Access to essential medicines to treat chronic respiratory disease in low-income countries
Access to essential medicines to treat chronic respiratory disease in low-income countries
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DOI：
10.5588/ijtld.15.0734
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发表时间：
2016-06-01
影响因子：
4
通讯作者：
Beran, D.
中科院分区：
文献类型：
--
作者：
Bissell, K.;Perrin, C.;Beran, D.
慢性呼吸道疾病（CRD）影响着数亿人。联合国2011年非传染性疾病问题会议标志着解决这一负担的一个转折点。这次会议之后确定的目标纳入了解决基本药物的供应和可负担性问题的具体措施。这些都与可持续发展目标（SDG）和推动全民健康覆盖相一致。然而，CRD的基本药物仍然负担不起，许多人无法获得。对于哮喘，公共和私营部门的药物供应分别为30.1%和43.1%。最高年度治疗费用分别为倍氯米松102.10美元、沙丁胺醇82.99美元和布地奈德1501.79美元，分别占马拉维、布基纳法索和几内亚人均收入的40%、15%和209%。多种因素造成可用性和可负担性差。从人体免疫缺陷病毒/获得性免疫缺陷综合征方面获得的经验表明，可以在低收入国家和非传染性疾病国家提供药品和护理。提供负担得起的基本CRD药物的有效机制的一个独特例子是哮喘药物基金。致力于世界卫生组织提出的六个卫生系统组成部分，不仅可以帮助各国解决获得药物方面的问题，还可以解决阻碍充分护理的问题。改善药品供应系统、培训、国家指导方针、筹资、研究、数据利用和初级卫生保健一级的护理模式将有所帮助。CRD目标（例如，哮喘住院率减少50%）以及将哮喘作为卫生系统有效性的衡量标准和将CRD作为可持续发展目标的示踪剂，将有助于集中全球、国家和地方的领导力。
Chronic respiratory diseases (CRDs) affect hundreds of millions of people. The United Nations 2011 meeting on non-communicable diseases (NCDs) marked a turning point in addressing this burden. The targets established following this meeting incorporated specific measures to address the availability and affordability of essential medicines. These are aligned with the sustainable development goals (SDGs) and the push for universal health coverage. However, essential medicines for CRDs remain unaffordable and unavailable to many. For asthma, the availability of medicines was respectively 30.1% and 43.1% in the public and private sectors. The maximum annual costs of treatment were US$102.10 for beclometasone, US$82.99 for salbutamol and US$1501.79 for budesonide, representing respectively 40%, 15% and 209% of per capita income in Malawi, Burkina Faso and Guinea. Multiple factors contribute to poor availability and affordability. Experience from human immunodeficiency virus/acquired immune-deficiency syndrome shows that medicines and care can be delivered in low-income countries and among the NCDs. A unique example of an effective mechanism for providing access to affordable essential CRD medicines is the Asthma Drug Facility. Working on the six health system building blocks proposed by the World Health Organization can help countries address not only problems regarding access to medicines, but also those hampering adequate care. Improving medicine supply systems, training, national guidelines, financing, research, data utilisation and models of care at the primary health care level will help. A CRD target (e.g., 50% reduction in asthma hospitalisations) as well as the use of asthma as a measure for health system effectiveness and CRDs as a tracer for SDGs would help focus global, national and local leadership.