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Irrational Use of Diabetes Medicines in Resource-Poor Settings

Irrational Use of Diabetes Medicines in Resource-Poor Settings. International Insulin Foundation David Beran, Geoff Gill, John S. Yudkin and Harry Keen. Background. Ideally what is needed to manage diabetes in resource poor settings? Barriers to care exist

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Irrational Use of Diabetes Medicines in Resource-Poor Settings

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  1. Irrational Use of Diabetes Medicines in Resource-Poor Settings International Insulin Foundation David Beran, Geoff Gill, John S. Yudkin and Harry Keen

  2. Background • Ideally what is needed to manage diabetes in resource poor settings? • Barriers to care exist • How can these be clearly identified? • Development of the Rapid Assessment Protocol for Insulin Access (RAPIA)

  3. Rapid Assessment Protocol for Insulin Access (RAPIA) Multi-level assessment of Health system • Micro • Healthcare Workers • Traditional Doctors • Patients • Meso • Regional Health Organisation • Hospitals, Health Centres, etc. • Pharmacies, Drug Dispensaries • Macro • Ministry of Health • Ministry of Trade • Ministry of Finance • Central Medical Store • National Diabetes Association • Private/Public drug importer • Educators Perspectives on the problem of access to Insulin and Diabetes care

  4. Countries where the RAPIA has been implemented Kyrgyzstan (2009) Mali (2004) Vietnam (2008) Nicaragua (2007) Philippines (2008)* Zambia (2003) Mozambique (2003) Reassessment (2009) * - carried out by WHO

  5. Results: Prices of insulin per 10ml 100 IU vial

  6. Results: Availability versus Affordability

  7. Results: Irrational choices (Kyrgyzstan) • Essential medicines WHO list versus Kyrgyz list

  8. Results: Irrational choices and their financial implications (Kyrgyzstan) * - Analogue insulin or insulin in penfill

  9. Results: Poor purchasing practices (Vietnam) • High tender prices compared to international prices * - Only generic versions ** - Only branded versions

  10. Results: Overall financial cost • Health Systems • Nicaragua: Estimated that 1 in 5 people with diabetes are receiving treatment • Represents 5% of total health budget • Mozambique: In 2003 purchase of insulin = 10% of government expenditure on medicines • Improved tendering + LEAD Initiative resulted in decrease of average price per vial from US$ 8.03 to US$ 4.50 (2003 to 2009) • Individuals • Mali: US$ 340 per year for treatment of an individual requiring insulin • 61% of per capita GDP • Vietnam: US$ 55 per month for treating child with Type 1 diabetes • 79% of per capita GDP

  11. Key Lessons • Not one price of insulin • Focus on proper purchasing at central level • Focus on cost to end user • Focus on affordability and availability • Mozambique 2003 versus 2009 • Rational medicine policies • Taxing • Selection • Purchasing • Prescribing • Someone has to pay • Health Systems versus Individuals • Access to Medicines versus Access to Treatment • Trained healthcare workers • Diagnostic tools • Education • Etc.

  12. Policy Implications – A “positive diabetes environment” Data collection Accessibility and affordability of Medicines Positive policy environment Community involvement/ diabetes association Prevention measures Diagnostic tools and infrastructure Patient education and empowerment Adherence issues Healthcare workers Organised centres for care Drug procurement and supply

  13. Future research • Further understanding of access to medicines for diabetes, especially insulin • How to improve affordability for medicines and care • Improving not only access to medicines, but also treatment for diabetes • Further RAPIAs • Assessments • For health system comparisons • As a tool for M&E • As a tool for Policy change • A model for other chronic diseases

  14. Any questions? International Insulin Foundation www.access2insulin.org

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