Access to essential medicines during the Sudanese civil war: a cross-sectional study

Essential medicines are those that meet the primary healthcare needs of the population. During the current Sudan war, access to these medicines is critical for evaluating the quality of the healthcare system in the aftermath of this crisis. This study aims to evaluate the availability and affordability of essential medicines in primary healthcare centers in Sudan. Additionally, it seeks to assess patients’ perceptions of the affordability, accessibility, acceptability, and impact of war on medicines in public healthcare facilities. We conducted a cross-sectional study across 35 primary healthcare centers in five of the seven safe states in Sudan. At each center’s dispensary unit, a standardized checklist was used to evaluate the availability, affordability, and storage conditions of 19 essential medicines chosen from Sudan’s national essential medicines list. Additionally, 975 patients from all dispensary units in the selected states were interviewed upon exiting to assess their perceptions of the accessibility, acceptability, accommodation, affordability, and impact of war on these medicines. Data were collected using the Kobo Toolbox and analyzed with SPSS version 26. The overall availability of essential medicines was 45.1%. Treatment costs exceeded the daily wage for insured patients in 8 out of 19 medications and for uninsured patients in 18 out of 19. The average median price ratio was 39.3 with insurance and 187.1 without insurance. Accessibility, affordability, accommodation, and acceptability ratings were 3.16/5, 1.02/4, 4.24/6, and 5.42/6, respectively. Only 14.3% of outlets had functioning storerooms, though dispensary areas were generally in good condition. Sudanese patients during the recent war had limited access to essential drugs due to high prices and low availability. The outcomes for the patients’ access variables (accessibility, accommodation, acceptability, and affordability) were comparable to those in low-income countries. Immediate action is critical to guarantee access to affordable medicines, especially since many families have lost their primary sources of income.