Assessing the Availability, Service Quality, and Price of Essential Medicines in Private Pharmacies in Afghanistan Norio Kasahara A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 2015 Reading Committee: Louis P. Garrison, Jr., Chair Joseph B. Babigumira Andy Stergachis Program Authorized to Offer Degree: Pharmaceutical Outcomes Research and Policy ©Copyright 2015 Norio Kasahara ii Table of Contents Abstract ................................................................................................................................................................................... ................................................................................................ ................................................................................................ .................................................................................. ............... vvv Acknowledgements ................................................................................................................................................................................... ................................................................................................ ................................................................................. ............ viiviivii Summary ................................................................................................................................................................................... ................................................................................................ ................................................................................................ ................................. viiiviiiviii Introduction ................................................................................................................................................................................... ................................................................................................ ................................................................................................ ......................... 111 Background .......................................................................................................................................................................... 1 Rationale ............................................................................................................................................................................... 1 Overall Research Objective .......................................................................................................................................... 2 Study Implications ........................................................................................................................................................... 2 Introduction References ................................................................................................................................................ 3 Chapter 1 A Baseline Survey on the State of Access to EssEssentientialal Medicines in Afghanistan: BBBackground,Background, Approach, and Key Findings ................................................................................................................................................................................... ................................................................................. ............ 444 Introduction ........................................................................................................................................................................ 4 Conceptual Framework .................................................................................................................................................. 7 Survey and Study Design ............................................................................................................................................... 8 Key Findings ...................................................................................................................................................................... 13 Chapter 1 Figures and Tables ................................................................................................................................................................................... ......................................................................................... ............ 151515 Chapter 1 References ................................................................................................................................................................................... ................................................................................................ ........................................... 181818 Chapter 2 Assessing the AAvailabilityvailability and Affordability of Essential MedicMedicinesines in Afghanistan ................................................................................................................................................................................... ................................................................................................ ................................................................................................ ................................................................................................ ................... 212121 Introduction ...................................................................................................................................................................... 21 Methods ............................................................................................................................................................................... 23 Analysis ................................................................................................................................................................................ 28 Results .................................................................................................................................................................................. 30 Limitations ......................................................................................................................................................................... 36 Conclusion .......................................................................................................................................................................... 38 Chapter 2 Figures and Tables ................................................................................................................................................................................... ......................................................................................... ............ 393939 iii Chapter 2 References ................................................................................................................................................................................... ................................................................................................ ........................................... 515151 Chapter 3 Prices and Affordability of Essential Medicines in Afghanistan: The Role of Service Quality, Licensure Status, and Other Factors ............................................................................................................................................................................ ............ 545454 Introduction ...................................................................................................................................................................... 54 Background ........................................................................................................................................................................ 55 Methods ............................................................................................................................................................................... 55 Results .................................................................................................................................................................................. 59 Conclusion .......................................................................................................................................................................... 63 Chapter 3 Figures and Tables ................................................................................................................................................................................... ......................................................................................... ............ 646464 Chapter 3 References ................................................................................................................................................................................... ................................................................................................ ........................................... 777777 Conclusion ................................................................................................................................................................................... ................................................................................................ ...............................................................................................