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Reaching out

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Two global life science firms share some of their projects and logistical solutions to deliver healthcare to parts of the world where it is needed the most.

Cardiovascular disease is currently the third leading killer in Africa. Hypertension, one of the main risk factors for cardiovascular disease, is estimated to affect nearly half of adults aged 25 years and older across the region and its prevalence is expected to grow, affecting 150 million adults in Sub-Saharan Africa alone by 2025. Multinational pharmaceutical giant AstraZeneca launched the Healthy Heart Africa (HHA) program in 2014 with the aim to support governments in reducing the burden of hypertension, and by extension heart disease, across the African continent. The ultimate goal is to reach 10 million hypertensive patients in the next ten years. One specific ambition within HHA is to facilitate access to low-cost, high quality antihypertensives.

“We have a portfolio of hypertensive medicines that we can make affordable. The problem, as we saw when we initiated the program, is that there is insufficient supply and demand for low and middle income populations for medicines for these conditions. So we are really trying to build a market and develop a supply chain solution that actually works. A comprehensive approach is thus needed to address the condition,” says Alec van Gelder, Director of Access and Affordability at AstraZeneca.

HHA was launched in Kenya in October 2014. Through the program more than 400 health facilities have been activated, ranging from large hospitals to lower level facilities, many of which have never systematically treated for hypertension before.

“Most of these didn’t even have trading accounts with medicines, which was something we needed to set up to begin with. In these smaller facilities credit is also a real challenge. There is typically not an initial pot of money to initiate supply of medicine. Thus, credit loans were provided to these rural and urban healthcare facilities to procure medicines from district pharmacies,” says van Gelder.

Through the program physicians at the facilities were also educated about appropriate drug prescriptions. An overall challenge that AstraZeneca has identified throughout the program is the lack of healthcare capabilities at healthcare facilities to treat hypertension.

“Healthcare staff are not always educated on the condition and there was sometimes also a lack of diagnostic equipment. Before we started the program there were no specific guidelines for hypertension for African patients. So an important part in providing access to medication is by educating,” says van Gelder.

Over 3 000 frontline healthcare workers, who are often the first point of entry for patients, became equipped and trained to provide chronic disease care throughout Kenya. In the project AstraZeneca has also conducted over 2.0 million hypertension screenings in the community and in health facilities. By working together with organizations already implementing other healthcare programs, it was possible to rapidly move into the community, going door-to-door, setting up stalls at shopping malls and transportation hubs.

“That way we were able to reach a great deal of people. One critical challenge is to target working-age men, a part of the population who are more likely to have the condition. To do this, we target transportation hubs and big employers like tea and coffee plantations,” says van Gelder.

The screenings were carried out to increase the knowledge among patients about the nature of the disease, risk factors, how the condition can be managed and guidelines for medication.

According to Alec van Gelder another key part of the solution is to ensure suitable packaging for the antihypertensive medicines themselves.

“In many instances we decided to change the packaging of the product to have the branding of the program on the package, facilitating for patients to identify it when they are consulting with healthcare workers. We are moving from bottles to blister packs as a low-technology way to encourage and manage patients to remain compliant with their medicines – a key way to ensure they work. With a blister it is easier to know how much to take.”

Ensuring availability of the medicines also meant that establishing a secure and lower cost supply chain than the solutions currently used by AstraZeneca throughout the region was essential. AstraZeneca collaborated with Mission for Essential Drugs and Supplies (MEDS), a faith-based Kenyan distributor, to establish a secure supply chains for the antihypertensive medicines. The organization delivers medicines and medical supplies to 1,800 public and private health facilities in Kenya.

Access to diabetes care

The prevalence of diabetes is drastically increasing all over the world. Millions of people in the developing countries still lack access to insulin. To raise awareness about the issue and bring changes, Novo Nordisk, the world’s largest insulin maker, has teamed up with the nonprofit organization PATH in The No Empty Shelves Project, a project that aims to reduce complications and death from diabetes by targeting the availability of essential medicines and technologies in low- and middle-income countries.

“Despite being a serious chronic disease, diabetes is generally under-prioritized in policy making in many low- and middle-income countries,” says Susanne Stormer, head of Corporate Sustainability at Novo Nordisk. The lack of access also has to do with the distribution system in these regions, she points out. “Here it is important to find distributors with wider access into the local and rural areas than the conventional distributors, as well as to cooperate with patient organizations and medical organizations. By engaging with some of various NGOs we can start to see the patterns of interactions and in the end reach out more effectively.”

A key is to raise awareness of diabetes as a disease that requires treatment.

“In some regions there might be a superstition about taking insulin, that it could harm the body. Treating diabetes is not always tied into any formal programs as it is not a highly prioritized area of disease. Thus, in order to have access to the treatments, it does not only revolve around the actual medicines but also the care needed for these patients,” says Stormer.

Novo Nordisk has also been working with the Changing Diabetes in Children program. Originally piloted in Tanzania in 2006, the program strives to develop long-term solutions for improving availability, accessibility, affordability and quality of diabetes care for children with type 1 diabetes in Africa and South-East Asia. The program is organized around a hub-and-spoke concept. The ‘hubs’ are main clinics and work as referral clinics. The ‘spokes’ are smaller clinics established to improve access to diabetes care for children and adolescents with type 1 diabetes by reducing the distance they have to travel. In instances where the geography of a country has made it necessary, additional ‘mini-spokes’ have been put into place to ensure that children have access to insulin and supplies between scheduled clinic visits.

A key finding from the program is the necessity of creating solutions for each country, region, rural area and individual need.

“In Indonesia, for example, we have developed programs to educate endocrinologists. Often there might be only one doctor available throughout several small islands to treat people with diabetes. With educational programs that rely on multiplication, that specific doctor can gain more knowledge and also pass this knowledge on to other general practitioners,” says Stormer.

It could also mean finding better storage solutions. Children with diabetes in rural areas of Kinshasa, for example, receive insulin for free through the program. However, many families where the parents have low-paid jobs do not have fridges at home to keep the insulin cold. With the support of MEMISA, a nonprofit organization, satellite clinics were established that were equipped with fridges to store insulin. Solar panels were also installed to ensure a reliable source of energy to keep the refrigerators running. Another solution is mobile clinics, like in Guinea. The journey to the nearest clinic to collect insulin and medical supplies can be very far for some of the children and adolescents to travel. To address this challenge, a mobile clinic fitted with monitoring equipment was launched that will travel to the areas where the children live. A specialized diabetes care team delivers services from the mobile clinic.

Photo showing Changing Diabetes in Children Programme, Ethiopia (Novo Nordisk)

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