Health Facility Factors Associated with Access to Essential Medicines for Non-Communicable Diseases Among Insured Patients in Level 4 Public Health Facilities in Nairobi City County, Kenya

Access to essential medicines is critical for effective management of non-communicable diseases (NCDs), particularly among patients requiring continuous pharmacological treatment. However, health facility constraints may limit medicine access even among insured patients. This study examined health facility factors associated with access to essential medicines for NCDs among insured patients attending selected Level 4 public health facilities in Nairobi City County, Kenya. A mixed-methods cross-sectional design was employed among insured adult patients diagnosed with NCDs. Of the 422 questionnaires administered, 351 were completed, yielding a response rate of 83.2%. Quantitative data were analysed using descriptive statistics, Pearson's chi-square test, and binary logistic regression, with statistical significance set at p < .05. Qualitative data were analysed thematically to complement the quantitative findings. The findings showed that 62.1% of respondents reported frequent medicine stock-outs, 53.0% indicated that they did not receive all prescribed medicines, and 73.8% reported referral to private pharmacies because of stock-outs. In the bivariate analysis, frequent medicine stock-outs were significantly associated with access to essential medicines (χ² = 11.233, p = .047), as were receipt of all prescribed medicines (χ² = 16.577, p = .001), waiting time (χ² = 10.583, p = .032), and efficiency of the medicine supply system (χ² = 12.539, p = .014). The logistic regression model was statistically significant, χ²(38) = 70.420, p = .001, with a Nagelkerke R² of .246. After adjustment, an efficient medicine supply system remained a significant independent predictor of access; patients reporting an efficient system had approximately 3.9 times higher odds of accessing essential medicines (AOR = 3.939, 95% CI [1.284–12.086], p = .017). The study concludes that facility-level pharmaceutical system performance remains critical to medicine access despite insurance coverage. Strengthening forecasting, procurement, inventory management, timely replenishment, and supply-system efficiency is necessary to improve access and continuity of NCD treatment in public health facilities.