With proper management and medicines, the severity of asthma can be dramatically reduced, and a person’s quality of life significantly improved. Yet for millions of people with asthma, especially those in low- and middle-income countries, these benefits are unattainable.

Although several effective asthma medicines are on the WHO Essential Medicines List, the most commonly reported obstacle to successful asthma management is the lack of access to essential medicines. For many patients and health systems, asthma medicines are prohibitively expensive and frequently not available.

The Asthma Drug Facility (ADF), a project of The Union, is helping to overcome this obstacle by making it possible for low- and middle-income countries to obtain quality-assured essential medicines at affordable prices. Through the ADF, the cost of one year of treatment for a patient with severe asthma has already come down to about US $40. In some countries, this is half of what they were paying before the ADF.

Assuring both quality and affordability

The Union places the highest importance on providing not only affordable but also quality-assured medicines. The ADF has a quality assurance system based on WHO norms and standards. Since asthma inhalers are not part of the WHO Prequalification Programme, the ADF has to organise the selection of manufacturers and products. It keeps prices down by having a limited competitive process among selected manufacturers, based on annual estimated volumes. Countries can then purchase these affordable products through the ADF.

Inhaled HFA corticosteroids
Beclometasone 100μg / puff, 200 doses, HFA inhaler
Budesonide 200μg / puff, 200 doses, HFA inhaler
Fluticasone 125μg / puff, 120 doses, HFA inhaler
Inhaled HFA short-acting beta2-agonist
Salbutamol 100μg / puff, 200 doses, HFA inhaler

Improving quality of care takes more than medicines

To address the other aspects of asthma care, the ADF provides The Union’s asthma management guidelines and training materials. These help clients build their capacity for asthma management and establish an information system for monitoring patient outcomes. By tracking the reduction in patients’ emergency visits and hospitalisations, health care providers and administrators see the health benefits and financial advantage of providing appropriate care and medicines. They can also evaluate and improve patient management.

Financing asthma medicines

Countries that have chosen to purchase quality-assured medicines through the ADF have done so using a variety of mechanisms. Some examples are:

The Global Fund

Countries may purchase asthma medicines through the ADF with funds from the Practical Approach to Lung Health (PAL) component of their TB grants from the Global Fund to Fight AIDS, TB and Malaria. Burundi and Guinea Conakry, for example, are using their PAL funds to purchase through the ADF.

Revolving drug funds

Another approach is for the government or a donor to make an initial capital investment to purchase medicines through the ADF. The medicines are then sold to patients with a small margin to cover local charges and increase the fund progressively. New orders are placed and the fund becomes self-financing. Sudan and Benin are using this approach. By applying a 12–18% margin, these countries have managed to make prices affordable for patients and replenish the funds for future orders.

Health budgets

Ministries of Health can ensure that asthma care is provided at primary health care level as well as reference levels by including this cost in their budgets. In El Salvador, for example, medicines are provided free-of-charge to patients in areas that are implementing the PAL strategy.

Scaling up

Some countries have developed sustainable financing solutions to guarantee continuous availability of medicines for this chronic condition. However, only a very small number of countries and patients have so far benefited from the ADF.

Countries using the ADF to improve asthma care

El Salvador: The National Tuberculosis Programme (NTP) is working with El Salvador’s PAL programme. The price of medicines decreased by more than 50% when purchased through the ADF.

Benin: began receiving medicines through ADF in 2009. The NTP is running the asthma project, using the systems and experience from the DOTS model for managing tuberculosis.

Sudan: EpiLab is working with the government to achieve a national asthma control strategy. Sudan has been piloting standardised asthma management based on the DOTS model since 2006.

Kenya: is focusing on patients in and around Nairobi. The Kenya Association for the Prevention of Tuberculosis and Lung Disease purchased inhalers with funds from the World Lung Foundation.

Burundi: The NTP is using Global Fund money to pilot PAL. Asthma medicines are making the asthma component of PAL an affordable reality.

Vietnam: is decentralising care to health posts attended by the poor in Vietnam. Inhalers are being purchased with funds raised by The Union’s staff, consultants and Board.

Guinea Conakry: The NTP has placed its first order, using funds from the Global Fund. The inhalers will be used for the country-wide implementation of PAL.

- Cécile Macé, Karen Bissell

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