Non-communicable diseases are life-long diseases that require continual use of medication. Thus, medicines for NCDs must always be available in health facilities. Availability of NCD medicines in public health facilities found in six regions of Bangladesh (Dhaka, Sylhet, Chittagong, Dinajpur, Khulna and Barisal) was significantly less as compared to the availability of medicines for infectious diseases.16 However, some medicines such as chlorpheniramine maleate, ranitidine, omeprazole, and losartan were widely available.16 Compared to the availability of medicines for NCDs in health facilities in Lesotho, this study findings indicated that medicines used in the management of diabetes mellitus, hypertension, asthma and epilepsy were mostly available in the past three months before the date of data collection at OPDs and healthcare centres. Similarly, prescribers in health facilities in Sri Lanka aligned to medicines for NCDs that were included in the list of priority drugs to manage NCD at primary-level healthcare institutions (published in 2013) or the list of price-regulated drugs published in 2017.17 Thus, patients with NCDs were prescribed more available and more affordable medicines so, patient experiences in Sri Lanka showed good availability and access to NCD medicines.17
The WHO Model List of Essential Medicines 21st 2019 is a guide for the development of national and institutional EML which list good quality, readily available, and affordable drugs necessary for the management of NCDs and other diseases.15 The medicines for NCDs available for managing hypertension, diabetes mellitus, asthma and epilepsy in the public health facilities of Lesotho were as per the WHO Model List of Essential Medicines 21st 2019 and the Lesotho EML 2017.14–15 Thus, the findings of the study revealed that the type of medicines for NCDs available in public health facilities in Lesotho were of good quality, safe, available and affordable.
Most respondents perceived that the type of medicines for NCDs that were available at OPDs in Lesotho included antidiabetics (gliclazide, glibenclamide, metformin, actraphane, actrapid and protaphane), antihypertensives (hydralazine, hydrochlorothiazide, atenolol, methyldopa, nifedipine and captopril), anti-asthmatics (salbutamol inhalers, beclomethasone inhalers, salbutamol tablets and prednisolone tablets), and anti-epileptics (phenytoin, carbamazepine, phenobarbitone, sodium valproate and diazepam tablets). The NCDs medicines that was available at healthcare centres in Lesotho as perceived by most respondents was as follows: diabetes mellitus medicines (glibenclamide, metformin and actraphane), hypertension medicines (hydrocholorothiazide, methyldopa, atenolol, nifedipine and captopril), asthma medicines (salbutamol tablets, salbutamol inhalers and prednisolone tablets) and epilepsy medicine (phenytoin and phenobarbitone). Likewise, in Malawi, widely available medicines for NCDs in public health facilities are as follows: anti-epileptics included phenobarbital sodium tablets, carbamazepine and diazepam injection, and antihypertensive included hydrochlorothiazide, and these medicines were listed in the Malawi EML.18 Also, thirty-two countries (94%) selected thiazide diuretics (hydrochlorothiazide), renin-angiotensin-aldosterone system (RAAS) inhibitors (enalapril or valsartan), selective beta-blockers (metoprolol) and dihydropyridine calcium channel blocker (amlodipine) for the management of hypertension.19 These medicines for hypertension were selected using international treatment guidelines for cardiovascular diseases (CVD) management such as WHO guidelines.19
One way of reducing the burden of NCDs is through the availability of medicines for NCDs. Assessment of perceptions of adult patients in Kenya on the availability of medicines for NCDs found that most adult patients with NCDs in Kenya perceived that medicines were not available at the government health facilities.20 Unavailability of medicines in government health facilities forced adult patients with NCDs to buy the medicines at private facilities and pharmacies.20 Likewise, the findings of this study indicated that some respondents at OPDs and healthcare centres also perceived that medicines for NCDs were out-of-stock during one point in time at OPDs and healthcare centres within the past three months before the date of data collection. Therefore, NCDs are chronic diseases that are managed continually with medication specific to a particular NCD a patient suffers from, and unavailability of these medicines means an interruption in the management of NCDs.
Currently, there is one leading statutory body established as a trading account of the Ministry of Health in Lesotho, which is the National Drug Supply Organisation (NDSO) which has been delegated to manage national drug supply.21–23 The NDSO is responsible for the procurement, storage and distribution of medicines and medical supplies for both the Christian Health Association of Lesotho (CHAL) and government health facilities.21,22 This study findings also revealed that the main supplier of medicines for NCDs at OPDs and healthcare centres was the NDSO. The situation of Lesotho is similar to that in Zimbabwe where the National Pharmaceutical Company of Zimbabwe is the national drug supplier working together with the Ministry of Health and Child Welfare and supplies pharmaceutical products to government health facilities.24
There were limitation and strengths when this study was conducted. A low response rate was a limitation where 16 out of 90 (17.8%) health workers at OPDs participated in this study and 86 out of 276 (31.2%) health workers at healthcare centres participated. The low response rate at OPDs and healthcare centres was due to a lack of personnel at OPDs and healthcare centres. Furthermore, staff transfers from one health facility to the other led to participants not complying with the inclusion criteria because they had less than six months working in the new health facility. However, information generated from this study will be used by the national, district, and primary healthcare levels to inform decision-making in the management of NCDs in Lesotho's health sector. The findings in this study also form a base for further investigations into availability of medicines for NCDs at public health facilities in Lesotho.