Procurement and expenditure of medicines used for mental, neurological and substance use disorders: a secondary analysis of the 2017/2018 Gauteng pharmaceutical database

Bouwer, Jade Catheryne
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Background: Access to essential medicines is necessary for an effective, efficient, and equitable health care system. Analysis of the procurement of and expenditure on medicines may assist in the planning of sustainable access. The procurement of medicines for mental, neurological, and substance use (MNS) disorders in South Africa has to date received little research attention. Aim: To examine the procurement of and expenditure on medicines used to treat MNS disorders in Gauteng province for the 2017/2018 financial year. Method: A secondary analysis of the Gauteng provincial pharmaceutical database was undertaken. Defined daily doses (DDD) and cost per 1000 population served were calculated to compare procurement across service levels and facilities. Results: MNS medicines accounted for 3.73% of total provincial medicine expenditure. More than three-quarters of this amount was spent on anti-epileptic medicines (47.5%) and antipsychotics (30.9%). Over 90% of the total DDD issued were issued at general healthcare clinics and hospitals. Chi square contingency testing revealed significant differences in procurement among facilities at each service level. Conclusion: Medicine for the treatment of MNS disorders, primarily epilepsy, psychosis, and bipolar disorder, accounted for less than 4% of total medicine expenditure. Inconsistency in procurement between sites suggests differences in patient populations and treatment approaches. Future studies using patient-linked data are recommended to evaluate medicine utilisation according to treatment outcomes
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the discipline of Psychiatry, 2021