Abstract
Background:To reduce the non-communicable diseases (NCDs) burden, the World Health Organization has set a target to reach 80% availability of the affordable essential medicines required to treat NCDs by 2025.Objectives:This study described the availability, costs, and stock-outs of essential NCD drugs in three rural Rwandan districts.Methods:We retrospectively assessed 54 NCD drugs listed for district hospitals or health centers in the Rwanda national essential medicines list. Data were collected from three district hospitals and 17 health centers that host NCD clinics. We extracted data on drug availability, quantity dispensed, costs, stock-outs, and the replenishing supplier for these drugs between January 1 and December 31, 2017.Results:Overall, 71% of essential medicines for health centers and 78% of essential medicines for district hospitals were available at facilities. Only 15% of health centers experienced a stock-out of beclomethasone, while 77% experienced at least one stock-out of amlodipine and metformin. The median length of stock-out ranged from nine to 72 days, and 78% of the stock-outs across all health centers were replenished by a Non-Governmental Organization (NGO) partner. Except for enoxaparin and metformin, all district hospitals experienced at least one stock-out of each drug. The median length of stock-out ranged from 3.5 to 228 days, and 82% of the stock-outs across all district hospitals were replenished by the Rwandan Ministry of Health (RMOH). The least expensive drug was digoxin ($0.02, Interquartile range (IQR): 0.01, 0.10), while the most expensive was beclomethasone ($9.35, IQR: 3.00, 13.20).Conclusions:This study shows the viability of drug-supported NCD care in rural settings of sub-Saharan Africa. Stock-outs are a challenge; our study emphasizes the importance of the MOH/NGO partnerships in this context. Medicine costs are also challenging, though, in these districts, drugs are more affordable through community-based health insurance, government, and NGO partner subsidies.
Highlights
Non-communicable diseases (NCDs), including cardiovascular, diabetes, and chronic respiratory diseases, are an increasing global health burden
Study Setting and Intervention This study was conducted in three rural Rwandan district hospitals – Butaro, located in the Northern Province and Kirehe and Rwinkwavu, located in the Eastern Province – and the 17 out of 28 surrounding health centers that have non-communicable diseases (NCDs) programs supported by Partners In Health/Inshuti Mu Buzima (PIH/IMB)
Of the 21 drugs that were on the Rwanda national essential medicines list for health centers, 15 (71.4%) drugs were ever available at any of the 17 health centers in 2017, including nine (81.8%) cardiovascular drugs, two (33.3%) diabetes drugs and four (100.0%) asthma drugs
Summary
Non-communicable diseases (NCDs), including cardiovascular, diabetes, and chronic respiratory diseases, are an increasing global health burden. Medical School, Boston, US ‖ Department of Public Health Sciences, Karolinska Institutet, ence the largest relative increase in the population living with NCDs, with NCDs taking over as the leading cause of death [4] Without adequate intervention, the increasing NCD burden will cause additional constraints to health systems that are notably already overstretched and fragile [5] This fragility is even more pronounced in rural areas where poor case detection, access to care, and documentation of NCDs has led to frequent under-estimation and under-prioritization of the endemic burden of NCDs. Despite the increasing NCD burden, most people in LMICs have poor availability and access to the NCD medicines that are crucial for prevention and treatment [6, 7]. Medicine costs are challenging, though, in these districts, drugs are more affordable through community-based health insurance, government, and NGO partner subsidies
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