Does access to credit services influence availability of essential child medicines and licensing status among private medicine retail outlets in Uganda?

BACKGROUND Despite making great progress in reducing under five mortality in the last three decades. Uganda still ranks high among countries with the highest under five mortality rates. More than a third (36%) of these deaths are caused by pneumonia (15%), malaria (12%), or diarrhea (9%). For many mothers and caregivers, private drug shops are a point of care seeking for these illnesses. However, many drug-shops, are unlicensed and do not stock essential commodities due to insufficient capital and operational funds. This study set out to understand the relationship, between access to credit services through financial loans or stock and i) availability of essential child medicines and ii) licensing status among medicine retail outlet including drug shops and pharmacies. METHODS This was a cross-sectional study conducted between April and March 2016. The country was divided into 168 enumeration areas based on the geographical regions and household population distribution within the region; these served as the primary sampling units. Within each enumeration area, all private medicine retail outlets (drug-shops and pharmacies) that provide consultation for childhood illnesses were identified and surveyed. Data on access to credit services was collected through interviews and data on stock, through observations of shelves for Oral rehydration salts, amoxicillin dispersible tablets, amoxicillin syrup, Artemether combined therapies, and Zinc dispersible tablets. Android tablets were used for data collection and results were analyzed using STATA12. A total of 586 outlets were visited during the study, 96% were drug shops and 4% were pharmacies. RESULTS For all five essential child medicines assessed, access to credit through financial loans or through obtaining stock on credit did not influence stock availability. Access to credit services through loans or through stock on credit was seen to influence licensing status. The odds increased by more than 50% (1.53, CI: 1.27-2) among outlets who accessed loans compared to those who hadn't and by 2 fold (2, CI: 1.03-3.8) among those who accessed stock on credit than in those who had not. CONCLUSIONS Access to credit does not influence stock availability of essential child medicines among private medicine outlets, however, it has an effect on licensing status. In addition to further research, the provision of financing mechanisms to support the licensing processes could increase the proportion of unlicensed outlets.