Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa Workshop Summary (2014) / Chapter Skim
Currently Skimming:
Appendix A: Access to Essential Medicines: Program Examples
Appendix A: Access to Essential Medicines: Program Examples
Pages 93-108
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 93... ...
In the 1990s, community-based mutual health insurance schemes were introduced in which members paid enrollment fees and premiums to receive health insurance coverage with minimum copayments. However, benefit packages were limited to a few health care providers due to the limited ability of patients to make payments and no additional financial support from the government.
|
From page 94... ...
For the first time, mental, neurological, and substance use (MNS) disorders have been recently integrated into the health insurance scheme, including premium exemptions for persons with MNS disorders.
|
From page 95... ...
Another program is the Parkinson's Disease in Ghana project, which seeks to increase demand by improving provider knowledge and providing free long-term medicines for patients. Ghana has several initiatives targeting selection challenges, including the development of national treatment guidelines and an essential medicines list; in addition, a new national guideline for epilepsy drugs will be released soon.
|
From page 96... ...
Akpalu closed by noting that while challenges remain related to financial sustainability, patient ability to pay premiums, quality of care, pricing of medicines, and supply chains, Ghana is actively working to address each area. Accredited Drug Dispensing Outlets (ADDO)
|
From page 97... ...
. ADDO was designed to help address these challenges through a series of steps aimed at enhancing regulatory compliance, improving health care provider skills, developing incentives for the legal sale of medicines, and increasing consumer education on the importance of treatment adherence and the quality of medicines.
|
From page 98... ...
The program is now in the maintenance and sustainability phase, with efforts to integrate public health into the program. As noted earlier, Liana stressed that local community residents feel comfortable going to local dispensaries and as a result these dispensaries serve as the first line of triage for individuals with health concerns.
|
From page 99... ...
In the case of Tanzania, the challenges associated with demand were low; however, other challenges associated with access to essential medicines are present, said Liana. Selection of authorized medicines for ADDOs was based on community needs, storage conditions, qualifications of personnel, and public health priorities.
|
From page 100... ...
Introduction of MNS medicines, like any new intervention, would require training, mentoring, supervision, and regular monitoring of dispensers. Linking with insurance schemes could help MNS patients reduce out-of-pocket spending for medicines.
|
From page 101... ...
Medicine procurement was typically done with one or two suppliers who discounted their prices for some key second line medicines. In 2007, following the revised recommendations, countries began to scale up treatment; however, increased demand coupled with a lack of effective supply chains and additional infrastructure components resulted in medicine shortages and long lead times, Zintl explained.
|
From page 102... ...
Based on his experience with MDR-TB, Zintl cautioned that it is not sufficient to make the case that MNS disorders, if ignored, will have a devastating impact. He stressed that it is necessary to also demonstrate that targeted access to medicines programs improve overall population health outcomes and are feasible.
|
From page 103... ...
Ilondo described challenges around supply chains due to limited government health care budgets in SSA countries and low priorities assigned to noncommunicable diseases, such as diabetes. Due to logistical challenges, diabetes medicines are generally available only in major cities in SSA.
|
From page 104... ...
Moving forward, Ilondo highlighted the need for government involvement in conducting needs estimates; health care provider training on recognition, diagnosis, and evidence-based treatment; and community awareness. Limited health care capacity, inefficient procurement and distribution practices, and inadequate transportation and facilities for storage of insulin are additional challenges.
|
From page 105... ...
Ultimately, the patients are at the center of the Access to Medicines program, he said, and attention must be paid simultaneously to addressing the issues surrounding diagnosis and care, affordable quality medicines, and awareness. Simply diagnosing an MNS disorder is not enough, opined Bompart; having access to medicines is critical, as is minimizing stigma which prevents patients from receiving access to care.
|
From page 106... ...
Stimulating demand, he reiterated, requires a comprehensive approach, including community awareness, health care provider training, and availability of affordable medicines. Pilot programs such as Sanofi's can stimulate demand at the ground level
|
From page 107... ...
Bompart suggested that the best approach to selection of medicines might be to have local experts select from the WHO list of essential medicines based on transparent criteria. The country list should be limited and sustainable, and accompanied by easy-to-follow treatment guidelines, he said.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.