# Presentation: 235036

## Global Initiative For Treatment of major chronic diseases

**	****	****	****	****	****	**** **

**Shanthi Mendis **
**MD FRCP FACC**
**Coordinator **
**Cardiovascular Diseases**

## Global Initiative For Treatment of major chronic diseases

**	****	****	****	****	****	**** **
**Rationale **
**Objectives  **
**Processes / activities **
**Expected outcomes  **

## Rationale 

**	**
**Mortality  **
**CVD   ****	****	****	****	****16.7  million **
**Diabetes ****	****	****	****	****0.98  million   **
**CRD****	****	**** ****	****	****3.7    million**
**Cancer****	****	****	****	**** 7.0   million****	****  **
** ****42% of NCD burden **
**CVD****	****  ****	****	****	**
**Diabetes ****	****	****	****	**
**CRD****	****	****	****	**
**Cancer****	****	****	****	**

## Number of Cardiovascular Deaths Projected to 2020 

**Millions  **

##  The potential of secondary prevention

**	****	****	**** **
**	****	****	****RR  reduction     ****	****	****2-year event rate**
**None****	****-----****	****	****	****	****8.0%**
**Aspirin****	****25%****	****	****	****	****6.0% **
**B B****	****25%****	****	****	****	****4.5%**
**Statin****	****30%****	****	****	****	****3.0%**
**ACEI****	****25%****	****	****	****	****2.3%**** **

## EUROASPIRE   Survey 

**Overall Percentage  on Rx  **

**EUROASPIRE   Survey **

**Lancet 2001;357:996-1001**

**Percentage  **

**Drugs  **

## Secondary Prevention of  CHD   

**Overall Percentage in 10 countries  **

**Secondary Prevention of  CHD   **

**WHO PREMISE 2003**

**Percentage  **

**Drugs  **

## Prevention and Control of CVD

**Primary prevention**
**	****	**
**Secondary prevention**

## Global Initiative For Treatment of major chronic diseases

**	****	****	****	**
**CHD/CeVD/RHD**
**Bronchial asthma **
**Diabetes **
**Glaucoma**
**Cancer (palliative care)**
**     **

## 			Objectives 

**	****	****	****	****	****	****	****	**
**To improve **
**Health outcomes**
**Efficiency **
**Equity    **

## Is affordability a problem? 

**	****	****	****	**** **
**Pakistan : statin 1 month supply  = one third the monthly wage  **
**Kenya : Furosemide generic form is 2.5% that of the originator brand form**

## Kg of (rice/yam) that can be purchased with money required for buying the cheapest statin  for 1  week

**	****	****	****	****Kg****	****	****   **
**China ****	****	****28****	****	**
**Egypt ****	****	****34****	****	**
**Georgia ****	****	****51****	****	**
**Indonesia****	****	****5****	****	**
**Iran  ****	****	****1.4**
**Mozambique****	****4.7****	****	**
**Nepal****	****	****13****	****	**
**Pakistan****	****	****24****	****	**
**Uruguay ****	****	****35****	****	**

**China:  28 Kg of rice can be bought for  cost of 1 week supply  of statins**

**Notes:**
The contents of WHR 2003 focus on a selected number of current global health priorities 
The statistical annex summarises many aspects of the global health situation

## World Health Survey

**Diagnosed as angina ****	****	****(4%-14%) **
**On Rx****	****	****	****	****(14%-60%) **
**Diagnosed angina –aspirin (1%-20%) **
**Diagnosed angina –BB ****	**** (<5%)**
**(Bangladesh, Burkina Faso, China,  India, Malawi, Malaysia, Mexico, Nepal, Sri Lanka , Vietnam)   **

## 	Determinants  of effective drug treatment 

## Players and Processes 

## How  ? 

**Assess situation**
**Identify barriers **
**Direct intervention **
**Advocate for change**

## Price of Medicines Survey 

**The survey will  gather information on: **
**Procurement / final prices   **
**Prices in different parts of the country **
**Relative prices of proprietary / generic   **
**Affordability of treatment for ordinary people**
**International difference in prices**

## Priority list of drugs  

**Aspirin**
**Thiazides**
**Betablockers**
**ACEI**
**Statin **
**Metformin**
**Glibenclamide **
**Insulin **
**Salbutamol **
**Beclometasone/oral steroids **
**Aminophylline **
**Benzathine penicillin **
**Beta blocker eye drops **
**Morphine **
**(Model list / PHC / minimum monitoring/Safety ) **
-   ** **

## Are there mechanisms to reduce  drug prices ?  

**	****	****	****	**** **
**Ensure generic medicines **
**Seek volume discounts for group purchases **
**Open competitive purchasing methods **
**Monitor prices paid by other purchasers**
**Eliminate duties and taxes and add-ons**
**Partnership arrangements **

**	****Expected outcomes **
**Reduce cost of drugs **
**Improve  accessibility **
**Efficient procurement practices**
**Evidence based prescriptions **
**National programs addressing Rx  needs  through equitable programs**
**Partnership arrangements with industry **
**Enhance  local production of generics **

## GIFT

**Affordability **

**Accessibility**

**Quality & efficacy  **

**Appropriate use **

** **
**prescription**

**GIFT**

**Global Initiative For Treatment of major chronic diseases**