Background: In developing countries, diabetes is the leading cause of blindness, renal failure and
lower limb amputation with most deaths due to cardiovascular disease complications. The
prognosis for diabetes is poor and life expectancy is short and akin to the era in which insulin
was not available to manage diabetes (Beran et al., 2005). These poor outcomes have been
attributed to chronic shortage and non-affordability of diabetic medicines.
Aim: This study determined the affordability of medicines for diabetic patients attending the
diabetic clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu.
Methods: The study was a cross-sectional, time-delimited, descriptive study of affordability of
medicines for diabetic patients aged >18 years and who pay for medicines out-of-pocket. All
eligible patients attending the diabetes clinic who are responsible for payment of their prescribed
medicines were recruited between September 19 to October 31, 2007. A structured questionnaire
was used to collect sociodemographic information about patients and the prescription was
assessed in terms of conformity with the essential medicines list (EML), cost and ability to be
completely filled by the patient. Data was analysed using EPI Info software.

Results: Of the 189 respondents, 37% were able to completely fill their prescriptions with funds
from income (40%), borrowed funds (15%) or gifts from friends/relatives (43%). The total
number able to completely fill their prescriptions increased to 47% when substitutes from the
EML were made. The mean number of days’ wages to completely fill the prescription was 6.5
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days and this reduced to 4.8 days when the choice was made wholly from the EML. The prices
patients paid to purchase the key medicines to manage diabetes and cardiovascular disease were
2 to 26 times international reference prices.
Conclusions: The results show that medicines prescribed for diabetes patients are unaffordable to
the majority of patients who attend the UNTH diabetic clinic. While choice from the EML would
have a positive impact on affordability, ability to afford out-of-pocket payment would also be
greatly improved with reduction in prices patients pay for their medicines. There is need to
restructure financing mechanisms for chronic disease management with the aim of reducing or
abolishing out-of-pocket payments for medicines and health services in the country