
| xdrug__carbamazapine | 43.8 |
| xdrug__epinephrine | 43.4 |
| xdrug__metformin | 40.9 |
| xdrug__hydrochlorothiazide | 36.4 |
| xdrug__salbutamol | 33.5 |
| xdrug__paracetamol_susp | 31.4 |
| xdrug__oxygen | 25.2 |
| xdrug__heparin | 18.2 |
Mali
| medicine | mean |
|---|---|
| xdrug__paracetamol_susp | 97.2 |
| xdrug__amoxicillin_tabs | 94.3 |
| xdrug__artemether | 89.6 |
| xdrug__oxytocin | 89.6 |
| xdrug__ivfluids | 85.8 |
| xdrug__hydrocortisone | 78.8 |
| xdrug__magnesiumsulphate | 69.8 |
| xdrug__oralcontracept | 56.1 |
| xdrug__salbutamol | 43.4 |
| xdrug__efavirenz | 34.0 |
| xdrug__hydrochlorothiazide | 33.0 |
| xdrug__metformin | 30.2 |
| xdrug__carbamazapine | 28.8 |
| xdrug__oxygen | 28.8 |
| xdrug__epinephrine | 27.4 |
| xdrug__isoniazid | 24.5 |
| xdrug__heparin | 18.9 |
Ukraine
| medicine | mean |
|---|---|
| xdrug__hydrocortisone | 96.5 |
| xdrug__paracetamol_susp | 94.9 |
| xdrug__ivfluids | 93.0 |
| xdrug__magnesiumsulphate | 89.5 |
| xdrug__salbutamol | 87.9 |
| xdrug__epinephrine | 72.3 |
| xdrug__hydrochlorothiazide | 72.3 |
| xdrug__metformin | 68.0 |
| xdrug__heparin | 63.7 |
| xdrug__amoxicillin_tabs | 59.8 |
| xdrug__carbamazapine | 46.1 |
| xdrug__oxygen | 32.4 |
| xdrug__oxytocin | 27.7 |
| xdrug__oralcontracept | 13.7 |
Namibia
| medicine | mean |
|---|---|
| xdrug__paracetamol_susp | 98.3 |
| xdrug__ivfluids | 97.4 |
| xdrug__amoxicillin_tabs | 96.6 |
| xdrug__hydrocortisone | 92.3 |
| xdrug__salbutamol | 88.9 |
| xdrug__carbamazapine | 88.0 |
| xdrug__isoniazid | 88.0 |
| xdrug__magnesiumsulphate | 86.3 |
| xdrug__oxygen | 86.3 |
| xdrug__efavirenz | 85.5 |
| xdrug__artemether | 79.5 |
| xdrug__oxytocin | 77.8 |
| xdrug__oralcontracept | 76.1 |
| xdrug__metformin | 71.8 |
| xdrug__epinephrine | 66.7 |
| xdrug__heparin | 43.6 |
| xdrug__hydrochlorothiazide | 43.6 |
Peru
| medicine | mean |
|---|---|
| xdrug__oxygen | 96.4 |
| xdrug__amoxicillin_tabs | 94.6 |
| xdrug__paracetamol_susp | 94.6 |
| xdrug__metformin | 93.8 |
| xdrug__hydrocortisone | 92.9 |
| xdrug__oralcontracept | 89.3 |
| xdrug__ivfluids | 86.6 |
| xdrug__salbutamol | 86.6 |
| xdrug__oxytocin | 82.1 |
| xdrug__epinephrine | 79.5 |
| xdrug__magnesiumsulphate | 78.6 |
| xdrug__isoniazid | 63.4 |
| xdrug__carbamazapine | 54.5 |
| xdrug__hydrochlorothiazide | 36.6 |
| xdrug__efavirenz | 9.8 |
| xdrug__heparin | 9.8 |
| xdrug__artemether | 2.7 |
5. Comparing indices
- Scores: based on the maximum possible percent score
(0-100), using different sets of medicines
- Quintiles: based on an index created from PCA, using different sets of medicines
The following shows the list of medicines.
1: All meds* available in the particular survey
2: First 9 medicines
3: Randomly selected 9 medicines
4: Randomly selected 7 medicines
5: Randomly selected 5 medicines
6: Specific 6 medicines
(“xdrug__amoxicillin_tabs”, “xdrug__epinephrine”, “xdrug__heparin”,
“xdrug__isoniazid”, “xdrug__metformin”, “xdrug__oxytocin”)
Afghanistan
[1] “AFG_R1” [1] “The number of medicines: 17”
Burundi
[1] “BDI_R1” [1] “The number of medicines: 17”
Cameroon
Ghana
[1] “GHA_R1” [1] “The number of medicines: 17”
Kenya, R1
[1] “KEN_R1” [1] “The number of medicines: 15”
Kenya, R2
[1] “KEN_R2” [1] “The number of medicines: 15”
Mali
[1] “MLI_R1” [1] “The number of medicines: 17”
Moldova
Namibia
[1] “NAM_R1” [1] “The number of medicines: 17”
Paraguay
Peru
[1] “PER_R1” [1] “The number of medicines: 17”
Ukraine
Zambia
[1] “ZMB_R1” [1] “The number of medicines: 16”
Annex: List of surveys and the number of facilities assessed
| country | survey | n.facilities | n.hospitals | n.non.hospitals | n.drugs |
|---|---|---|---|---|---|
| Afghanistan | AFG_R1 | 92 | 9 | 83 | 17 |
| Burundi | BDI_R1 | 117 | 0 | 117 | 17 |
| Cameroon | CMR_R1 | 186 | 6 | 180 | 5 |
| Ghana | GHA_R1 | 143 | 0 | 0 | 17 |
| Kenya | KEN_R1 | 91 | 47 | 44 | 15 |
| Kenya | KEN_R2 | 208 | 116 | 92 | 15 |
| Mali | MLI_R1 | 212 | 15 | 196 | 17 |
| Moldova | MDA_R1 | 99 | 49 | 50 | 17 |
| Namibia | NAM_R1 | 117 | 39 | 78 | 17 |
| Paraguay | PRY_R1 | 68 | 0 | 68 | 12 |
| Peru | PER_R1 | 112 | 112 | 0 | 17 |
| Ukraine | UKR_R1 | 256 | 33 | 223 | 14 |
| Zambia | ZMB_R1 | 242 | 30 | 212 | 16 |
END OF OUTPUT