Accessibility of medications by chronically ill older patients: a cross-sectional assessment of universal health coverage in Nigeria

Background: Universal health coverage (UHC) is defined by WHO as ensuring that all people and communities receive the quality services they need, and are protected from health threats without financial hardship. Without considering the health and social care needs of the increasing numbers of older people, UHC will be impossible to achieve. One of the six assessment questions asked in UHC is “can you get medicine and other products that you need?” Hypertension, diabetes, and arthritis are common chronic illnesses among older populations, requiring constant accessibility of medication to prevent complications. We aimed to assess UHC among older patients in Nigeria. Methods: Using a cross-sectional study design, we did a 1-day enrolment (on Dec 16, 2016) of older people in community projects in three communities (Ukpo, Uburu, and Afikpo) across Nigeria. Using a systematic random sampling technique, people who were aged 55 years or older and had at least one reported common chronic medical condition (hypertension, arthritis, and/or diabetes) were selected. An in-depth interview using a guided structured questionnaire was conducted. Participants’ demographics were recorded along with self-reported chronic medical conditions. Key questions on accessibility of medication and UHC were “Can you always afford the medicine that you need for your chronic medical condition?” and “Are you under the National Health Insurance scheme that aids health access?” Data was analysed using SPSS version 20, comparing demographic characteristics of respondents. Findings: Respondents were 521 older people aged 55–91 years. 365 (70%) were female, 302 (58%) had a minimum of primary education, 240 (46%) reported farming as their occupation, and 81 (16%) reported business as their occupation. 279 (54%) reported at least two of the three common chronic illnesses associated with ageing: 234 (45%) reported hypertension, 229 (44%) arthritis, and 57 (11%) had diabetes. Only 22% (114/521) responded yes to the question “Can you always afford the medicine that you need for your chronic medical condition?”—19% (44/234) of hypertensive patients, 24% (55/229) of arthritic patients, and 7% (4/57) of diabetic patients. The remaining 78% had missed medications owing to unaffordability. Those who stated “business” as occupation were most likely to afford medications compared with others (odds ratio 0·20, 95% CI 0·13–0·31, p<0·0001). On the other hand, most (82% [427/521]) responded “no” to the question “Are you under the National Health Insurance scheme that aids health access?” Interpretation: Chronically ill older people in Nigeria cannot always afford medications or health access and thus are short of UHC. An innovative strategy to improve UHC among the older population is recommended. Funding: Mission to Elderlies Project.