Executive Summary of Zambia Report
This report, prepared by the International Insulin Foundation (IIF), is to be the first stage in a collaborative process between different stakeholders both at a national and international level to find creative means to improve the welfare of people with Type 1 diabetes in Zambia. The IIF aims to mobilise different areas of expertise and resources to frame practical proposals to help Zambia provide the care that people with Type 1 diabetes require. In parallel this report hopes to contribute positively to the issues of chronic diseases in Zambia.
Type 1 diabetes is considered a rare disease in Africa estimated as affecting only 108,000 people. Since survival in many is short this probably greatly underestimates the true prevalence and the potential care needs. Despite major healthcare problems of communicable diseases, Zambia is caring for its citizens with diabetes relatively well. Data suggest four times as many patients than estimated for many other sub-Saharan countries. Moreover, there is little evidence of an urban/rural divide in Zambia.
All these issues need to be placed in Zambia’s general health care context where problems of staff, infrastructure and resources are omnipresent.
- Variations in Central Board of Health purchasing price of insulin
- Patients do not know where to get insulin
- Price of insulin to patients is often high, even though it should be supplied to them for free
- Lack of syringes
- VAT and duty are present on syringes and testing material
- Diabetes Care:
- Lack of structure around diabetes care
- No national guidelines for diabetes care
- Lack of educational materials for patients and Healthcare Workers
- MedLab policy on laboratory supplies is not properly implemented, which leads to patients not being able to access the proper diagnostic tools
- Healthcare worker education:
- Lack of education in frontline healthcare workers
- Curriculum for medical and nursing students is not adapted to treating and managing diabetes and other Non-Communicable Diseases
- The Diabetes Association of Zambia (DAZ) needs to raise its profile and find sustainable means of funding
- A Policy framework is being developed in Zambia to address Non-Communicable Diseases
- A Health Management Information System (HMIS) that collects disease data from most facilities in Zambia does not include diabetes
- Important role of Traditional Healers
- Long distances between patients and source of care/insulin, which means the added expense of travel for patients
- Very low knowledge about diabetes in the general population and government
Keeping in mind the resource restrictions present in Zambia the following recommendations aim to make best use of limited resources and also to benefit other areas of the health system in Zambia.
- Proper acquisition process to ensure lowest possible cost to Central Board of Health for insulin
- Information and guidelines for patients on where they can receive their insulin
- Implementation/Enforcement of policy of free care for chronic conditions
- Add syringes to essential drug list and supply insulin and syringes together
- Develop diabetes clinics based on the model of University Teaching Hospital (UTH) paediatric clinic
- Define role of each type of facility in diabetes care
- Develop national guidelines for diabetes including patient and healthcare worker information
- Laboratory supplies need to be present as per MedLab Policy and reliable suppliers need to be found for these materials
- Develop an Integrated Competence Training (ICT) manual on diabetes and Non-Communicable Disease diagnosis, treatment and management
- Develop curriculum at medical and nursing schools to include treatment and management of diabetes and Non-Communicable Diseases
- Promotion of DAZ and increase its visibility, in parallel with raising the knowledge about diabetes in the general public and government
- Policy being developed by the Ministry of Health should be far reaching, not only addressing issues affecting the health sector, but also issues of food, transport, sports, education, etc.
- Add diabetes to HMIS system
- Include Traditional Healers in any policy or guidelines developed for diabetes and Non-Communicable Diseases
- VAT and duties on any items linked to the care of people with diabetes should be dropped
A full copy of the report can be downloaded here: