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Providing access to affordable quality assured essential asthma medicines



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‡ 300 million cases worldwide, still increasing


‡ Common chronic disease among children
‡ Majority in low- and lower-middle income countries
‡ Prevalence higher in urban areas
‡ Number of DALYs lost 15 million/year
‡ Asthma accounts for about 1 death in every 250 deaths
worldwide
‡ Health cost of asthma increases with ineffective
management
Masoli M et al.
Burden of asthma. http://www.ginasthma.com
¢ W Lai et all, Thorax.2008.106609
¢  
  
j  j 
    
‡ Prevalence of asthma increasing in urban areas
‡ Major cause of unplanned visits to health facilities
in urban centres
‡ Low income and low health expenditure per capita
and priority is given to communicable diseases
‡ Poor access to health services particularly for
long-term management
‡ Lack of trained health personnel
‡ Low or non-affordability of asthma medicines for
patients
     

‡ Improve 
 of essential asthma
medicines in developing countries

‡ Improve  of health personnel by the


development of a training package

‡ Assess  by regular monitoring and


evaluation

Ait-Khaled N et al. Allergy 2007;62:230-36.


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Ñmprove affordability
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 $particularly inhaled
corticosteroids, has been demonstrated
since 1998 in The Union studies:
± Majority of patients cannot afford the
essential medicines
± Minority of rich patients are purchasing
very costly unnecessary medicines
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Low affordability

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    +1)2
¢    ( 
%   &'
ü $5 15
$5-9 11
'%)*+, -.
$30-55 4
Do not know 22
Survey (46 countries), The Union and ADF, 2005
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The health costs arguments
3"


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Costs increase when asthma not treated or
incorrectly treated. We need to:
XReduce unnecessary expense of emergency
visits, hospitalisation, and ineffective and
inappropriate medicines
XReduce indirect costs on
patients, families, governments
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‡ ADF organises qualification of manufacturers and products (as


part of its Quality Assurance system), since asthma inhalers
are not part of the WHO Prequalification Programme
‡ ADF establishes contracts with selected manufacturers for
qualified products and proposes these products to countries,
organisations, programmes
‡ Countries purchase generics at affordable prices
‡ ADF provides training materials and EpiData information
system

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‡ Training courses and technical assistance
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The client must agree to:


‡ Take the responsibility for the importation of medicines into the
recipient country
‡ Sell the medicines with a minimal mark-up or to provide them
free of charge to patients
‡ Not re-export or resell these medicines
‡ Make a full payment in advance to ADF
‡ Use the products supplied according to international guidelines
for diagnosis and treatment
‡ Identify an individual responsible for providing monitoring reports
to the ADF
‡ Submit routine monitoring reports, as specified in the Technical
Agreement with the ADF
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5o         
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  j       
     
!j j |   "    # $  %
4
 4 &  4   ¢|55
¢ # 6#

Beclometasone 100µg/puff, Beximco 1.07


200 doses, HFA inhaler* (Bangladesh)

Salbutamol 100 µg/dose, Beximco 0.83


200doses, HFA inhaler* (Bangladesh)

Budesonide 200µg/puff, Cipla/Medispray 2.69


200 doses, HFA inhaler* (India)

Fluticasone 125µg/puff, Cipla/Goa 3.23


120 doses, HFA inhaler (India)
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¢  7  


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‡ Pilot Projects in Benin (NTP), El Salvador (NTP),
Sudan (Epi-Lab)
‡ Kenya (KAPTLD) funded by World Lung Foundation
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‡ Burundi (NTP) funded by Global Fund
‡ Vietnam (CHRDI) funded by The Union¶s staff and
board fundraising
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‡ 30 PAL countries receiving funds from Global Fund
‡ Other contacts through asthma, TB, NCD networks
o
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   #
90 83
79
80
70
60
50 In 2009, through
48 national procurement
40
In 2010, through ADF
30 35 procurement
20
10
0
BENIN EL SALVADOR
  
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‡ Commitment from respiratory specialists, public
health specialists, health workers, communities
‡ Convince governments to
define an asthma strategy
and buy essential medicines
for the majority of patients
‡ Convince donors to finance
asthma medicines
‡ Country adoption / adaptation of international
asthma guidelines
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68, Boulevard Saint-Michel
75006 Paris, France
Tel: (+33) 1 44 32 03 75
Fax: (+33) 1 43 29 90 87
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   9"""/| /(in English, French
and Spanish)
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Improving the management of asthma patients
in low- and middle-income countries