Retail pharmacy prescription medicines' availability, prices and affordability in Eswatini

Background: Limited availability of medicines in public facilities and unaffordable prices in the private sector act as barriers to medicines' access. Patients in Eswatini may be forced to buy medicine from the private sector resulting from chronic medicines' shortages in public health facilities. The extent to which they can afford to do so is unknown. Aim: To determine the availability, price and affordability of medicines in the retail pharmacies in Eswatini, and to compare the results regionally and internationally. Setting: Retail pharmacy sector in the four administrative regions of Eswatini. Methods: Data on availability, price and affordability to patients for 50 medicines in the originator brand (OB) and the lowest priced generic (LPG) equivalent, were collated using the standardised World Health Organization/Health Action International methodology from 32 retail pharmacies in the four regions of Eswatini. Prices were then compared with selected countries. Results: The overall mean availability of all medicines in selected retail pharmacies was 38.5%; standard deviation [s.d.] = 20.4% for OBs and 80.9%; s.d. = 19.0% for LPGs. The overall median price ratio (MPR) in the surveyed pharmacies was 18.61 for the OBs and 4.67 for LPGs. Most standard treatments with LPGs cost less than a day's wages whilst for OBs cost more than a day's wages. The differences between Eswatini and South African prices were statistically significant. Conclusion: Drug pricing policies and price monitoring tools are needed for the whole pharmaceutical chain in Eswatini to monitor availability, affordability and accessibility of medicines to the general populace.