Regional Inequities in Access to Cardiovascular Medicines in Selected Areas of Sri Lanka

Abstract

Background: Cardiovascular diseases (CVDs) pose a substantial burden to the healthcare system of Sri Lanka, requiring consistent access to essential medicines for effective management. Disparities in the availability and affordability of these medicines between urban and semi-urban regions may negatively impact healthcare equity. Identifying and addressing these regional differences is vital for ensuring equitable access to cardiovascular care. Objective: To compare the availability and pricing of essential cardiovascular medicines in privately owned pharmacies and State Pharmaceutical Corporation (SPC) pharmacies located in urban (Kandy, Kurunegala) and semi-urban areas (Nikaweratiya, Peradeniya) of Sri Lanka Methods: A cross-sectional survey was conducted from June to October 2024 in four locations within Kandy and Kurunegala districts, following the WHO/HAI standardized methodology. Data were collected from 40 pharmacies; 36 privately owned and 4 SPC pharmacies, focusing on 13 essential cardiovascular medicines. The availability and prices of Originator Brands (OBs) and Lowest Priced Generics (LPGs) were compared, and Median Price Ratios (MPRs) were analysed. Results: In privately owned pharmacies, OB availability was notably higher in urban areas; Kandy and Kurunegala (4.75%), compared to semi-urban Nikaweratiya (1.58%). LPGs showed greater accessibility in urban areas (Kandy: 79.83%, Kurunegala: 77.05%) compared to semi- urban areas (Nikaweratiya: 63.84%, Peradeniya: 73.57%). LPG availability at SPC pharmacies was also higher in urban areas (Kandy: 81.25%, Kurunegala: 75.62%) than in semi-urban locations (Nikaweratiya: 75%, Peradeniya: 68.75%). Regarding pricing, the median MPR for LPGs in privately owned pharmacies was uniform (0.27) across all areas, whereas Peradeniya had the highest (0.19) and Nikaweratiya the lowest (0.15) in SPC pharmacies. Conclusions: Availability of essential cardiovascular medicines was consistently higher in urban than semi-urban areas. There was no significant price variation across regions in either sector. Targeted improvements in medicine distribution and supply chain management are recommended to promote equitable healthcare access across Sri Lanka.