Background: United Nations in 2017 reported that over the coming decades, the number of older persons is expected to grow fastest in Africa, including Nigeria. As population aging increases, it comes with health system burden of age-related chronic illness which has become prominent cause of morbidities and mortalities among the elderly, especially in absence of reliable access to medications. Nigeria is challenged with poor accessibility and affordability of quality health care and medications, impeding the achievement of Universal Health Coverage (UHC) goal. To address this challenge in face of increasing age-related chronic illnesses, attention must be given to status of UHC among the elderly in order to inform intervention strategies. We aimed to assess UHC among the elderly through assessing the accessibility of medication by chronically ill older patients in Nigeria.

Methods: Using a cross-sectional study design, study was conducted in three communities in Nigeria from Dec 2016 to Aug 2017. From total 6,632,730 population of older persons in Nigeria, minimum sample size of 385 was calculated. Using a systematic random sampling technique, participants who met inclusion criteria were selected from list of older persons who attended community projects held in study areas. A guided structured questionnaire was used to conduct an in-depth interview among participants. Participants’ demographics were recorded along with self-reported chronic medical conditions and UHC assessment questions. 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 analyzed using SPSS version 20, comparing demographic characteristics of respondents and responses from assessments of UHC.

Findings: Respondents were 521 (above minimum sample size of 385), with age range of 55–95 years. 365 (70%) were female, 302 (58%) had a minimum of primary education, and 240 (46%) reported farming as their occupation. 235 (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/cost. Those who stated “business” as occupation were most likely to afford medications compared to others (X2 =129.71, p < 0.00001 at 95% CI). On the other hand, only 18% are enrolled into health insurance program to aid health and medication access.

Conclusion: Chronically ill older patients in Nigeria cannot always afford medications and majority are not enrolled into health insurance program to aid health and medication access. Thus aim of UHC is short of being achieved among the elderly in Nigeria. Innovative strategies - such as enrollment of elderly persons into health insurance program to aid access to health care and medication and providing socioeconomic support for the elderly - are recommended to improve UHC among the elderly in Nigeria.

Keywords: Accessibility of Medications; Chronically Ill; Older Persons; Universal Health Coverage; Nigeria

References

1. World Health Organization. Aging and health (2018). 
2. United Nations. World population aging (2017). 
3. United Nations. World Population aging (2015). 
4. Central Intelligence Agency. Africa: Nigeria, The World Factbook (2019). 
5. Population Reference Bureau. World population data sheet (2017). 
6. National Council on Aging. Falls prevention: Fact sheet (2016). 
7. Sophie Okolo. “Quality of Life for Elders: Lessons from South Africa and Bolivia”. Global health Africa (2013). 
8. Global Aging. 
9. Oye G., et al. “Determinants of quality of life of elderly Nigerians: results from the Ibadan Study of Ageing”. African Journal of Medicine and Medical Sciences 37.3 (2008): 239-247.
10. Adebowale SA., et al. “Elderly Well-being in a Rural Community in North Central Nigeria, sub-Saharan Africa”. Public Health Research 2.4 (2012). 
11. World Health Organization. Innovative care for chronic conditions: building blocks for action. World Health Organization, Geneva (2012). 
12. Paul Osemeke Nwani. Chronic diseases and multimorbidity among elderly patients admitted in the medical wards of a Nigerian tertiary hospital 7.3 (2016). 
13. Fortin M., et al. “Prevalence of multimorbidity among adults seen in family practice”. The Annals of Family Medicine 3 (2005): 223-228. 
14. Cadmus EO., et al. “A descriptive study of the morbidity pattern of older persons presenting at a Geriatric Centre in Southwestern Nigeria”. Nigerian Journal of Clinical Practice 20 (2017): 873-878.
15. National council on Aging. Top 10 Chronic Conditions in Adults 65+ and What you Can do to prevent or Manage Them (2019). 
16. Abdulraheem IS., et al. “Prevalence and Correlates of Physical Disability and Functional Limitation among Elderly Rural Population in Nigeria”. Journal of Aging Research (2011). 
17. GlaxosmithKline. Access to healthcare (2019).
18. Alex EA. “Healthcare Coverage and Affordability in Nigeria: An Alternative Model to Equitable Healthcare Delivery”. Intech Open Journal (2019). 
19. The World Bank. Nigeria: Bi-Annual Economic Update: Fragile Economy (2017). 
20. World Health Organisation (WHO). Older people’s access to medicines and assistive devices in the Western Pacific Region. WHO Library Cataloguing-in-Publication Data (2016). 
21. World Health Organisation (WHO). Universal Health Coverage and Ageing (2018). 
22. World Health Organisation (WHO). Universal Health Coverage (2019). 
23. National Health Insurance Scheme. Operational guideline (2012): 1-12. 
24. Aregbeshola BS. Out of pocket payments in Nigeria 385 (2016): 1-2. 

Citation

Citation: Amara Frances Chizoba., et al. “Accessibility of Medications by Chronically Ill Older Patients: A Cross-Sectional Assessment of Universal Health Coverage Among the Elderly in Nigeria". Acta Scientific Medical Sciences 4.2 (2020): 03-11.

Copyright

Copyright: © 2020 Amara Frances Chizoba., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.