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

Globalization and Health

David Beran²  Kees de Joncheere³  Gilles Forte³  Cécile Macé³  Jane Robertson¹ 

[1] University of Newcastle, Calvary Mater Hospital, Newcastle 2298, Australia;University of Geneva, 24 rue du Général-Dufour, Geneva, 1211, Switzerland;World Health Organization, 20, avenue Appia, Geneva, 1211, Switzerland

关键词: Monitoring;    Availability;    Non-communicable diseases;    Essential medicines;   

Others  :  1209025
DOI  :  10.1186/s12992-015-0105-0

 received in 2014-12-23, accepted in 2015-04-24,  发布年份 2015

【 摘 要 】

Background

In 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.

Methods

Availability 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).

Results

Comparisons 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.

Conclusions

All 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.

【 授权许可】

   
2015 Robertson et al.; licensee BioMed Central.

【 参考文献 】

• [1]World Health Organization. Key components of a well-functioning health system. Geneva: World Health Organization, 2010. [http://www.who.int/healthsystems/publications/hss_key/en/]
• [2]World Health Organization. The Selection and Use of Essential Medicines. Report of the WHO Expert Committee, 2013. Technical Report Series 985. [http://www.who.int/medicines/publications/essentialmeds_committeereports/en/]
• [3]Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HG, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ. 2011; 89:412-21.
• [4]Mendis S, Fukino K, Cameron A, Laing R, Filipe A, Khatib O et al.. The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull World Health Organ. 2007; 85:279-88.
• [5]Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009; 373:240-9.
• [6]van Mourik MS, Cameron A, Ewen M, Laing RO. Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data. BMC Cardiovasc Disord. 2010; 10:25. BioMed Central Full Text
• [7]Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. United Nations General Assembly, New York; 2012.
• [8]World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva: World Health Organization, 2013. [http://www.who.int/nmh/events/ncd_action_plan/en/]
• [9]World Health Organization. NCD Global Monitoring Framework: ensuring progress on noncommunicable diseases in countries. [http://www.who.int/nmh/global_monitoring_framework/en/]
• [10]World Health Organization. Implementation tools Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Geneva: World Health Organization, 2013. [http://www.who.int/cardiovascular_diseases/publications/implementation_tools_WHO_PEN/en/]
• [11]Peck R, Mghamba J, Vanobberghen F, Kavishe B, Rugarabamu V, Smeeth L et al.. Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey. Lancet Global Health. 2014; 2:e285-92.
• [12]WHO/HAI. Measuring medicine prices, availability, affordability and price components. 2nd Edition. Geneva, Switzerland; 2008 [http://www.haiweb.org/medicineprices/manual/documents.html]
• [13]Ministry of Health and Social Welfare, Tanzania. Tanzania Service Availability and Readiness Assessment (2012). Final report July 2013. [http://www.ihi.or.tz/announ/availabilityandreadinessassessmentresultsannounced]
• [14]O’Neill K, Takane M, Sheffel A, Abou-Zahr C, Boerma T. Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment. Bull World Health Organ. 2013; 91:923-931.
• [15]Madden JM, Meza E, Ewen M, Laing RO, Stephens P, Ross-Degnan D. Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology. Rev Panam Salud Publica. 2010; 27:291-9.
• [16]World Health Organization. WHO’s Leadership Priorities. [http://www.who.int/about/who_reform/change_at_who/leadership_priorities/en/#.VUp0xfmqqko]
• [17]Beran D, Yudkin JS. Looking beyond the issue of access to insulin: what is needed for proper diabetes care in resource poor settings. Diabetes Res Clin Pract. 2010; 88:217-21.
• [18]Adeloye D, Basquill C. Estimating the prevalence and awareness rates of hypertension in Africa: a systematic analysis. PLoS ONE. 2014; 9(8):e104300.
• [19]Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P et al.. Priority actions for the non-communicable disease crisis. Lancet. 2011; 377:1438-47.
• [20]World Health Organization 2014. Access to Medicines. Sixty-seventh World Health Assembly WHA67.22. [http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R22-en.pdf]