How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings?

Abstract

BackgroundIt is very challenging for resource-limited settings to introduce universal health coverage (UHC), particularly regarding the inclusion of high-cost renal dialysis as part of the UHC benefit package. This paper addresses three issues: (1) whether a setting commits to include renal dialysis in its UHC benefit package and if so, why and how; (2) how to ensure quality of renal dialysis services; and (3) how to improve the quality of life of patients using psychosocial and community interventions.DiscussionThis article reviews experiences of renal dialysis programs in seven settings based on presentations and discussions during the International Forum on Peritoneal Dialysis as a Priority Health Policy in Asia. A literature review was conducted to verify and validate the data as well as to fill information gaps presented in the forum.Five out of the seven settings implemented renal dialysis as part of their benefits package, while the other two have pilots or programs in their nascent stage. Renal replacement therapy has become part of the universal access package because these governments recognize the rising number of chronic kidney disease (CKD) cases, the catastrophically high costs of treatment, and that this is the only life-saving treatment available to patients. The recommendations are as follows: Governments should have a holistic approach to CKD interventions, including primary prevention as well as psychosocial interventions. Governments should consider subsidizing CKD treatment costs depending on their resources. Multi-stakeholder cooperation should be facilitated to enact these policies and conduct research and development for all aspects of interventions. International collaboration should be initiated to share experiences, good practices, and joint activities (e.g. capacity building and multinational procurement of medical supplies).ConclusionThis study provides practical recommendations to country governments as well as the international community on how to meet the demand for good quality renal dialysis as part of UHC in resource-limited settings.

Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project

“…A review of the experiences of resource-limited countries attempting to implement good quality dialysis as part of universal health coverage reforms recommended that low-and middle-income countries should opt for PD as first-line treatment whenever there is limited budget allocation for dialysis programs, restricted human resources for health or significant geographical barriers to health care facility access or both. 33 While the barriers and enablers for establishing PD in resource-limited countries were not specifically evaluated in the present study, practical solutions would likely include securing reliable local manufacture and distribution of lowcost PD solutions and local training of health care professionals in PD care. As an example, PD solutions and catheters are considerably more expensive in sub-Saharan Africa than in other parts of the world; this problem could be successfully addressed through partnership among governments, international health agencies, and industry, as occurred with the provision of low-cost antiretroviral therapy to African countries.…”

How to increase dialysis adequacy; A randomized clinical trial

“…Endstage renal disease (ESRD) is the last and most critical stage of chronic kidney disease (1)(2)(3). The incidence of ESRD is increasing globally at an annual growth rate of 8% (4). The number of patients with ESRD was 3 1730 000 at the end of 2016.…”

Global Cardiovascular and Renal Outcomes of Reduced GFR

“…The health and social effects of CKD patients who progress to ESRD are well known. [5][6][7] The burden of health loss and premature mortality to CV disease within the CKD population is less known. Increasing severity of predialysis reduced GFR is associated with a higher likelihood of CV disease diagnoses, severity, and death.…”