Barriers to accessing essential medicines for kidney disease in low- and lower middle–income countries|

Francis, Anna; Hafidz, Muhammad; Ekrikpo, Udeme; Chen, Titi; Wijewickrama, Eranga; Tannor, Elliot Koranteng; Nakhoul, Georges; Wong, Michelle M.Y.; Pereira-Kamath, Nikhil; Chanchlani, Rahul; Kalyesubula, Robert; Karam, Sabine; Kumar, Vivek; Calice‐Silva, Viviane; Jha, Vivekanand

doi:10.1016/j.kint.2022.07.029

Cited by 27 publications

(16 citation statements)

References 6 publications

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“…Regulation and monitoring of drug Essential Medication List (Table 1). These must be provided at national levels under universal health coverage (Francis et al, 2022).…”

Section: Health Systemsmentioning

confidence: 99%

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Mind the gap in kidney care: Translating what we know into what we do

Luyckx,

Tuttle,

Abdellatif

et al. 2024

Journal of Renal Care

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Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

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“…Regulation and monitoring of drug Essential Medication List (Table 1). These must be provided at national levels under universal health coverage (Francis et al, 2022).…”

Section: Health Systemsmentioning

confidence: 99%

“…Medications required for kidney care are already included in the World Health Organization Essential Medication List (Table 1). These must be provided at national levels under universal health coverage (Francis et al, 2022). Pharmaceutical companies should provide these at affordable prices.…”

Section: Closing the ‘Gap’ Between What We Know And What We Domentioning

confidence: 99%

Mind the gap in kidney care: Translating what we know into what we do

Luyckx,

Tuttle,

Abdellatif

et al. 2024

Journal of Renal Care

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“…In lower-resource settings a small fraction of those requiring KRT receive it long-term 34 . For example, most African countries have healthcare systems with poor/no health insurance coverage, leaving the vast majority of people with kidney failure unable to obtain KRT 77,78 . Elsewhere, macro-economic factors and services for kidney care are also more strongly related to KRT incidence than demographics or general health 79 .…”

Section: Global Distribution Of Krtmentioning

confidence: 99%

“…Availability of medicines required for kidney care is often limited in lowerresource settings, but even within HICs inequities may arise based on coverage differences between patients and insurers 77,78 . Similarly the nephrology workforce is unequally distributed across the globe: the number of nephrologists per million population (pmp) ranges from 31 in Western Europe to 1 or less in Africa 79 .…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Inequities in kidney health and kidney care

Vanholder,

Annemans,

Braks

et al. 2023

Nat Rev Nephrol

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Health inequity refers to unnecessary and unfair differences in the capacity to achieve optimal health and appropriate accessibility of care. Kidney diseases [including acute kidney injury (AKI) and chronic kidney disease (CKD)] have strong associations with inequity. This is largely due to the intrinsic risks of kidney diseases, the heavy burden of comorbidities and the high cost of therapies, e.g. for dialysis on wich survival for many may depend. However, inequities occur across the entire clinical course of kidney diseases. This review offers a comprehensive overview of the array of inequities in kidney health and kidney care, including inequities between countries, regions and social classes, inequities in healthcare, inequities specific to therapeutic modalities, and healtheconomic and ethical implications. This review also proposes solutions, which may inspire nephrology professionals to recognize and mitigate inequities. In addition to the main text that summarizes the relevant elements, and interested readers are referred to the comprehensive tables (including case stories) and references, which review some facets more deeply. It is the responsibility of all implicated to call attention to inherent risks of inequity in their immediate and broader environments, and to pursue the best possible solutions together with their communities. the one stop thing?"

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“…Challenges such as shortages of medicines, stock-outs of essential medicines, procurement processes, and inventory management systems (IMS) persist in delivering quality healthcare services globally, mainly in LMICs like Nepal [ 1 , 2 ]. While acknowledging the global prevalence of studies on stock-outs [ 3 , 4 ], barriers [ 5 – 7 ], and supply chain issues [ 8 , 9 ] related to essential medicines, it is necessary to highlight the unique circumstances faced by the health system of Nepal. Despite the abundance of worldwide research in this area, the focus on Nepal remains limited, creating a gap in understanding the specific challenges within its context.…”

Section: Introductionmentioning

confidence: 99%

Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal

Adhikari,

Ranabhat,

Khanal

et al. 2024

PLOS Glob Public Health

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Ensuring access to essential medicines remains a formidable challenge in Nepal. The specific reasons for the shortage of essential medicines within Nepal have not been extensively investigated. This study addresses challenges associated with access to essential medicines, procurement process difficulties, and functionality of inventory management systems at different levels of public health facilities. Fifty-nine semi-structured in-depth interviews were conducted with health managers and service providers at provincial and local levels in six randomly selected districts of Bagmati province, Nepal. Interviews were audiotaped and transcribed verbatim, and the results were analyzed using the inductive approach and were later mapped within the four domains of “Procurement of essential medicines”. The major barriers for the effective management of essential medicines included delays in the procurement process, primarily locally, leading to frequent stock-out of essential drugs, particularly at the health post level. Additionally, challenges arise from storage problems, mainly due to insufficient storage space and the need to manage additional comorbidities related to COVID-19. Other identified challenges encompass the absence of training on logistics management information systems, a lack of information technology resources in primary health facilities, inadequate qualified human resources to operate the IT system, and insufficient power backup. Moreover, unrealistic demand estimation from the service points, inadequate transportation costs, and manual inventory management systems further contributed to the complex landscape of challenges. This study identified procurement delays as the primary cause of essential medicine shortages in Bagmati Province, Nepal. We recommend implementing comprehensive procurement guidelines, collaborative training, and dedicated budgets to address this issue. Improving the procurement and inventory management process in low-resource settings requires a well-trained workforce, suitable storage spaces, and enhanced coordinated administrative tiers within health facilities at different levels to ensure the year-round availability of essential medicines in these settings.

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Barriers to accessing essential medicines for kidney disease in low- and lower middle–income countries|

Cited by 27 publications

References 6 publications

Mind the gap in kidney care: Translating what we know into what we do

Mind the gap in kidney care: Translating what we know into what we do

Inequities in kidney health and kidney care

Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal

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