Assessing access to insulin in Mali, Mozambique and Zambia

Assessing access to insulin in Mali, Mozambique and Zambia

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 Africanchildren are living with type 1 diabetes. Patients with this disease need an ongoingsupply of insulin, syringes and monitoring. They also need access to a healthcare 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 ofquestionnaires and a protocol for gathering other data through site visits,discussions and document reviews. Countries can choose from a range of datacollection tools for their own situation. The researchers implemented theprotocol in three areas in each country: the capital city, a large urban centreand a mainly rural area. The process involved a total of 472 interviews and groupdiscussions.

In each country, RAPIAdelivered information covering:

  • estimates ofdiabetes prevalence and life expectancy in different areas
  • purchaseprocedures, pricing, distribution, supply and availability of insulin andsyringes throughout the country
  • levels ofdiabetes care in different facilities
  • availability andcost of diagnostics
  • levels of healthworker training
  • role andactivities of diabetes associations
  • policiesregarding diabetes
  • role oftraditional healers
  • other barriers to care and insulin, such as travel,distance and cost.

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

  • collectingvaluable information on patients’ access to insulin, syringes, monitoring andcare
  • bringing diabetesto the attention of the health authorities through the involvement of localstakeholders
  • raising theprofile of diabetes associations
  • improving public awareness of diabetes and other non-communicablediseases (NCDs).

Type 1 diabetes may be amarker for effective health care systems. Continuous supplies of drugs,diagnostic facilities, health worker training and retention, and patienteducation are vital in the management of other NCDsand chronic communicable diseases such as tuberculosis and HIV. The researchersconclude that health planners could use this tool to assess the capacity oftheir health system to deal with all chronic conditions.

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