Anti-Diabetic Drugs In The Private And Public Sector In Dar Es Salaam, Tanzania

Abstract

Objectives: To compare availability, cost, affordability and sources of anti-diabeticdrugs between private and public health facilities in Dar es Salaam, Tanzania.

Design: Cross sectional descriptive study.

Setting: Diabetic clinics in private and public health facilities in Dar es Salaam,Tanzania.

Subjects: Eighty patients randomly selected and 45 health facility personnel staffworking in the diabetic clinics. Semi-structured questionnaires and a checklist wereused to collect the information.

Results: Oral hypoglycaemic agents were available in all seven private and three publicfacilities that were studied. Private facilities stocked more types of oral hypoglycaemicagents than public facilities, which stocked only chlorpropamide and tolbutamide,based on the National Essential Drugs List. The cost of chlorpropamide was five timeshigher in private facilities compared to public facilities. Insulin was also available inall the facilities. The price of animal insulin in private health facilities was ten timesthat in public health facilities. Human insulin, which is generally more expensive thananimal insulin, was only available in private facilities. Although prices were muchlower in public facilities, affordability emerged as a common issue in both privateand public facilities.

Conclusions: Urban private health facilities offer a wider choice for the needs ofdiabetic patients but this advantage is compromised by higher prices as compared topublic facilities as well as inconsistent supply across facilities. Public health facilitiesoffer only a limited selection of essential oral hypoglycaemics and insulin but at alower price and across all facilities. Twenty six per cent and 10% of patients in publicand private facilities respectively are unable to afford anti-diabetic drugs. The needfor intervention to increase affordability of anti-diabetic drugs is evident. Financingand cost of drugs needs to be addressed, either by means of health insurance orother mechanisms, in this era of increasing prevalence of diabetes mellitus amongdeveloping countries.