Endocrinology and Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Global Pediatric Endocrinology and Diabetes (GPED), Vancouver, British Columbia, Canada.
Horm Res Paediatr. 2018;90(2):82-92. doi: 10.1159/000490467. Epub 2018 Jul 26.
Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs.
We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon.
Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs.
Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.
在资源有限的国家，儿科内分泌学和糖尿病的基本药物的获取受到限制。世界卫生组织（WHO）维护着两份非约束性的基本药物清单（EML），这些清单经常被用作制定国家 EML 的模板。
我们将之前发表的一份儿科内分泌学和糖尿病药物主清单与世界卫生组织 EML 以及非洲区域国家的国家 EML 进行了比较。为了更好地了解患者实际获得药物的情况，我们专注于糖尿病，并对来自 5 个国家的儿科内分泌学家进行了调查，评估了胰岛素和胰高血糖素的供应情况和实际成本。
大多数在儿科内分泌学和糖尿病中必不可少的药物都包含在国家 EML 中。然而，尽管世界卫生组织推荐使用，但一些必要药物，如氟氢可的松，却只出现在不到 30%的国家 EML 中。来自 5 个重点国家的儿科内分泌学家报告说，胰岛素的供应和公众获取情况存在显著差异，城乡之间也存在差异。除了博茨瓦纳，很少有地方可以获得胰高血糖素。国民总收入与国家 EML 中包含的药物数量之间没有显著关系。
资源有限的国家的政府可以采取进一步措施来改善 EML 和药物获取情况，例如加强卫生当局、制药业、患者团体、卫生专业人员之间的合作，并开展儿科内分泌学培训中心等能力建设计划。
