title: Medicines availability for non-communicable diseases: the case for standardized monitoring.
abstract: BACKGROUND
  In response to the global burden of non-communicable diseases (NCDs), the World Health Organization (WHO) has developed a Global Action Plan that includes a voluntary medicines target of 80% availability and affordability of essential medicines for the prevention and treatment of diabetes, cardiovascular disease and respiratory disease both in public and private health facilities. Reliable measures of medicines availability are needed to track progress towards meeting this target. The results of three studies measuring the availability of medicines for hypertension and diabetes conducted in Tanzania in 2012-2013 were compared to assess the consistency of the results across the studies.
  
  
  METHODS
  Availability was defined by observation of the medicine (no minimum quantity) on the day of the survey. The three studies involved 24, 107 and 1297 health facilities. Estimates of the availability of medicines for hypertension and diabetes were compared for medicines availability overall, by managing authority (government, mission/faith-based, private-for-profit), by facility level (hospital, health centre, dispensary) and by setting (urban, rural).
  
  
  RESULTS
  Comparisons of the availability of medicines were limited by differences in the definitions of the medicines and the classifications of the facilities surveyed. Metformin was variously reported as available in 33%, 39%, 46%, and 57% of facilities. Glibenclamide availability ranged from 19% to 52%. One study reported low levels of insulin availability (9-16% depending on insulin type) compared to 34% in a second study. Captopril (or angiotensin converting enzyme [ACE] inhibitor) availability ranged from 13% to 48%while availability of calcium channel blockers was 29% to 57% and beta-blockers 15% to 50%. Trends were similar across studies with lower availability in government compared to mission or private facilities, in dispensary and health centres compared to hospitals, and in rural compared to urban facilities.
  
  
  CONCLUSIONS
  All three studies showed suboptimal availability of NCD medicines, however the estimates of availability differed. Regular monitoring using reproducible methods and measuring key medicines must replace ad-hoc studies, small selected samples and differences in definitions. Low and middle-income countries need to implement monitoring and evaluation systems to track progress towards meeting the NCD medicines target and to inform country-level interventions to improve access to NCD medicines.
authors.affiliation: World Health Organization, 20, avenue Appia, 1211, Geneva, Switzerland. Jane.Robertson@newcastle.edu.au.|University of Newcastle, Calvary Mater Hospital, Newcastle, 2298, Australia. Jane.Robertson@newcastle.edu.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Robertson
authors.affiliation: World Health Organization, 20, avenue Appia, 1211, Geneva, Switzerland. macec@who.int.
authors.forename: Cécile
authors.initials: C
authors.lastname: Macé
authors.affiliation: World Health Organization, 20, avenue Appia, 1211, Geneva, Switzerland. forteg@who.int.
authors.forename: Gilles
authors.initials: G
authors.lastname: Forte
authors.affiliation: World Health Organization, 20, avenue Appia, 1211, Geneva, Switzerland. dejoncheerec@who.int.
authors.forename: Kees
authors.initials: K
authors.lastname: de Joncheere
authors.affiliation: Geneva University Hospitals (HUG), 4, rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. david.beran@unige.ch.|University of Geneva, 24 rue du Général-Dufour, 1211, Geneva, Switzerland. david.beran@unige.ch.
authors.forename: David
authors.initials: D
authors.lastname: Beran
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy*; D017598:Efficiency, Organizational; D014943:Global Health; D006268:Health Facilities; D006801:Humans; D055553:Prescription Drugs / Q000600:supply & distribution*; D013636:Tanzania
chemical_list: D055553:Prescription Drugs