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Effect of Essential Medicine Availability on Treatment Adherence among Patients with Chronic Diseases in Nigeria

Abstract

Chronic diseases are a major and growing public health concern in Nigeria and require continuous treatment, regular monitoring, and long-term adherence to prescribed medications. Conditions such as hypertension, diabetes mellitus, asthma, cardiovascular diseases, and other chronic illnesses often require patients to take medicines consistently over extended periods. However, treatment adherence may be affected by the availability, affordability, accessibility, and continuity of essential medicines within healthcare facilities. Essential medicine availability refers to the consistent presence of medicines that are required to meet the priority healthcare needs of the population and are available in appropriate quantities, at appropriate quality, and at affordable prices. Treatment adherence refers to the extent to which patients take prescribed medicines according to the recommended dose, frequency, timing, and duration. In Nigeria, frequent medicine stock-outs, inadequate pharmaceutical supply systems, financial constraints, limited access to healthcare facilities, and interruptions in medicine availability may compel patients with chronic diseases to miss doses, discontinue treatment, reduce prescribed doses, or seek alternative sources of medication. Ensuring continuous availability of essential medicines may therefore support patients' ability to maintain recommended treatment regimens and improve chronic disease management. Against this background, this study investigates the effect of essential medicine availability on treatment adherence among patients with chronic diseases in Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Health Systems Framework. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how access to medicines may influence treatment-related behaviour. The Health Belief Model explains medication-related behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. The Health Systems Framework emphasizes essential medicines, service delivery, health workforce, health information, financing, and access to healthcare as important components of an effective health system. Collectively, these theoretical perspectives provide a suitable framework for explaining how essential medicine availability may influence treatment adherence among patients with chronic diseases in Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from adult patients diagnosed with selected chronic diseases who receive care from selected public healthcare facilities across selected locations in Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, and eligible patients. Essential medicine availability will be assessed using indicators such as availability of prescribed essential medicines, frequency of medicine stock-outs, duration of stock-outs, availability of alternative medicines, continuity of medicine supply, affordability, accessibility of medicines, and availability of appropriate pharmaceutical services. Treatment adherence will be assessed using indicators such as regular medication use, adherence to prescribed dosage, adherence to prescribed frequency, timely medication refills, missed doses, treatment interruption, and continuity of prescribed treatment. Structured questionnaires, facility medicine availability checklists, pharmacy records, and patients' medication records will be used for data collection where available. Descriptive statistics will be used to summarize participants' characteristics, medicine availability, and treatment adherence patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the effect of essential medicine availability on treatment adherence. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that consistent availability of essential medicines has a significant positive effect on treatment adherence among patients with chronic diseases in Nigeria. Patients who consistently obtain their prescribed medicines from healthcare facilities are expected to demonstrate better treatment adherence than patients who frequently encounter medicine stock-outs or interruptions in supply. Continuous medicine availability may reduce missed doses, treatment interruptions, and delays in medication refills and may enable patients to follow prescribed treatment regimens more consistently. Reliable medicine supplies may also reduce the financial and logistical burden associated with searching for medicines from alternative sources. Conversely, frequent stock-outs and inconsistent medicine availability may contribute to missed doses, self-reduction of prescribed doses, treatment discontinuation, delayed refills, and reliance on alternative or unregulated sources of medicines. However, medicine availability alone may not fully determine treatment adherence because patients' knowledge, perceived treatment benefits, medication side effects, financial circumstances, forgetfulness, healthcare-provider communication, family support, and complexity of treatment regimens may also influence adherence. The study is expected to contribute to the literature on essential medicines, treatment adherence, chronic disease management, pharmaceutical services, healthcare utilization, primary healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, pharmaceutical service providers, chronic disease programme managers, healthcare workers, development partners, and policymakers regarding strategies for improving continuity of chronic disease treatment. The study will also provide evidence-based recommendations for strengthening essential medicine procurement and supply systems, reducing medicine stock-outs, improving pharmaceutical inventory management, ensuring affordability of chronic disease medicines, strengthening medicine distribution systems, improving facility-level medicine monitoring, and integrating reliable essential medicine availability into comprehensive chronic disease management programmes across Nigeria.

Keywords: Essential medicine availability, treatment adherence, chronic diseases, Nigeria, medication adherence, medicine stock-outs, chronic disease management, pharmaceutical services, primary healthcare, healthcare utilization, public health.