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Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, India
Access to medicines is an essential human right and is imperative for attaining the best health outcomes across the globe. Despite advancements made in the area of research and development, millions of people around the world still find it challenging to have access to their medicines, especially in low and middle-income countries. The study will explore some of the major barriers that hinder the accessibility of medicines in a cross-sectional study involving 32 foreign students from Punjabi University, Patiala, India. It explores some of the major barriers associated with accessing medicines including affordability, availability, quality assurance, and other obstacles like intellectual property rights and logistics. Primary data collected using a pre-designed questionnaire shows that 78.1% of the participants found medicines expensive while 65.6% of them had to compromise between medicines and other expenditures. Also, 53.1% were hindered by administrative difficulties in accessing their medications. According to the findings, medicine cost is the most significant barrier (31.3%) that prevents individuals from accessing necessary medication. Distance from healthcare facilities and mistrust about the quality of the medicines rank second (21.9% for each of these factors). Such statistics reveal that it is high time for governments to implement policies aimed at differential pricing, health care system strengthening, provision of greater coverage under insurance schemes, and more efficient administrative procedures.
The availability of essential drugs is one of the key pillars of universal health coverage and serves as a basic human right. According to the World Health Organization (WHO), access to medicines is described as the ability to access and use medications in a timely, affordable, and fair manner [1]. There are several aspects of this definition that need to be addressed, such as physical availability, affordability, and geographic accessibility. Although there have been many advancements in medical science and technology in recent years, substantial gaps remain when it comes to medicine accessibility among certain regions and population groups. As much as two billion people lack access to essential medicines worldwide, with most of these individuals residing in developing countries [2]. Access to essential medicines plays an important role in preventing illness and death; however, it has remained inaccessible for many people who are living in poverty, thereby increasing inequality. The issue of medicine accessibility is complicated by multiple dimensions including intellectual property protection, price strategies, logistics, regulation, and health care systems' capacity. Intellectual property protection allows pharmaceutical companies to sustain high drug prices, making numerous potentially life-saving medicines unaffordable to poor people [3]. Besides, poor health infrastructure, lack of effective regulation, and limited health care professionals' workforce contribute to difficulties in accessing medicines. The proposed paper attempts to fill an important research gap related to medicine accessibility in the context of international students' experiences and perceptions. The target group represents a particular demographic segment that might have difficulties in obtaining medical assistance due to language, cultural, insurance, and other reasons. Through exploring international students' perceptions about medicine accessibility, the study contributes to identifying systemic barriers that hinder medicine accessibility not only among international students but also in general. The main aim of this study is to analyze the critical obstacles to accessing medication by international students at Punjabi University, Patiala, India, and to explore possible opportunities that can facilitate access. The following are the research questions of this study:
(1) What are the major obstacles international students face when it comes to accessing necessary medication?
(2) What impact does the unaffordability of medicine and its scarcity have on access to medication?
(3) In what ways do the bureaucratic and administrative obstacles influence access to medicines?
(4) How many students have access to financial aid or medical insurance for medicines?
LITERATURE REVIEW
2.1 Conceptual Framework of Medicine Access
Access to medicines involves several interrelated aspects that determine the extent to which individuals can access necessary medications. According to the conceptual framework established by the World Health Organization, the main aspects that need to be considered include availability (the presence of medicines), affordability (the ability to purchase medicine without difficulty), accessibility (ease of access), and acceptability (the acceptance of medicine) [1].
2.2 Intellectual Property Rights and Patents
Intellectual property rights and patent protection have been cited as one of the main structural barriers affecting global access to medicines. A patent gives exclusive rights of production for long durations of about twenty years to the pharmaceutical companies allowing them to dictate pricing without competition from generics [2]. Although advocates of patenting maintain that patents protect innovation and promote R&D, others have argued that patents create artificial monopolies that increase prices to an unaffordable level for the most vulnerable populations. Trade-Related Aspects of Intellectual Property Rights (TRIPS), managed by the World Trade Organization, is among the controversial issues with regard to global access to medicines. TRIPS provides certain minimum standards for intellectual property laws among its member states thereby limiting access to affordable generic drugs in developing countries [3]. However, in 2001, the Doha declaration on TRIPS and Public Health stipulated that TRIPS would be interpreted in ways that support public health, giving member states flexibility in using options such as compulsory licensing in cases of public health emergencies.
2.3 Economic barriers: affordability and pricing
Affordability is probably one of the most direct barriers to accessing medicines by people and their households. The cost of medicines may become a factor of catastrophic expenditure, causing families to fall below the poverty line and making them choose either health care services or other needs [4]. In many low- and middle-income countries, cash payments are the main source of funding for health care. The differential pricing scheme can be considered an alternative approach to making medicines affordable while encouraging further innovations in the pharmaceutical industry. Differential pricing implies selling the same drug at varying costs depending on the purchasing power of countries [2]. The difficulties in implementing such a strategy lie in addressing the issue of parallel imports and referencing the prices in other countries.
2.4 Supply Chain and Availability Issues
The availability of medicines relies on the presence of efficient supply chains capable of transporting the product from the manufacturer to the consumer. In areas with limited resources, there are often shortages of essential medicines because of ineffective procurement systems, insufficient storage space, poor stock management practices, and ineffective logistics [1]. This could result in the cessation of therapy, worsening illness, and the emergence of drug resistance, especially for chronic diseases which require constant medicine intake. Improving pharmaceutical supply chains involves significant investment in infrastructure and the development of skills within supply chain management, the introduction of an information system to monitor stocks, and ensuring the implementation of quality assurance systems in the supply chain. One potential solution to increase the availability of medicines is local manufacture, which may involve a considerable investment in manufacturing capacity and quality control systems.
2.5 Quality Assurance and Regulatory Systems
Quality is an important but frequently neglected aspect of medicine access. Poor quality medicines not only pose severe health risks but also may result in poor patient response, side effects, increased drug resistance, and even death [4]. Poor regulation, quality management practices, and enforcement capacity may result in poor medicine quality especially in resource-constrained countries with weak ability to regulate the pharmaceutical sector. Quality medicine management involves well-developed regulatory systems consisting of production quality control, pre- and post-marketing surveillance, testing, and regulatory compliance. International collaboration efforts aimed at developing regulatory capacity and quality standards include the WHO Prequalification Programme [1].
2.6 Health Systems and Infrastructure
Health system issues significantly influence medicine access. Poor health systems marked by a lack of infrastructure, poorly developed medical workforce, weak financial base, and low governance capacity hinder medicine access in numerous ways. Health facilities may be unable to provide essential services because of a lack of basic equipment, such as electricity and refrigerators for medicine preservation. There may not be enough specialists to conduct effective prescriptions and counseling. Building strong health systems will involve holistic efforts aimed at infrastructure, workforce, finance, and governance issues. Infrastructure investments in primary healthcare facilities can enhance geographic accessibility, while training healthcare staff can build capacity in the proper use of medicines and patient education [3].
2.7 Global Partnerships and Innovative Approaches
Global partnerships have become increasingly crucial in enhancing access to medicines, especially when dealing with diseases prevalent among poor people. Programs such as the Global Fund to fight AIDS, tuberculosis, and malaria, GAVI vaccines program, and the PEPFAR have raised enormous funds and brought about remarkable progress towards better access to specific medications [4]. New financing tools, such as advance market commitment schemes, pooling procurement, and tiered pricing models, may offer great potential for increasing affordability and accessibility of medicines. Technology transfer programs and voluntary licensing schemes could be useful in facilitating technology transfer from developed nations to developing countries [1].
METHODOLOGY
3.1 Study Design
Cross-sectional survey design was used to gather quantitative data from international students about their access to medicines. Cross-sectional study design was chosen due to its effectiveness in obtaining a quick snapshot of the experiences and opinions of respondents at a particular time, thereby identifying the common challenges and trends in medicine access.
3.2 Study Setting
The study was carried out at Punjabi University, Patiala, which is a highly reputed university in Punjab, India. Students from all over the world attend this university, making it easier for researchers to find international students who face difficulties accessing medicines while residing in India.
3.3 Sampling Strategy
Convenience sampling method was applied to recruit participants. Convenience sampling is a form of nonprobability sampling, where the researcher makes use of samples available at hand to answer their research questions. This method was chosen based on feasibility reasons, including access to the targeted population and efficient data collection within limited resources and time frame.
3.4 Participant Selection
Participants were selected as follows: (1) Currently enrolled international students at Punjabi University, Patiala; (2) willing participants for voluntary participation in the survey; and (3) the ability to fill out the form in English. There were no other criteria for exclusion and only general criteria for selection, which made the sample as diverse as possible among international students.
3.5 Instrument for Data Collection
Data was collected through a self-administrated and structured questionnaire distributed online by using Google Forms. This form contained closed-ended questions covering several aspects of access to medicines including:
Challenges related to the access of medicines specifically The time required to answer all the questions and complete the form was expected to take from 10 to 15 minutes.
3.6 Data Collection Procedure
The survey via the Google Forms link was disseminated to potential respondents using a number of methods such as emails, social media, and student networks. Information regarding the aims and objectives of the survey, its voluntary nature, guarantee of confidentiality, and the duration it might take to fill the form were provided in the introductory part of the questionnaire.
3.7 Ethics
This study strictly followed ethical considerations such as voluntariness of participants, informed consent, confidentiality, and anonymity. As no official ethical clearance was required for conducting this study, all data were collected in adherence to confidentiality measures. In addition, personally identifiable data were not collected from any participant, and confidentiality was assured throughout the data collection process.
3.8 Data Analysis
Data collected during this research were analyzed using descriptive statistics, which served to characterize the population under study and determine the extent of different medicine access experiences. Categorical data were expressed in terms of frequency distributions, cross tabulated to investigate the association between various variables, and visualized using pie charts and bar graphs.
3.9 Research Limitations
There are several limitations that need to be considered. First, since convenience sampling was used, the results might not be generalized to other populations. Second, there was a limited number of respondents who participated in the study (n=32). Third, the responses were based on self-reporting and are susceptible to recall bias and social desirability bias. Fourth, the results are not longitudinal as the study employed a cross-sectional research design. Fifth, the study was conducted at only one Indian university.
RESULTS
4.1 Demographic Characteristics
The sample of the research included 32 foreign students, with an almost equal gender representation, where there were 17 male students (53.1%) and 15 female students (46.9%). As for the educational level of the participants, the following figures have been revealed: 4 high school graduates (12.5%), 4 students who had received only partial higher education (12.5%), 10 bachelor students (31.3%), 10 master's students (31.3%), and 4 PhD students (12.5%).
4.2 Affordability and Financial Barriers
Affordability proved to be the biggest impediment to accessing medicine. The majority of participants, i.e., 78.1% (n=25), indicated that the medicine required was unaffordable. In contrast, only 21.9% (n=7) felt the medicines were affordable. These results were confirmed by the data collected when participants were asked if they ever had to make difficult choices regarding healthcare financing. The majority, i.e., 65.6% (n=21), stated that they have faced situations where they had to decide between purchasing medication or meeting their other basic needs. There is little access to financial support schemes or insurance coverage. Thirty-seven percent (n=12) of participants were beneficiaries of financial assistance programs or insurance coverage that enabled them to obtain medicines. However, more than two-thirds of the participants, i.e., 62.5% (n=20), did not benefit from such schemes.
4.3 Medicine Availability and Stock-Out Experiences
As far as medicine accessibility is concerned, the stories were inconsistent. Upon asking how often the respondents had experienced stock-outs in relation to the nearest health care facilities, 10 respondents (31.3%) indicated that they had never experienced stock-outs, 18 respondents (56.3%) seldom experienced stock-outs, while 2 (6.3%) often experienced stock-outs. Even though most people indicated seldom or never experiencing stock-outs, stock-outs in general is a serious issue indeed. With respect to availability of medications at the nearest healthcare facility, 15 students (46.9%), 9 students (28.1%), and 8 students (25.0%) stated availability, unavailability, and did not know respectively. From the results, it is evident that although almost half of the students are able to access the required medication, there are many who cannot.
4.4 Quality Perceptions and Trust
The perceived quality of drugs was relatively high, with 20 individuals (62.5%) indicating their trust in the quality of available medicines, 8 (25.0%) indicating their distrust of the drug quality, and 4 (12.5%) being unsure about the quality of medications. It can be stated that while there were some quality concerns, those were less common than availability and affordability issues. Prescription satisfaction among patients was almost identical to drug quality perceptions, with 16 individuals (50.0%) reporting their satisfaction with prescriptions, 5 (15.6%) dissatisfaction, 6 (18.8%) neutrality, and another 5 (15.6%) who indicated neither satisfaction nor dissatisfaction with prescription practice.
4.5 Geographical Accessibility
The distances from the nearest health facility were quite positive for most participants. The breakdown of the distances is as follows: 11 respondents (34.4%) resided 1 km from the health facility, 13 (40.6%) resided 2 km from the health facility, 3 (9.4%) resided 3 km from the health facility, 3 (9.4%) resided 4 km from the health facility, and 2 (6.3%) resided 5 km from the health facility.
4.6 Bureaucratic and Administrative Barriers
The issues relating to bureaucratic and administrative constraints were noted by slightly more than half of the participants. In particular, 53.1% (n=17) of the participants faced problems related to these constraints in their efforts to gain access to medicines, whereas 46.9% (n=15) had no such problems.
4.7 Social and Cultural Factors
Factors related to social and culture had apparently a minimal impact on medicine access for this group of people. In the questionnaire that posed the question regarding the impact of either of these two factors, the responses received included "Yes" from 53.1% (n=17), "No" from 43.8% (n=14), and "Maybe" from 3.1% (n=1). While the responses indicate some impact from these factors, they seem to be less impactful than economic or other types of factors.
4.8 Specific Medicines and Access Difficulties
As for the issue of difficulty in accessing some medicines, 43.8% (n=14) answered that there were certain medicines that were consistently difficult to access, and 56.3% (n=18) experienced no such difficulties. It may be assumed that, despite not being an issue for all medication types, access challenges do persist in regard to certain medicines for a considerable number of patients.
4.9 Main Barriers to Medicine Access
Respondents stated their views on the primary barriers to medicine access, which is presented below:
Cost of medicine: 10 (31.3%) – the leading barrier
Distance from health centers: 7 (21.9%)
Not trusting the medication/doctors: 7 (21.9%)
Insufficient medicine: 2 (6.3%)
None: 8 (25.0%)
From the above information, it is clear that the cost of medication is the key issue for many, with geographic proximity and trust forming secondary barriers. It should be noted that, in contrast, one-quarter of the respondents had no issues at all with medication access.
DISCUSSION
5.1 Affordability as the Main Barrier
The finding that 78.1% of the participants regarded medicine prices as too high corroborates the wide range of studies showing that economic barriers constitute the most substantial obstacle to accessing medicine worldwide [1], [2]. It is evident from the fact that 65.6% of the participants were unable to buy their medication due to the conflict of interests with another necessary expenditure category. The affordability barrier faced by international students can be seen as a manifestation of the more general problem related to the rising costs of medicines. Indeed, foreign students may not have comprehensive health insurance plans or access to government-funded programs. Therefore, a lack of access to any financial assistance programs (only 37.5% participated in any) makes the cost burden even worse. Measures that may contribute to overcoming affordability barriers can include: (1) increasing insurance coverage among international students; (2) introduction of differential pricing schemes based on students' inability to pay; (3) organizing health assistance programs at universities; (4) advocating the consumption of generic medicines; and (5) regulating the prices for essential drugs.
5.2 Medicine Availability and Logistics Management
Although stock outs were not common (occurring often or sometimes for only 12.6% of participants), any disruption in availability can significantly affect medicine supply, especially for patients with chronic illnesses. The 28.1% of participants who indicated unavailability of required medicines in the nearby healthcare center suggests problems with logistics management and inventory control. Medicine availability can be improved by optimizing pharmaceutical logistics with enhanced forecasting methods, better inventory management tools, dependable distribution channels, and sufficient storage capacity [3]. University students would benefit from access to on-campus pharmacies with an adequate supply of the necessary medicines.
5.3 Views on Medicine Quality and Trust
The comparatively high level of trust in the quality of medicine supply (62.5%) is reassuring, but the 25% lack of trust and 12.5% uncertainty are concerning as they imply possible problems with adherence and searching for other (potentially unreliable) medicine suppliers [4]. Trust needs to be built and maintained through transparent quality assurance programs, educating patients about medication regulation and quality control, proper labeling and provision of information, and adequate mechanisms for reporting and resolving issues of quality.
5.4 Geographical Accessibility
The fact that 75% of those surveyed lived within 2 km of healthcare facilities is a positive indicator of geographical accessibility, and this factor should be capitalized on by complementing efforts that address other factors limiting medication access. For the remaining 25%, the distance factor might exacerbate difficulties in accessing medicines, especially when coupled with financial limitations regarding transportation costs.
5.5 Bureaucratic and Administrative Barriers
That 53.1% of respondents faced bureaucratic and administrative barriers underscores the need for efficiency within the healthcare system. Such barriers may include stringent prescription policies, complicated approval procedures, documentation procedures, linguistic barriers when dealing with bureaucracy, and confusing procedures. Administrative streamlining via simple processes, provision of information in several languages, support services for international students, and digitization of administrative processes can mitigate such barriers [1].
5.6 Social and Cultural Barriers
Although social and cultural barriers were mentioned by 53.1% of the participants, they were less commonly mentioned as key barriers compared to economic and systemic barriers. However, the cultural disparities in health belief models, communication issues with healthcare professionals, unfamiliarity with the healthcare system of the destination country, and possible stigma associated with some medical conditions can impact the seeking and adherence behaviors related to medicines. Socially responsive healthcare services, provision of translation services, educational literature in different languages, and peer support groups can overcome such barriers [2].
5.7 Variation in Experiences
The discovery of the 25% of respondents not having faced any difficulties in obtaining medicines is indicative of a heterogeneous experience among the international students. These variations can be due to disparities in terms of financial ability, health insurance coverage, state of health, understanding of the system, etc. Learning more about how individuals are able to navigate through the system successfully can help develop strategies for students experiencing problems.
5.8 Policy and Practical Implications
The study has several practical implications, some of which include:
For Universities: Universities that have international students on their rolls must ensure that there are adequate health support services. Some of these include availability of health insurance, presence of health facilities on campus with sufficient medicines, assistance with navigating the health care system, and financial support programs to enable students cope with difficult financial times.
For Health Facilities: Health facilities with international patients must provide culturally appropriate care, interpretive services, simplification of procedures and an information system for obtaining medicines.
Pharmaceutical Policy Recommendations:
Policy makers need to explore differential pricing policies for the student demographic, encourage the use of generic drugs, control the prices of essential medications, and ensure that international students are included in health finance programs.
Health Education Recommendations:
Universities and health care facilities need to provide orientations for international students about navigating their country’s health care systems, accessing medication, using their insurance plans, and accessing support service.
5.9 Contributions of the Study
The study adds to the scanty body of knowledge on medicine access among international student demographics, who have peculiar problems accessing medicines in foreign countries. The study shows that international students face considerable challenges accessing medicines because of high costs and have to make tough choices among health care and other basic necessities.
Limitations and Future Directions
In conclusion, it is necessary to acknowledge several limitations that should be taken into account when considering the outcomes of this research. First, the use of convenience sampling and the rather modest number of participants reduce the possibility of generalization. The chosen cross-sectional design does not allow identifying changes in experience over time or establishing causation. Finally, self-reports are prone to certain biases like recall bias and social desirability bias. In terms of future directions for this research topic, it would be important to use probability sampling and work with bigger samples in multiple organizations from various countries. It might be useful to use longitudinal designs that can track changes in medicine access experiences over time and their impact on health. Moreover, qualitative approaches can give better insights into the issue by discussing the personal experiences of international students regarding medicine access.
CONCLUSION
This research offers empirical proof of serious barriers to medicines accessibility among international students at Punjabi University, Patiala, with price becoming the principal barrier. The fact that more than three-quarters of those surveyed viewed medicines as being too expensive and that almost two-thirds of participants had to prioritize medicines over other expenditures shows that medicines prices become an actual financial burden to these people. Other barriers to obtaining medicines include bureaucratic barriers (faced by 53.1% of participants), lack of insurance cover (only one-third of participants had medical insurance), and availability issues (28.1% of participants could not obtain necessary medicines). This calls for urgent and well-designed policy measures to ensure access to medicines among international student populations. Such measures should be as follows: (1) expanding coverage of affordable health insurance among international students; (2) introducing differential pricing regimes and promoting generic medicines; (3) setting up university-based health service facilities complete with pharmacies on campus; (4) reducing bureaucracy and delivering culturally sensitive healthcare services; (5) launching financial assistance programs for economically disadvantaged students; and (6) enhancing supply chain management for medicines. However, addressing access barriers to medicines for international students goes beyond ensuring that their health rights are met. It is important to recognize that there are other implications of ensuring that international students receive their medicines without any barriers. There is no doubt that ensuring access to medicines will enhance the academic achievements of the students while minimizing unnecessary suffering that might negatively impact their studies. It is worth noting that the barriers described in this research paper are similar to barriers to accessing essential medicines faced by vulnerable groups globally. Therefore, addressing the issues associated with medicine access barriers in universities is vital, but it needs to go beyond universities. For instance, there are several strategies to improve medicine access that should be adopted by universities and health care institutions. Further research is needed to identify and evaluate the strategies used to minimize the effects of medicine access barriers on the health status of international students. It would be interesting to conduct comparative research among different health care settings to determine the best practices for enhancing access to essential medicines for international students. In conclusion, making sure that all groups have equal access to essential drugs is key to attaining universal health coverage and sustainable development goals. The findings of this study provide useful information that can be used to develop policies and procedures designed to remove obstacles to equal access to the needed drugs by all people.
REFERENCES
Lehlohonolo Phineas Lebesa*, Barriers to Equitable Access to Essential Medicines: A Cross-Sectional Study of International Students' Experiences and Perspective, Int. J. Med. Pharm. Sci., 2026, 2 (5), 500-509. https://doi.org/10.5281/zenodo.20203393
10.5281/zenodo.20203393