Availability of two essential medicines for mental health in Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Malawi, Senegal, and Tanzania: Evidence from nationally representative samples of 7958 health facilities

Background Access to effective mental health services in low- and-middle income coun-tries (LMICs) is limited, leading to a substantial global treatment gap. Amitriptyline, an an-ti-depressant, and diazepam, an anxiolytic drug, are classified as essential medications by the World Health Organization (WHO). They are the only psychotropic medications whose availability in health facilities is documented as part of Service Provision Assessment sur-veys. Our objective was to characterize the availability of these medicines in seven countries. Methods We pooled nationally representative data from Service Provision Assessment sur-veys of health facilities conducted in Bangladesh, Democratic Republic of Congo (DRC), Haiti, Malawi, Nepal, Senegal, and Tanzania, from 2012 to 2018. We estimated the dis-tribution and determinants of facility-level amitriptyline and diazepam availability in each country. Results We analysed data from 7958 health facilities. An estimated 8.2% of facilities had amitriptyline and 46.1% had diazepam on the day of assessment. There was significant heterogeneity in both amitriptyline and diazepam availability across countries and within countries across facility characteristics. Multivariable models indicated that hospitals, faith-based and private-for-profit facilities, facilities with more staff, and facilities with more tech-nological resources were more likely to have each medicine, relative to primary care facili-ties, public sector facilities, facilities with fewer staff, and facilities with fewer technological resources, respectively. Conclusion Our results indicate limited availability of amitriptyline in health facilities in these seven LMICs. Diazepam is much more commonly available than amitriptyline. Efforts to narrow the global treatment gap for mental health - and especially to integrate men-tal health services into primary care in LMICs - will be limited without the availability of essential medicines like amitriptyline. Efforts to expand purchasing, distribution, and ca-pacity-building in the appropriate use of essential mental health medicines in LMICs are warranted.