Medicines availability for non-communicable diseases: the case for standardized monitoring

Abstract

BackgroundIn response to the global burden of non-communicable diseases (NCDs), the World Health Organization (WHO) has developed a Global Action Plan that includes a voluntary medicines target of 80% availability and affordability of essential medicines for the prevention and treatment of diabetes, cardiovascular disease and respiratory disease both in public and private health facilities. Reliable measures of medicines availability are needed to track progress towards meeting this target. The results of three studies measuring the availability of medicines for hypertension and diabetes conducted in Tanzania in 2012–2013 were compared to assess the consistency of the results across the studies.MethodsAvailability was defined by observation of the medicine (no minimum quantity) on the day of the survey. The three studies involved 24, 107 and 1297 health facilities. Estimates of the availability of medicines for hypertension and diabetes were compared for medicines availability overall, by managing authority (government, mission/faith-based, private-for-profit), by facility level (hospital, health centre, dispensary) and by setting (urban, rural).ResultsComparisons of the availability of medicines were limited by differences in the definitions of the medicines and the classifications of the facilities surveyed. Metformin was variously reported as available in 33%, 39%, 46%, and 57% of facilities. Glibenclamide availability ranged from 19% to 52%. One study reported low levels of insulin availability (9-16% depending on insulin type) compared to 34% in a second study. Captopril (or angiotensin converting enzyme [ACE] inhibitor) availability ranged from 13% to 48%while availability of calcium channel blockers was 29% to 57% and beta-blockers 15% to 50%. Trends were similar across studies with lower availability in government compared to mission or private facilities, in dispensary and health centres compared to hospitals, and in rural compared to urban facilities.ConclusionsAll three studies showed suboptimal availability of NCD medicines, however the estimates of availability differed. Regular monitoring using reproducible methods and measuring key medicines must replace ad-hoc studies, small selected samples and differences in definitions. Low and middle-income countries need to implement monitoring and evaluation systems to track progress towards meeting the NCD medicines target and to inform country-level interventions to improve access to NCD medicines.

Risk Differences between Elderly Men and Women toward Doctor-Diagnosed Diabetes Mellitus in Urban Areas in Indonesia: 2013 National Basic Health Research Data

“…25,26 Having all of the risk factors, the public need to get information that the essential medicines and basic technologies for early detection, diagnosis and monitoring of diabetes at primary care level are now available. 27,28 Indonesia is already capable to procure the three essential medicines for diabetes management, namely insulin, metformin and sulphonylurea(s). 4 Nonetheless, prevention and early detection are still much better.…”

Availability, cost and affordability of essential cardiovascular disease medicines in the south west region of Cameroon: Preliminary findings from the Cameroon science for disease study

“…Availability of medicines in urban and semi-urban outlets was considerably higher than in rural outlets, probably because rural outlets preferably stock medicines for communicable diseases [14] which are symptomatic at onset and readily diagnosed as opposed to cardiovascular diseases and diabetes which are asymptomatic until complications set in, at which point patients migrate to urban centres for further care. This variability in the availability of EM in outlets in different settings may be accounted for, at least in part, by the concentration of private medicine outlets (private facilities and community pharmacies) in the urban and semiurban settings.…”

“…In 2012, the world health organization (WHO) formulated the 25 × 25 Goal which aims at achieving a 25% reduction in the number of premature deaths (occurring before 70 years of age) due to non-communicable disease (NCD) by 2025 [12]. This was followed by a Global Action Plan (GAP) that includes, amongst others, a target of 80% availability and affordability of essential medicines (EMs) for treatment and secondary prevention of CVDs and other NCDs, and at least 50% of eligible people to receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes [13,14]. An availability of medicines for cardiovascular diseases ranging from 9.1% to 50%, and 36.4 to 59.1% in rural and urban settings respectively was reported in the West region of Cameroon in 2012 [15].…”

“…There is ample evidence on the use of pharmacological treatment for secondary prevention of cardiovascular events [12,16,17], thus affordable access to EM is urgently warranted in efforts to reduce the burden of CVD [18]. It has been estimated that up to 80% of the burden of NCDs in many countries can be reduced with the use of appropriate medicines [14]. In spite of this proven benefit of EM, their availability in many low-and middle-income countries is sub-optimal.…”

Targeted Screening Reveals High Numbers of Prediabetes and Diabetes Mellitus in Moshi, Tanzania

“…One major criticism is that screening should only be done if medical treatment is available [14,15]. Assessments indicate that there are insufficient medical supplies and treatment facilities in Tanzania [49][50][51]. However, as progression of pre-diabetes to type 2 diabetes mellitus and related complications might be modified with lifestyle changes [52,53], especially increased physical activity, a screening of pre-diabetes or diabetes may be worthwhile.…”