New report on price, availability and affordability of medicines for chronic diseases (6)
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Dear all,
It is quite a challenge to try and bring chronic diseases on the agenda when majority of deaths in developing countries is still infectious diseases! As a public health practictioner from a developing country, it is obvious to me that we can gain a lot more mileage dealing with infectious diseases, including respiratory infections, other than the well known HIV/AIDS,Malaria and TB. However,perhaps there is need right now to evaluate whether the attention given to HIV/TB/malaria is bearing fruit.
As a hospital pharmacist, I see the need not to ignore the matter of chronic illness management, as I am faced by these patients every day. However, the reality on the ground is that these patients with a chronic illness are much more likely to die from an infection, than the chronic illness itself.
Of course access to proper treatment and care,for example in Asthma, remains a challenge. In Kenya,we are still grappling with the basics of how to diagnose asthma, particularly in children. Due to the myriad environmental pollutants, we know that asthma is prevalent, but,in real life, how does one differentiate asthma from chronic bronchitis or any other COPD? Is there need to split hairs? Who has peak flow meters in their budgets? Kenya has recently launched guidelines for the diagnosis and management of asthma. We wait to see if practice will change.
When asthma diagnosis in the young is finally made, parental acceptance is still very poor. Once treatment is started, the transfer of knowledge on the various inhaler techniques is still a challenge. In the case of children, there is the added cost of the use of spacers, which are much more expensive than the inhalers themselves. Physicians still prescribe oral salbutamol,long term antihistamines and ephedrine derivatives for asthma management! The use of steroids is gaining ground, albeit slowly as the perceived fear of steroid side effects is huge. Perhaps this is because a lot of steroid use is still oral prednisolone.
Can this area of chronic disease management be dealt with like HIV/AIDs where there is some form of pre and post diagnosis counseling, followed by agressive adherence counseling and support?
I agree however,that any disparities must be dealt with. At the moment, anyone diagnosed with a chronic illness in a developing country is prescribed a death sentence. As a tertiary referral hospital,we are unable to regularly make available anticancers, antidiabetics (except insulin at cost to the patient), and other medicines for chronic illnesses, as we cannot afford them in the government budgets. Patients are often very willing to raise funds and purchase the first course of therapy as they are desparate for a solution, but they soon are unable to continue. Private pharmacies do not regularly stock such expensive medicines as they remain "dead stock". So,in effect,even where individual patients could afford to buy the medicines, they might not get it easily.
The other challenge with chronic disease management is the need for regular diagnostic support for follow up and maintenance of therapy. The diabetic patient needs ability to monitor blood glucose levels regulalry. the hypertensive needs to monitor blood pressure regularly, Peak flow meters for asthma patients etc. These gadgets are costly and are hardly remembered in any budget.
[Thank you Atieno for this important message. Your description of the situation comprises very relevant points to bear in mind. I have worked in countries where donations of medicines would come, but e.g. no diagnostics... As for antibiotics, please visit the HAI database (www.haiweb.org/medicineprices) for data on antibiotics. They are at least as unaffordable! KM, moderator]
Atieno Ojoo, BPharm, MPH
Chief Pharmacist,Kenyatta National Hospital
P O Box 20723
Nairobi,Kenya
Tel 254 (0)20 272 6300 ext 43515
atisojoo@yahoo.co.uk