Every month I spend over 28,000 Francs (48 USD) to refill my medications for diabetes and hypertension”, recounts Joan (not her real name), a 63-year old retired agricultural/community development technician, who has been living with diabetes and hypertension for the past 6 years, in Cameroon
NCDs impose large financial burdens to individuals living with the condition and their families and are an important barrier to care. This burden is in the form of direct cost such as consultation fees, hospitalization, and purchase of medicines, and indirect costs like transportation, time lost while the patient, and/or caregiver are not able to work. The cost increases when medicines or other related supplies become limited and prices for the available stock increase. Also, intercurrent acute or short-term illnesses increase the cost.
“It has become worst now with spiked prices of drugs. Insulin which I used to buy for 3000 Francs is now sold at 6000 Francs (10 USD). There is another medicine called vildagliptine, which I used to acquire at the Mission Hospital (name of Health Facility withheld) at 4,900 FRS, but it’s no longer available, now, I buy it from pharmacies in town at 22,500 FRS (38 USD), four times more expensively. I am a retired citizen, how am I supposed to survive?)”. Joan laments.
Health care cost varies with the source of care. Public and Confessional Health Care Services tend to be cheaper than the Private services.
Unfortunately, insurance schemes are not widely available and when they are, they typically cover medical cost related to infections conditions and surgical procedures, not chronic diseases. The chronic nature of NCDs and their propensity to be co-morbid implies that related expenditures would continue to mount as long as the patient lives. Patients have no choice but to rely on their personal income and most times, with support from their relatives. Consequently, an individual’s illness literally becomes a family burden.
“Everything stems from finances, from running out of drugs to the absence of a support system, either friends or family members. There are those who will always be there and wish you well, but others tend to shy or run away from you for fear of financial involvement. Sometimes, consumables (medical supplies required for procedures) don’t arrive on time, forcing patients to start looking for them on the black market to secure treatment schedules.” Explains Susan (not her real name), who is living with end-stage kidney disease (requiring haemodialysis)
The CBC Health Services runs Outpatient Clinics with support group system for persons living with diabetes and hypertension and sickle cell disease. These Clinics provide an opportunity for patients to share their experiences, success stories, challenges, and encourage one another. This is also an avenue for the health care worker to continually dispel myths and enhance lifestyle counselling. Financial constraint is the most commonly challenge or barrier patients always talk about.
.“It is so disheartening to see what persons living with NCDs go through for their health needs. They have to set aside a portion of their income, on a regular basis, for routine health care expenses. When new complications set in, or if their condition exacerbates, these expenses Increase. Also, when we have stock-outs of some medicines at a given period within the CBC Health Services, the patients have no choice but to get the branded forms which are considerably more expensive from community Pharmacies. The price difference between our Services and the Community Pharmacies is can be explained by the fact that the latter are businesses and thus profit-making, whereas the CBC Health Services is a not-for-profit entity. We are putting in place strategies to ensure uninterrupted availability of medicines and other NCD-related supplies to optimize the care we provide to our patients.””. Dr. Epie Njume, General Supervisor, NCD Prevention and Control Program CBC Health Services.
There has been chronic underinvestment in screening, early diagnosis treatment and rehabilitation and prevention of NCDs. In 2019, Health Systems were unable to fully respond to the healthcare needs of people living with or affected by NCDs in most countries. Existing gaps have been highlighted and their effects made more acute by the COVID-19 pandemic. Currently, there are growing calls to from the international community to improve spending on NCDs and rebuild Health Systems which are inclusive, robust and in which people living with NCDs have a voice. Hence the social media trend: #BuildBackBetter