The burden of diabetes is increasing globally. There are approximately half a billion people around the world living with the disease. In sub-Saharan Africa, 23 million people suffered from diabetes in 2021. This number is expected to increase to 33 million by 2030 and 55 million by 2045.
Currently there is no cure for diabetes. But it can be controlled using medication, diet, and lifestyle modification.
As part of its 2013-2020 Global Action Plan, the World Health Organization has set targets for the prevention and control of noncommunicable diseases. He said essential drugs and basic technologies should be at least 80% available in public or private health facilities. For diabetes, these drugs include insulin and oral agents that lower blood sugar. There should also be drugs like aspirin and statins that lower the risk of heart related diseases. The technology includes glucometers (to test blood sugar) and test strips for urine protein and ketones.
Out of reach
Sub-Saharan Africa faces the double burden of communicable and non-communicable diseases that strain countries’ health resources and fragile health systems. Access to essential medicines and diagnostic tests remains a challenge in the region. Public health facilities face frequent drug shortages, and patients often pay for the drugs themselves.
Insulin and oral diabetes medications are generally not available at the recommended level in the area. A recent study in 13 low- and middle-income countries (including countries in sub-Saharan Africa) found 55-80% insulin availability in health facilities that should have had it. A previous survey had shown 0% availability of insulin in health facilities in Benin and Eritrea. The trend is similar with blood sugar, urine protein, and ketone tests.
The monthly dose of the cheapest generic drugs, metformin and glibenclamide, costs around two days’ wages in sub-Saharan Africa. This is based on the salary of the lowest paid official.
The cost is even higher for new generation agents. For example, glimepiride costs the equivalent of three days’ wages in Uganda. Short-acting and intermediate-acting insulin costs around five days ‘wages in Uganda and four days’ wages in Cameroon. Various tests also cost a few days’ wages in Uganda and Cameroon.
Some brands of insulin cost significantly more. For example, the innovative brand of intermediate-acting insulin costs around 20 salary days in Malawi and premixed insulin costs 19 salary days in Cameroon.
How to improve access?
There are several ways to improve access to affordable medicines. These include increasing funding for drugs by governments and international organizations. The legislation could encourage the entry of generics into the market. Generic drugs need to be properly priced and subsidized so that patients do not have to pay the full price. The selection and use of drugs requires care. And robust electronic surveillance systems would minimize stockouts.
Responsibility for making changes lies with governments, local and international nongovernmental organizations, pharmaceutical companies and health workers.
Some global biopharmaceutical companies have initiatives targeting low- and middle-income countries. One example is the Novartis Access program, currently underway in Kenya, Uganda, Tanzania, Rwanda, Malawi, Ethiopia and Cameroon. The program provides grants to governments, nongovernmental organizations and other institutional clients for a portfolio of drugs to treat noncommunicable diseases. It also strengthens the capacities of health systems for the prevention and management of noncommunicable diseases, including diabetes.
Another company, Novo Nordisk, began in 2009 supplying insulin at a subsidized cost to some low-income countries in sub-Saharan Africa. With partners, it supports the “Changing Diabetes in Children” program in 10 countries in sub-Saharan Africa. It offers free glucose monitors and insulin to children and adolescents with type 1 diabetes.
But more needs to be done. Government health ministries and other implementing agencies should encourage health professionals to follow evidence-based, locally relevant treatment guidelines. They should undergo continuing professional development in diabetes care. National essential drugs lists need to be regularly updated to include cost-effective drugs.
Finally, governments and the private sector in sub-Saharan Africa should invest in the local production of high-quality generic drugs for diabetes.