ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Horm Res Paediatr. 2018; Jul 26:1-1

As the global burden of non-communicable diseases (NCD) is rising to epidemic levels worldwide, efforts are underway to build capacity for childhood NCDs in low- and middle-income countries (LMICs), including among health care providers in pediatric endocrinology. With increased ability to recognize and diagnose pediatric endocrine conditions in resource-constrained settings, limited access to essential medicines is becoming more palpable. Following their initial assessment of effective translation of the World Health Organization (WHO) Essential Medicines List (EML) to national EMLs in Central America, this second paper by Rowlands et al. focuses on the African continent. While most of the medicines deemed essential in pediatric endocrinology were present on both WHO and national EMLs, not all were – including life-saving medications like fludrocortisone and diazoxide – and only 50% of the medicines included on the author’s master list were included. More concerningly but maybe not surprisingly, neither the WHO nor the national EMLs were reliably predictive of access to insulin and glucagon. The authors verified actual availability and affordability of these two most important medicines for diabetes care with pediatric endocrinologists in 5 African countries of variable Gross National Income and found highly variable actual access. A review of aspects of the health systems in these 5 countries that can affect access to medicines, including health care coverage schemes, outreach capacity to remote regions, government supported special programs, and involvement of the private sector and international support programs are among potential factors that may modulate access.

Stakeholders in the public and private sector need to take action to increase transparency of listed and actual availability of essential medicines, and develop evidence-based recommendations for the procurement and reliable disposition of cost-effective essential medicines.