October 21

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Two weeks in the field – Tambacounda & Ziguinchor

This month, I was fortunate enough to spend two weeks in two distant regions of Senegal, conducting a study on essential medicine and technologies for diabetes. In a nutshell, there is a gap in data on the affordability and availability of essential medicines for NCDs in low-income countries, which is in part to blame for the slow-moving and minimal resource mobilization available to address these disease states. The results of this study (taking place in Senegal and Kenya) will gather some of that much-needed data and will be part of a global advocacy plan to tackle increasing access to these essential medicines and technologies.

Our team of three (a driver, my colleague and I) visited 41 health structures (regional hospitals, public health centers, public health posts, NGO (non-governmental organizations) and FBO (faith-based organizations) supported health centers, private clinics and private pharmacies) and conducted over 80 interviews (Ministry of Health delegates, physicians, nurses, pharmacists, supply chain professionals). The days were HOT, long and very interesting.

The first region we visited was Tambacounda, a seven hour drive from Dakar through Senegalese countryside, an agriculture-based region that unfortunately experiences some of the lowest socio-economic rates in the country.

Typical rainy season landscape in Tambacounda

Typical rainy season landscape in Tambacounda

Entrance to a public sector health post

Entrance to a public sector health post

A faith-based organization (FBO) health structure

A faith-based organization (FBO) health structure

The second region was Ziguinchor, a trip that required a flight to get to as it is below Gambia. Ziguinchor struck me as having two distinct sides to it – one is for the tourists (home to some of the nicest beaches in Senegal, at Cap Skirring) and the other is for the residents of the area, made up in majority by the Jola ethnicity; a group that boasts several different dialects within the same language and historically was the last ethnic group in the Senegambia region to accept Islam.

Picturesque Cap Skirring

Picturesque Cap Skirring

Hospitalization structure in a public health center

Hospitalization structure in a public health center

Recording medication inventory in a private pharmcy

Recording medication inventory in a private pharmcy

Below are some of my off-the-cuff observations from our time in the field. Please note that they are of my own opinion, they do not reflect the analysis of the study, nor PATH or GSK’s positions.

  • Medications that were predominately not available in the public structures we visited were almost always found in private structures, even in the most remote areas
  • Pricing for medications was general harmonized within systems (e.g. similar prices in different private pharmacies, similar prices in different public structures) however pricing for laboratory tests varied widely, even within the same system (e.g. public health center charging eight times more for a test in one region versus another)
  • Ongoing patient tracking, the kind of surveillance needed for chronic conditions such as diabetes, is a huge challenge in particular since the public system has been set up for acute care
  • Patient associations, such as ASSAD (the Senegalese Diabetes Patient Association) play a critical role in bridging the communication gap between public health, private clinics and general information critical to disease management
  • Senegal’s health system does not only support the Senegalese; in Tambacounda, many of the patients were from Mali and Guinea while in Ziguinchor, many were from Guinea-Bissau
  • Diet and nutrition are formally and informally discussed as the most important risk factors to both diabetes and heart disease. A diet high in starch , fat, sugar and salt and low in vegetables and fruits is both culturally and economically engrained (much more expensive to buy fresh vegetables)

This was my first time contributing to a global health study in such a hands-on manner. The term ‘Data Collection’ now means much more to me than a generalized buzz-word. The findings from this study in Senegal will be compiled with the results from Kenya and the final report is scheduled to be released in early 2016. Needless to say, I am looking forward to the final synthesis and presentation of the data and the evidence-based action plans that will be created to tackle some of the enormous challenges around access to NCD treatments.