Please note - this article was originally published on the id21 website which has now closed. This and other articles produced by id21 were archived by Eldis in 2009 and are not actively maintained. If you find links and references which are no longer valid please email eldis@ids.ac.uk.

Assessing access to insulin in Mali, Mozambique and Zambia

Insulin treatment is essential for the survival of people with Type 1 diabetes. But uninterrupted insulin supplies are not available in many developing countries. Researchers from University College London, UK tested a Rapid Assessment Protocol for Insulin Access (RAPIA) in Mali, Mozambique and Zambia to identify barriers to good diabetes care.

An estimated 35,100 African children are living with type 1 diabetes. Patients with this disease need an ongoing supply of insulin, syringes and monitoring. They also need access to a health care system staffed by trained health workers able to provide these supplies. The RAPIA aims to assess all these factors through a protocol that is rapid, cost-effective, uses multiple data sources, and is practical rather than scientifically perfect.

RAPIA consists of a series of questionnaires and a protocol for gathering other data through site visits, discussions and document reviews. Countries can choose from a range of data collection tools for their own situation. The researchers implemented the protocol in three areas in each country: the capital city, a large urban centre and a mainly rural area. The process involved a total of 472 interviews and group discussions.

In each country, RAPIA delivered information covering:

estimates of diabetes prevalence and life expectancy in different areas
purchase procedures, pricing, distribution, supply and availability of insulin and syringes throughout the country
levels of diabetes care in different facilities
availability and cost of diagnostics
levels of health worker training
role and activities of diabetes associations
policies regarding diabetes
role of traditional healers
other barriers to care and insulin, such as travel, distance and cost.

The protocol was developed to help make recommendations to national ministries of health and diabetes associations. The researchers report other benefits from its use, including:

collecting valuable information on patients’ access to insulin, syringes, monitoring and care
bringing diabetes to the attention of the health authorities through the involvement of local stakeholders
raising the profile of diabetes associations
improving public awareness of diabetes and other non-communicable diseases (NCDs).

Type 1 diabetes may be a marker for effective health care systems. Continuous supplies of drugs, diagnostic facilities, health worker training and retention, and patient education are vital in the management of other NCDs and chronic communicable diseases such as tuberculosis and HIV. The researchers conclude that health planners could use this tool to assess the capacity of their health system to deal with all chronic conditions.

Source(s):
‘Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a ‘Rapid Assessment Protocol for Insulin Access’’, BMC Health Services Research 6(17), by David Beran, John Yudkin and Maximilian de Courten, 2006 Full document.

Funded by: World Diabetes Foundation, Diabetes Foundation UK, World Health Organization

id21 Research Highlight: 3 November 2006

Further Information:
David Beran
International Insulin Foundation
International Health and Medical Education Centre
University College London
Holborn Union Building
Archway Campus
2-10 Highgate Hill
London N19 5LW
UK

Contact the contributor: david.beran@access2insulin.org

International Insulin Foundation, International Health and Medical Education Centre, University College London, UK

Views expressed on these pages are not necessarily those of DfID, IDS, id21 or other contributing institutions. Articles featured on the id21 site may be copied or quoted without restriction provided id21 and originating author(s) and institution(s) are acknowledged. Copyright © 2009 IDS. All rights reserved.

id21 is funded by the UK Department for International Development. id21 is one of a family of knowledge services at the Institute of Development Studies at the University of Sussex. id21 is a www.oneworld.net partner and an affiliate of www.mediachannel.org. IDS is a charitable company, No. 877338.