The purpose of this indicator is to measure affordability of basic drug treatment as an indicator of access to essential drugs.

In this study, the affordability of treating moderate pneumonia (without hospitalization) in both adults and children is assessed by comparing the total cost of a full course of therapy with the lowest daily government salary (approx. 6.7 ETB or US$ 0.8). More formally, affordability is expressed as the ratio of the cost of treating moderate pneumonia to the lowest daily salary of unskilled government worker. Amoxicillin 250mg or 500 mg capsules and Cotrimoxazole (200+40) mg/5ml oral suspension were chosen as drugs of choice for pneumonia in adult and children, respectively. The treatment cost as % of the lowest daily salary of an unskilled government employee is calculated at facility level (both public and private), at regional and national level.

In PHCFs, the national average for affordability of treatment cost was 135% for adults and 67.7% for children (Table 2). These figures show that approximately 1.4 days' and 0.7 days' wage of the lowest paid unskilled government worker are required to cover the cost of a single course of therapy of pneumonia in adults and children, respectively.

In the PDROs, affordability for adult was 195% while for children it was 127% (Table 2). Comparison of affordability (both for adult and child) between the public sector and private sector (Figure 8) shows that treatment costs are more affordable in the public sector than the private sector. The mean variation was also insignificant (P > 0.05).

Figure 8 Affordablity of key essential drugs in public and private sectors

Affordability for adult in PHCFs varied in the six regions (Figure 9) between 97% (Tigray) to 158% (SNNPR) while affordability for children varied between 33% (Tigray) to 99% (Benishangul-Gumuz). In both cases, treatment costs are lowest in Tigray. The overall mean variation between the regions was significant (P < 0.05).

Figure 9 Affordablity of key essential drugs in PHCFs in six regions

When considered by level of health care facilities, affordability for adult were 133%, 143.8% and 132.2% for hospitals (n=7), health centers (n=18) and health stations (n=51), respectively. This shows that adult treatment costs are best affordable in health stations but least affordable in health centers. On the other hand, affordability for children were 84.7%, 60.9% and 68.1% in hospitals (n=6), health centers ((n=19) and health stations (n=71), respectively. It indicates that pediatric preparations are best affordable in health centers but least affordable in hospitals (Figure 10).

But, the mean variations in both cases (adult & children) were not significant (P > 0.05). It is also interesting to note that in all cases, irrespective of the sector and the level of health care facilities; pediatric preparations were relatively more affordable than adult preparations.

Figure 10 Affordablity of key essential drugs by level of PHCFs