Medicines For Non-communicable Diseases Research Articles

Post-Flood Rapid Needs Assessment in Srinagar City, Jammu and Kashmir State, India, September, 2014.

Torrential rainfall and flooding from September 2-6, 2014 submerged >350 villages in Jammu and Kashmir state. We conducted rapid needs assessment in capital Srinagar from 27 September to 1 October to assess population health and safety needs. Based on Community Assessment for Public Health Emergency Response (CASPER) methodology, we selected 7 households each from 30 census blocks using 2-stage cluster sampling. We collected information on demographics, needs, and illnesses using structured questionnaire. Of the 210 households surveyed, an estimated 57% (CI: 41%-73%) reported significant damage, 50% (CI: 36%-63%) were evacuated, and 16% (CI: 10%-22%) reported injuries. Households lacked electricity (22%; CI: 8.8%-36%), tap water (13%; CI: 5%-21%), working toilets (11%; CI: 4%-19%), and adequate food supply (14%; CI: 8%-20%). Moreover, 55% (CI: 45%-64%) of households reported cough, cold, fever, rashes, or diarrhea; 68% (CI: 59%-77%) experienced agitation, anxiety, depression, or nightmares since the flooding. Of the households with a member on medicines for non-communicable diseases, 40% did not have a week's supply. Restoring basic essentials (30%; CI: 22%-37%) and repairing houses (30%; CI: 19%-40%) were the most urgent needs expressed. Floods damaged >1/2 of households in Srinagar, disrupting basic essentials, and causing mental trauma. These findings helped authorities prioritize assistance with psychological symptoms and availability of prescription medicines. (Disaster Med Public Health Preparedness. 2019;13:133-137).

Prescribing and dispensing practices for medicines used to treat non-communicable diseases in Uganda: a cross-sectional study

Abstract Background Non-communicable diseases (NCDs) are increasingly prevalent in low-income and middle-income countries (LMIC) and accessibility of medicines is essential for the management of these conditions. In Uganda, although many NCD medicines are now included in the national essential medicines list, sporadic evidence suggests that these medicines are widely unavailable to patients. The prescribing patterns of NCD medicines by providers and the dispensing patterns by dispensers represent important knowledge gaps in efforts to understand the care cascade for NCDs in Uganda. We aimed to describe the prescribing and dispensing practices for medicines used to treat NCDs, particularly hypertension, diabetes, and heart failure in Ugandan health-care facilities. Methods Based on WHO methodology, we did a cross-sectional study in which systematic sampling was used to collect data from patients attending outpatient NCD clinics at 15 higher-level public health-care facilities throughout Uganda. Demographic, prescribing, and dispensing information were collected using pre-tested structured questionnaires. Prescribing information was recorded from prescriptions, and dispensing information was obtained from medicine packets. Medicine tablets were counted by data collectors. Patients who reported not receiving all of their prescribed doses were contacted by phone to determine if they obtained the non-dispensed doses elsewhere. The primary outcome, which we term the Prescribing-Dispensing (P-D) Gap, was the percentage of prescribed doses that were not dispensed. Associations were tested using a linear mixed model. Findings We analysed data from 477 participants, of whom 454 (71%) were women. The average age was 51·4 years (SD 13·5). The mean number of drugs prescribed per encounter was 2·5 (SD 1·1), of which only 1·4 (0·9) drugs were dispensed. Overall, 82 591 total doses were prescribed, and 35 290·5 doses were dispensed, resulting in a P-D Gap of 57·3%. The P-D Gap was smaller for diabetes medicines than for medicines for cardiovascular diseases (46·2% vs 67·5%; p Interpretation A large P-D Gap exists for medicines used to treat NCDs in Ugandan public health-care facilities. The P-D Gap differs by medicine class and appears to be driven by medicine availability at public sector pharmacies. Most patients do not close this gap by purchasing medicines at private pharmacies, suggesting that under-treatment of these chronic conditions is widespread in patients who are already linked to care. Future work should explore feasible approaches to decrease this P-D Gap. Funding Doris Duke Clinical Research Fellowship.

A novel initiative to improve access to medicines for control of non-communicable diseases in low-and middle- income countries

The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and treatment strategies remain limited, especially for those in low- and middle-income countries (LMICs). Novel approaches are needed to improve access and affordability of medicines that can treat NCDs in LMICs. An integrated approach including differential pricing, health systems strengthening, improved supply chain management and greater affordability can improve access to innovative branded medicines for NCDs. While differential pricing has several advantages for improving the affordability of NCD medicines in LMICs, it can’t overcome all access barriers as a standalone approach. An integrated approach to health systems strengthening, supply chain management and affordability are needed to overcome key challenges in getting medicines for NCD to patients in LMICs. The Access and Affordability Initiative (AAI) is a public private partnership aiming to improve access to and availability of essential medicines for the treatment of NCDs and strengthening of health systems. Through this novel initiative a prospective cohort of patients with hypertension and diabetes were followed in Ghana and the Philippines to examine the effect of differential pricing on access to treatment of hypertension and diabetes.

Access to diabetes medicines at the household level in eight counties of Kenya

Background: In 2016, an estimated 872,000 Kenyans were living with diabetes, a country average of 4%. The study objectives were (1) to describe the sociodemographic and geographic characteristics of the households with individuals diagnosed and on treatment for diabetes (2) to describe the medicines available at the household level, monthly household expenditure on medicines, location of diagnosis and treatment and the associated factors of medicines purchase location. Methods: A household survey in eight countries was conducted asking whether a household member had been diagnosed and treated for a non-communicable disease (NCD). Households with at least one member with diabetes were included in this study. Results: Out of the 142 individuals being diagnosed and treated for diabetes, 68 participants (47.9%) were prescribed single and 74 (52.1%) multiple treatments. While 54.9% of the participants were diagnosed at public hospitals, 50% of individuals purchased their medicines from a private pharmacy/chemist or private hospitals. Purchase of medicines in public facilities was associated with being less wealthy and having more than one NCD. Having medicines not available at home was reported by 26.1% of individuals, mostly because the medicines were too expensive to buy. Conclusions: Affordability of diabetes medicines remains an important barrier to access. In addition, essential medicine list restrictions to offer diabetes medicines at public primary care level limit access. Programs to increase access to NCD medicines need to consider that diagnosis and choice of treatment occurs largely in the public sector whereas medicines purchase most frequently takes place in the private sector.

Impact of economic sanctions on access to noncommunicable diseases medicines in the Islamic Republic of Iran

It has been argued that economic sanctions and the economic crisis have adversely affected access to drugs. To assess the impact of economic sanctions on the Iranian banking system in 2011 and Central Bank in 2012 on access to and use of drugs for noncommunicable diseases (NCDs). An interrupted time series study assessed the effects of sanctions on drugs for diabetes (5 drug groups), asthma (5 drug groups), cancer (14 drugs) and multiple sclerosis (2 drugs). We extracted data from national reference databases on the list of drugs on the Iranian pharmaceutical market before 2011 for each selected NCD and their monthly sales. For cancer drugs, we used stratified random sampling by volume and value of sales, and source of supply (domestic or imported). Data were analysed monthly from 2008 to 2013. Market availability of 13 of 26 drugs was significantly reduced. Ten other drugs showed nonsignificant reductions in their market availability. Interferon α2b usage reduced from 0.014 defined daily doses per 1000 inhabitants per day (DID) in 2010 to 0.008 in 2013; and cytarabine from 1.40 mg per 1000 population per day in 2010 to 0.96 in 2013. Selective β2-adrenoreceptor agonists usage reduced from 8.4 to 6.8 DID in the same time period. There is strong evidence that sanctions have had a negative effect on access to drugs, particularly those that depended on the import of their raw material or finished products.

Survey on the availability, price and affordability of selected essential medicines for non-communicable diseases in community pharmacies of Kathmandu valley

Background:The access to essential medicines for non-communicable disease treatment is unacceptably low worldwide. The fundamental right to health cannot be fulfilled without equitable access to essential medicines.Methodology:A cross-sectional study was carried out in 94 community pharmacies of Kathmandu valley. Non-probability quota sampling method was adopted for the purpose. Village Development Committees with more than 5000 populations were included in the study. The availability of the selected essential medicines, their price and producer identity were observed. Data entry and analysis were carried out in Microsoft Excel and Statistical package for social science.Result:The availability of the essential medicines was not 100% in Kathmandu valley. High competition and high price variation were seen in metformin 500 mg (254.6%) and atorvastatin 10 mg (327.6%). The study showed that maximum (54.7%) brands were manufactured in Nepal. Furthermore, atorvastatin 10 mg (0.6 day wage) was found to be quite expensive, and glibenclamide 5 mg (0.1 day wage) was the cheapest one for diabetes mellitus treatment for 1 month of treatment period compared to daily wages of other essential medicines.Conclusion:The availability of the selected essential medicines was found to be ununiform and insufficient in the entire region. High competition was observed in the products with high price variation, and the access to cost-effective brand was poor. Furthermore, it was found that government salary is affordable to treat non-communicable disease with the help of the essential medicines.

Baseline assessment of WHO's target for both availability and affordability of essential medicines to treat non-communicable diseases.

BackgroundWHO has set a voluntary target of 80% availability of affordable essential medicines, including generics, to treat major non-communicable diseases (NCDs), in the public and private sectors of countries by 2025. We undertook a secondary analysis of data from 30 surveys in low- and middle-income countries, conducted from 2008–2015 using the World Health Organization (WHO)/Health Action International (HAI) medicine availability and price survey methodology, to establish a baseline for this target.MethodsData for 49 medicines (lowest priced generics and originator brands) to treat cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary diseases (COPD) and central nervous system (CNS) conditions were analysed to determine their availability in healthcare facilities and pharmacies, their affordability for those on low incomes (based on median patient prices of each medicine), and the percentage of medicines that were both available and affordable. Affordability was expressed as the number of days’ wages of the lowest-paid unskilled government worker needed to purchase 30 days’ supply using standard treatment regimens. Paying more than 1 days’ wages was considered unaffordable.FindingsIn low-income countries, 15.2% and 18.9% of lowest-priced generics met WHO’s target in the public and private sectors, respectively, and 2.6% and 5.2% of originator brands. In lower-middle income countries, 23.8% and 23.2% of lowest priced generics, and 0.8% and 1.4% of originator brands, met the target in the public and private sectors, respectively. In upper-middle income countries, the situation was better for generics but still suboptimal as 36.0% and 39.4% met the target in public and private sectors, respectively. For originator brands in upper-middle income countries, none reached the target in the public sector and 13.7% in the private sector. Across the therapeutic groups for lowest priced generics, CVD medicines in low-income countries (11.9%), and CNS medicines in lower-middle (10.2%) and upper-middle income countries (33.3%), were least available and affordable in the public sector. In the private sector for lowest priced generics, CNS medicines were least available and affordable in all three country income groups (11.4%, 5.8% and 29.3% in low-, lower-middle and upper-middle income countries respectively).InterpretationThis data, which can act as a baseline for the WHO target, shows low availability and/or poor affordability is resulting in few essential NCD medicines meeting the target in low- and middle-income countries. In the era of Sustainable Development Goals, and as countries work to achieve Universal Health Coverage, increased commitments are needed by governments to improve the situation through the development of evidence-informed, nationally-contextualised interventions, with regular monitoring of NCD medicine availability, patient prices and affordability.

Study protocol for a cluster-randomised controlled trial of an NCD access to medicines initiative: evaluation of Novartis Access in Kenya

IntroductionNovartis recently launched Novartis Access, an initiative to provide a basket of reduced price medicines for non-communicable diseases (NCDs) to be sold through the public and private non-profit sectors in...

Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design.

BackgroundIndia has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres. In this study, we aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases.MethodsThis study aims to understand if (and how) a package of interventions targeting primary health centres and community participation platforms affect utilisation and access to generic medicines for people with non-communicable diseases in the current district context in India. This study will employ a quasi-experimental design and a qualitative theory-driven approach. PHCs will be randomly assigned to one of three arms of the intervention. In one arm, PHCs will receive inputs to optimise service delivery for non-communicable diseases, while the second arm will receive an additional package of interventions to strengthen community participation platforms for improving non-communicable disease care. The third arm will be the control. We will conduct household and facility surveys, before and after the intervention and will estimate the effect of the intervention by difference-in-difference analysis. Sample size for measuring effects was calculated based on obtaining at least 30 households for each primary health centre spread across three distance-based clusters. Primary outcomes include availability and utilisation of medicines at primary health centres and out-of-pocket expenditure for medicines by non-communicable disease households. Focus group discussions with patients and in-depth interviews with health workers will also be conducted. Qualitative and process documentation data will be used to explain how the intervention could have worked.DiscussionBy taking into consideration several health system building blocks and trying to understand how they interact, our study aims to generate evidence for health planners on how to optimise health services to improve access to medicines.Trial registrationProtocol registered on Clinical Trials Registry of India with registration identifier number CTRI/2015/03/005640 on 17th March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1680-3) contains supplementary material, which is available to authorized users.

World Health Organization.

World Health Organization.

Opportunities and Challenges of Indian Pharmaceutical Sector: An overview

The global pharmaceutical market size is estimated to reach USD 1.4 trillion and the Indian pharmaceutical market size is estimated as USD 55 billion by the year 2020. The Indian pharmaceutical sector is expected to grow with faster compound annual growth rate (CAGR) compared to global growth rate during the period 2015-2020. The world market will be dominated by countries like USA, EU and Japan and the contribution of Phrmerging countries is expected to be more in coming years. The future of the world pharmaceutical sector will be dominated by medicines for non communicable diseases and original branded medicines. The Indian pharmaceutical sector evolved in different phases from pre independence era to post Trade-Related Aspects of Intellectual Property Rights (TRIPS). Presently, Indian pharmaceutical sector is dominated by the generics drugs and more drugs are sold in anti-infective category. The Indian pharmaceutical industry is having opportunities in the domestic market with growing demand for quality health care. More opportunities are seen in the area of Contract Research and Manufacturing Services (CRAMS) by Mergers and Acquisitions (M&A) and Biogenic market. The government of India has taken measures to boost pharmaceutical sector, even though, the pharmaceutical sector is facing challenges in patent rights and methods used for fixing ceiling price for drugs. More challenges are expected due to immature clinical trial regulations and ethical aspects.

National drug policy reform for noncommunicable diseases in low-resource countries: an example from Bangladesh.

In recent years, the incidence of cardiovascular diseases, diabetes, cancers and chronic respiratory diseases has increased in epidemic proportions in many low-resource countries, including Bangladesh. (1) Noncommunicable diseases accounted for an estimated 38 of 56 million deaths worldwide in 2012. Yet most of the deaths (74%, 28 million) occurred in low- and middle-income countries, where access to essential medicines to prevent and treat these diseases remains low. (2,3) The Global Burden of Disease study projected that noncommunicable diseases will be the leading global cause of disability by 2030. (4) Lack of access to essential medicines for noncommunicable diseases is a major challenge for the health systems in many low-resource countries, potentially contributing to increased mortality and morbidity in these countries. (5) The World Health Organization (WHO) has recommended that every country should have a national drug policy that ensures access, quality and rational use of medicines as an integral p art of its broader strategic health-care policy. (6) It has also recommended that noncommunicable diseases be incorporated into the strategic plans of national drug policies. (7) The WHO Model list of essential medicines contains 95 basic medicines for most noncommunicable diseases, including 16 new medicines for cancer that were added in May 2015. (8) Despite the wide adoption of national drug policies in low- and middle-income countries, the majority of these do not include essential medicines for noncommunicable diseases. Bangladesh is one of the pioneer countries to develop a national drug policy, launching its first in 1982. Based on the WHO essential medicines concept, the national drug policy identified 150 essential drugs for controlled pricing. The policy was instrumental in improving the supply and accessibility of quality essential drugs at an affordable price. (9) However, during the 1980s and 1990s in Bangladesh the quality assurance of medicines started to be neglected, the price of local medicines increased and there was a shift in production from essential medicines to more profitable unregulated medicines by the major pharmaceutical industries. Despite being one of the world's poorest countries, Bangladesh has made great progress over the last few decades in reducing maternal and child mortality, decreasing the burden of communicable diseases and improving life expectancy. (10) In 2011, the Government of Bangladesh adopted a new national health policy, incorporating a strategic plan for the surveillance and prevention of noncommunicable diseases, along with a plan for the provision of essential drugs for these diseases. (10) However, these policy documents did not mention specific medicines for noncommunicable diseases or requirements for their availability, price, quality assurance or rational use. Many issues prevented the optimal implementation of the essential drugs and noncommunicable diseases' policies in Bangladesh: lack of specific financial resources; lack of leadership and accountability; insufficient planning and forecasting; inefficient procurement; coordination and monitoring; and other competing priorities. However, several countries have undertaken initiatives to promote access to medicines for these diseases. For example, the Brazilian government, through its popular pharmacy programme, partnered with private pharmacies to market subsidized medicines for noncommunicable diseases, a scheme that can be replicated in other countries. (11) Most noncommunicable diseases can be treated or managed with a small range of low-cost generic medicines such as anti-hypertensives, statins and other cardiovascular drugs, analgesics, anti-asthmatics and some common anti-cancer drugs. (2) However, many of the essential medicines for diabetes in Bangladesh are too expensive for the general population or are not available in government facilities. (12) A study in 2016 found that for patients with diabetes the cost of drugs accounted for the largest share of their total healthcare expenditure. …

Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova.

Background: To assess progress in improving affordability of medicines since the introduction of mandatory health insurance in the Republic of Moldova.Method: Using data from national health insurance, we estimate affordability of partially reimbursed medicines for the treatment of non-communicable diseases, and analyse which factors contributed to changes in affordability.Results: Affordability of subsidized medicines improved over time. In 2013, it took a median of 0.84 days of income for the lowest income quintile (ranging from 0 to 3.32 days) to purchase 1 month of treatment for cardiovascular conditions in comparison to 1.85 days in 2006. This improvement however was mainly driven by higher incomes rather than deeper coverage through the reimbursement list.Conclusion: If mandatory health insurance is to improve affordability of medicines for the Moldovan population, more funds need to be (re-)allocated to enable higher percentage coverage of essential medicines and efficiencies need to be generated within the health system. These should include a budget reallocation between secondary and primary care, strengthening primary care to manage chronic conditions and raise population awareness, implementation of evidence-based selection and quality use of medicines in both outpatient and inpatient settings, improving monitoring and regulation of prices and the supply chain; and alignment of national treatment guidelines and clinical practice with international best practices and evidence-based medicine.

Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes.

BackgroundNon-communicable diseases (NCD) pose challenges to Cambodia’s health system. Medicines for NCD are on the National Essential Medicines List but no clinical guidelines support their utilization. Two social health protection schemes aimed at the informal sector population exist (Health Equity Funds and Insurance) together with two disease-specific interventions (a Peer Educator Network and Chronic Diseases Clinics) targeted at NCD patients. This study examines performance of these various schemes in relation to NCD.MethodsCross-sectional household survey among 709 individuals self-reporting diabetes and/or hypertension in three geographical locations in rural Cambodia using a structured questionnaire investigating diagnostic and treatment pathways, health seeking behaviour, health expenditures, and financial coping mechanisms.ResultsTwo third of respondents with NCD were female and 55% did not belong to any scheme. The majority (59%) were diagnosed in the private sector and only 56% were on allopathic treatment that was mainly sought in the private sector (49%). Outpatient treatment cost was higher in the private sector and when using multiple providers of care. The majority were indebted, 11% due to health-related expenses. Contrary to social health protection schemes, disease-specific interventions offered better access to allopathic treatment and provided medicines in accordance with NEML.ConclusionThe benefit packages of existing social health protection schemes and services in the public health sector should be adjusted to cater for the needs of people living with NCD in rural Cambodia. Initiatives that offer active disease management strategies and promote patients and community participation appear more successful in increasing treatment adherence and decreasing the risk of financial hardship.

Access to medicines for chronic diseases in Brazil: a multidimensional approach.

ABSTRACTOBJECTIVE To analyze the access to medicines to treat non-communicable diseases in Brazil according to socioeconomic, demographic, and health-related factors, from a multidimensional perspective.METHODS Analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), household survey, sampling plan by conglomerates with representativeness of the Brazilian population and large areas of the country, according to sex and age domains. Data collected in 2013–2014 with sample of adults (≥ 20 years) who reported having non-communicable diseases and medical indication for use of medicines (n = 12,725). We assessed the prevalence of access to medicines for self-reported non-communicable diseases, considering four dimensions: availability, geographic accessibility, acceptability, and affordability. We applied Pearson’s Chi-square test to assess the statistical significance of the differences between strata, considering the level of significance of 5%. We found prevalence of 94.3%, 5.2%, and 0.5% for full, partial, and null access, respectively. Higher prevalence was observed among seniors in the South compared to the Northeast; for those who reported having one non-communicable disease compared to those who reported having two or more; for those who needed one medicine compared to those who needed three or more; and for those who self-assessed their health as good or very good. Geographic accessibility was similar in the Unified Health System and in the private pharmacies (72.0%). Total availability of medicines was 45.2% in the Unified Health System, 67.4% in the Popular Pharmacy Program, and 88.5% in private pharmacies. Acceptability was 92.5% in the Unified Health System, 97.8% in the Popular Pharmacy Program, and 98.7% in private pharmacies. As to affordability, 2.6% of the individuals failed to take the medicines they should in the 30-day period prior to the interview due to financial difficulty. Prevalence of full access to medicines for non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed.

QandA: Increasing global access to medicines for non-communicable diseases

QandA: Increasing global access to medicines for non-communicable diseases

Polypill: Progress and Challenges to Global Use--Update on the Trials and Policy Implementation.

Cardiovascular disease (CVD) is the leading cause of mortality globally. Most people with cardiovascular disease do not take long-term cholesterol-lowering, anti-platelet and blood pressure-lowering medications despite proven benefits. Fixed-dose combination pills ('polypills') have been shown to improve adherence to these recommended medications with corresponding improvements in risk factors such as blood pressure and low-density lipoprotein (LDL) cholesterol. Among patients not taking the full complement of recommended CVD preventive therapies, use of a polypill-based strategy (i.e. initiating treatment with single-pill combination medication then titrating further therapy as needed) has large potential benefits in reducing global morbidity and mortality. Despite this, few polypills are available on the market due to market failure in the funding of research and development for affordable non-communicable disease medicines. Additionally, defining a path to market has been problematic in that fixed-dose combinations with multiple different drug classes included are quite novel, and regulatory processes to review these types of applications are not well established. Despite these delays, progress is slowly being made.

Medicines availability at a Swaziland hospital and impact on patients.

BackgroundThe burden of non-communicable diseases (NCDs) in low- and middle-income countries is increasing. Where patients are expected to make increased out-of-pocket payments this can lead to treatment interruptions or non-adherence. Swaziland is no exception in this regard.AimThe aim of the study was to investigate the availability of medicines for NCDs in a hospital and the impact of out-of-pocket spending by patients for medicines not available at the hospital.SettingThe study was conducted at Raleigh Fitkin Memorial Hospital in Manzini, Swaziland.MethodsExit interviews to assess availability of a selected basket of medicines were conducted with 300 patients diagnosed with diabetes, hypertension or asthma. The stock status record of a basket of medicines for these conditions in 2012 was assessed at the Central Medical Stores. Results were analysed using the Statistical Package for Social Sciences version 20.0.ResultsMost of the patients (n = 213; 71%) confirmed not receiving all of their prescribed medicines at each visit to the hospital in the past six months. On average patients spent 10–50 times more on their medicines at private pharmacies compared to user fees in the health facility. Stock-outs at the Central Medical Stores ranging from 30 days to over 180 days were recorded during the course of the assessment period (12 months), and were found to contribute to inconsistent availability of medicines in the health facility.ConclusionOut-of-pocket expenditure is common for patients with chronic conditions using this health facility, which suggests the possibility of patients defaulting on treatment due to lack of affordability.

Overcoming Obstacles To Enable Access To Medicines For Noncommunicable Diseases In Poor Countries.

The modern access-to-medicines movement grew largely out of the civil-society reaction to the HIV/AIDS pandemic three decades ago. While the movement was successful with regard to HIV/AIDS medications, the increasingly urgent challenge to address access to medicines for noncommunicable diseases has lagged behind-and, in some cases, has been forgotten. In this article we first ask what causes the access gap with respect to lifesaving essential noncommunicable disease medicines and then what can be done to close the gap. Using the example of the push for access to antiretrovirals for HIV/AIDS patients for comparison, we highlight the problems of inadequate global financing and procurement for noncommunicable disease medications, intellectual property barriers and concerns raised by the pharmaceutical industry, and challenges to building stronger civil-society organizations and a patient and humanitarian response from the bottom up to demand treatment. We provide targeted policy recommendations, specific to the public sector, the private sector, and civil society, with the goal of improving access to noncommunicable disease medications globally.

Access to and quality use of non-communicable diseases medicines in Nepal.

Noncommunicable diseases are a major healthcare problem in Nepal and their burden is increasingevery year. Noncommunicable diseases (NCDs) bring additional challenges to the Nepalese healthcaresystem which is already experiencing infrastructure shortages, poor service delivery, inadequate essential medicines coverage and shortages of healthcare workers. The Nepal government provides a limited number of free essential medicines through the free essential healthcare services program. This consists of a basic healthcare package provided through primary healthcare (PHC) facilities and district hospitals. Though around 40 essential medicines are provided without charge, studies have reported problems with access especially in all rural areas. There is a need to improve access to, coverage and quality use of medicines. The government has decided to provide some free medicines for NCDs alongside free essential medicines to be distributed via current healthcare structures. Though well intended, this decision will put extra strain on the essential medicines program. It should be supplemented by a comprehensive NCDs policy that takes account of the issues of sustainability and quality use of medicines. Complex cases of NCDs will be managed by tertiary hospitals but most of the cases of NCDs especially for rural people and the poor will end up in secondary level public hospitals (district and zonal hospitals). Therefore, the government needs to strengthen these public hospitals. Meanwhile, given the severity of the NCDs problem in Nepal, the Ministry of Health and Population (MoHP) should liaise with nongovernmental and missionary hospitals especially in rural areas to run NCDs management services. The Ministry should encourage these hospitals to run hospital pharmacies to improve people’s access to and quality use of NCDs medicines. At the primary healthcare level, the Ministry could run NCDs prevention and control programs but existing PHC workers need training to perform proper dispensing of NCDs medicines. PHC facilities need a medical record system so that they can address the needs of NCDs patients requiring long term medication supply via a proximate PHC facility.