Article Text
Abstract
Introduction Generic medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines.
Methods The study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system.
Results The generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients’ and health workers’ perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system.
Conclusion Negative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.
- health systems
- public health
- diabetes
- hypertension
- qualitative study
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial IGO License (CC BY-NC 3.0 IGO), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL. See:https://creativecommons.org/licenses/by-nc/3.0/igo
Statistics from Altmetric.com
Footnotes
Handling editor Seye Abimbola
Contributors PA and PNS were involved in the conception and design of the study. Field work, lab testing and initial analysis was done by PA, MKP, CMG, SB and MAE. MAE and PA were involved in initial analysis of the qualitative data, MAE reviewed and finalised the qualitative findings. PA wrote the first draft of the manuscript with review and addition by PNS and ZCS. All authors contributed to interpretation of findings and preparing, reading, revising and approving the manuscript.
Funding This study was funded by the Alliance for Health Policy and Systems Research, World Health Organization, Geneva.
Disclaimer The author(s) is(are) staff member(s) of the World Health Organization. The author(s) alone is(are) responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization. ZCS is a staff member of WHO. He is himself alone responsible for the views expressed in the Article, which do not necessarily represent the views, decisions or policies of WHO.
Competing interests ZCS is a staff member of the Alliance for Health Policy and Systems Research, WHO that funded for this study.
Ethics approval Ethics clearance was obtained from the WHO Ethics Review Committee as well as from the and Institutional Ethics Committee of the Institute of Public Health, Bangaluru. Before proceeding with data collection, permission in writing was sought from the Department of Health and Family Welfare, Government of Karnataka.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement No additional data are available.