Gaps in access and trust: essential medicine availability, affordability, and barriers to generic medicine use

SETTING Selected public health facility pharmacies, private pharmacies, and Jan Aushadhi Kendras (JAKs) outlets dispensing generic medicines in four districts of Tamil Nadu, India. OBJECTIVE To compare essential medicine availability, affordability, and knowledge on generic medicines among clients across pharmacy types. Additionally, to explore barriers to the use of generic medicines. DESIGN A concurrent mixed-methods study with a quantitative cross-sectional assessment of the availability of 50 essential medicines in 70 pharmacies and structured interview of 1,750 clients. Eight focus group discussions with clients and 24 in-depth interviews with health care providers to qualitatively explore barriers. RESULTS The median number of essential medicines available in private pharmacies (43) was higher than that in public pharmacies (30) and JAKs (29) ( P < 0.001). The medicine purchase was unaffordable (expenditure >6USD) for 92% of clients in JAKs and 98% of private pharmacies. Knowledge of generic medicine was low among clients attending public (24%) and private (31%) pharmacies. Barriers to generic medicine use included unavailability of medicines, concerns about effectiveness, and suboptimal marketing. CONCLUSION JAKs have to address the unavailability of medicines, high unaffordability, and barriers to utilisation by expanding their drug baskets, further reducing costs, and implementing strategies to build trust in generic medicines.