E-DRUG: Papers on Health System Capacity and Access Barriers to CVD and Diabetes care in Nepal and in India (Kerala state)
----------------------------------------------------------------------------
Dear E-Drug Community
I hope you and yours are doing well - esp. those based in regions that
currently remain hard hit by the infections.
We recently published findings of our assessment of "Health System Capacity
and Access Barriers to Diagnosis and Treatment of CVD and Diabetes in
Nepal" in the journal Global Heart. In this nationally-representative
mixed-methods study, we evaluated the various dimensions of access (e.g.,
availability, affordability, adoption and accessibility) through facility
surveys, review of relevant literature & policy documents, and
health-facility exit interviews among patients. Pasted below is the
abstract, and you can access the full text here:
https://globalheartjournal.com/articles/10.5334/gh.927/
ALSO, sharing another paper on "Availability, price and affordability of
essential medicines for managing cardiovascular diseases and diabetes: a
statewide survey in Kerala, India" that we published in *Tropical Medicine
& International Heath*. In this study, we also provide baseline
availability and price data for the four anti-hypertensive FDCs that were
recently (2019) included in WHO Model EML. The paper is not open access, so
please feel free to email any of the authors for a full text pdf.
https://onlinelibrary.wiley.com/doi/10.1111/tmi.13494
Sharma A, Kaplan WA, Satheesh G, Poudyal IP, Gyawali P, Neupane D, et al..
Health System Capacity and Access Barriers to Diagnosis and Treatment of
CVD and Diabetes in Nepal. Global Heart. 2021;16(1):38. DOI:
http://doi.org/10.5334/gh.927
Abstract
Background: Universal access to essential medicines and routine
diagnostics is required to combat the growing burden of cardiovascular
disease (CVD) and diabetes. Evaluating health systems and various access
dimensions - availability, affordability, accessibility, acceptability, and quality is crucial - yet rarely performed, especially in low- and
middle-income countries.
Objective: To evaluate health system capacity and barriers in accessing
diagnostics and essential medicines for CVD and diabetes in Nepal.
*Methods: We conducted a WHO/HAI nationally-representative survey in 45
health-facilities (public sector: 11; private sector: 34) in Nepal to
collect availability and price data for 21 essential medicines for treating
CVD and diabetes, during May - July 2017. Data for 13 routine diagnostics
were obtained in 12 health facilities. Medicines were considered
unaffordable if the lowest paid worker spends >1 day's wage to purchase a
monthly supply. To evaluate accessibility, we conducted facility exit
interviews among 636 CVD patients. Accessibility (e.g., private-public
health facility mix, travel to hospital/pharmacy) and acceptability (i.e.
Nepal's adoption of WHO Essential Medicine List, and patient medication
adherence) were summarized using descriptive statistics, and we conducted a
systematic review of relevant literature. We did not evaluate medicine
quality.
Results: We found that mean availability of generic medicines is low
(<50%) in both public and private sectors, and less than one-third
medicines met WHO’s availability target (80%). Mean (SD) availability of
diagnostics was 73.1% (26.8%). Essential medicines appear locally
unaffordable. On average, the lowest-paid worker would spend 1.03 (public
sector) and 1.26 (private sector) days wages to purchase a monthly
medicine supply. For a person undergoing CVD secondary-prevention
interventions in the private sector, the associated expenditure would be
7.5 - 11.2% of monthly household income. Exit interviews suggest that a
long/expensive commute to health facilities and poor medicine affordability
constrain access.
Conclusions: This study highlights critical gaps in Nepal's health system
capacity to offer basic health services to CVD and diabetes patients, owing
to low availability and poor affordability and accessibility. Research and
policy initiatives are needed to ensure uninterrupted supply of affordable
essential medicines and diagnostics.
Best regards,
Abhishek (on behalf of co-authors)
Adjunct Researcher
Department of Global Health
Boston University School of Public Health
801 Massachusetts Ave, 3rd floor, Boston, MA, USA
abhishek sharma <abhisheksharma0991@gmail.com>