Market Concentration and Its Relevance in Pharmaceutical Health Care Access in Rural Communities in Nigeria

Abstract

Background: Universal Health Coverage (UHC) of populations is now a key objective of global health systems. UHC seeks to provide equitable access to essential health care for all who need health care without financial hardship. Unfortunately, the 21^st century has rolled off with the majority of Nigerians still unable to have adequate access to affordable essential medicines for preventing, mitigating or curing diseases from formal sources, particularly in rural communities. In these settings, informal pharmaceutical entrepreneurs (called patent medicine vendors) are often the sole sources of modern medicines and sometimes double as prescribers as well. There are a number of studies about these entrepreneurs, but none that examines the market structure. The study seeks to gain insight into the structure and conduct of this market in order to improve its performance. Method: A cross-sectional, mixed method design based on the structure-conduct-performance (S-C-P) paradigm was used to collect quantitative and qualitative data from patent medicine vendor operators and clients in Kastina-Ala local government council of Benue State, Nigeria. Quantitative data was analyzed using statistical package for social sciences (SPSS) version 20.0, while qualitative data was manually analyzed guided by aproiri themes.Findings: Sellers in the market were small sized, selling branded and generic drugs, with none capable of price leadership. There were low entry barriers, with an overall inverse HHI of 0.01 and a shop per capita of 1:2,669 populations, signifying inadequate access to essential medicines,Conclusion: We conclude that focusing on market concentration as a marker of market efficiency may not always result in the socially desirable health system goal of adequate access to care. Greater emphasis should be placed on developing new health care market policy frameworks that embed both competition and access dimensions in guiding health care market operations.

Keywords: Pharmaceuticals; Market concentration; Health care access; Rural communities; Nigeria

DOI: 10.7176/JESD/10-14-10

Publication date:July 31^st 2020