Comprehensive Approach to Lung Health project.
In 2008, in order to improve the management of asthma in Benin and facilitate better access to quality care, the World Bank, with the technical support of the International Union Against Tuberculosis and Lung Diseases (The Union), implemented the “Comprehensive Approach to Lung Health” project. In 2009, The Union funded the “Asthma Drug Facility”, donating essential quality-assured asthma medicines, with the goal of making them affordable for patients. Six health facilities, including the national reference hospital for respiratory diseases, implemented these projects. With the funds injected from these two projects, Benin established a “Revolving Drug Fund” (RDF) to buy asthma medicines and sell them to patients at an affordable price and to ensure regular renewal of the supply of essential asthma medicines. Ten years on, assessment of asthma management in these facilities is uniformly positive, although some challenges still exist.
Since the project started, physicians use simple tools to confirm asthma diagnosis. Medical doctors and nurses provide a daily clinic in the reference hospital for people with asthma and plan for follow-up appointments. Compared to the price in private pharmacies, essential asthma medicines (short-acting bronchodilator and inhaled corticosteroid (ICS)) are low cost. The RDF system is working well, ensuring regular renewal of the supply of medicines. When indicated, those involved in the project prescribe preventers to patients, and systematic training of new staff ensures continuity of care.
The high rate of “lost to follow-up” within the cohort remains a concern. Many such patients do not attend follow-up appointments because their asthma improves, while others describe persistent poor control of their disease, resulting in them abandoning ICS treatment. For these patients, prescription of a combination ICS with long-acting β2-agonist (LABA) bronchodilator (on the World Health Organization Essential Medicines List since 2017) may improve disease control, but the cost of these medicines remains too high. Discussions are ongoing to address these issues.