Surveys

The Task Force has carried out three surveys on the access to and availability of insulin in IDF member countries. Survey results were based on responses by IDF member associations and were not the result of a rigorous epidemiological study. Nonetheless, each survey showed that major obstacles identified in the earlier survey continued to hinder people from diabetes from obtaining the insulin they needed to survive. This serves to underline the urgent need to take action to increase access to insulin and diabetes supplies in many countries.

The Task Force has carried out four surveys on the access to and availability of insulin in IDF member countries. Survey results were based on responses by IDF member associations and were not the result of a rigorous epidemiological study. Nonetheless, each survey showed that major obstacles identified in the earlier survey continued to hinder people from diabetes from obtaining the insulin they needed to survive. This serves to underline the urgent need to take action to increase access to insulin and diabetes supplies in many countries. 

2006 Survey

The key findings of the survey carried out in 2006 were:

  • Africa on the whole had the lowest level of access to insulin for people with type 1 diabetes.
  • People who required insulin were able to obtain it on a continuous basis in only seven countries that were surveyed.
  • Insulin was most widely available in private pharmacies, followed by public pharmacies, in countries where respondents gave an answer.
  • Half of the countries surveyed had taxes on insulin.
  • The main reason for not doing self-monitoring reported from different countries was cost of supplies.

Download the full report (pdf).

2002 Survey

The most recent survey, carried out in 2002, extended coverage to the access to and availability of diabetes supplies including urine test strips, blood glucose meters and blood glucose test strips. The survey reconfirmed the wide variation in prices of insulin and diabetes supplies which an IDF survey of diabetes associations in 1999 had found. The 1999 survey found, for example, that the price of a 10-ml vial of U100 animal insulin varied from USD10 to USD47 in countries where there were no state subsidies for this essential drug.

The 2002 survey also found, among other things, that:

  • Many people in economically developing countries do not appear able to access insulin because they cannot afford it.
  • Animal insulin is considerably cheaper in those countries where both human and animal insulin are available.
  • In many countries, insulin in vial form is significantly cheaper than the same type of insulin in pen-fill cartridge form.
  • Blood glucose test strips appear to be even less accessible than insulin for the same reason of affordability.
  • Urine test strips are significantly more accessible because they are much more affordable. They provide a viable testing method in the absence of affordable glucose testing. There seems to be evidence that the use of urine test strips may be decreasing without a commensurate increase in the use of blood glucose test strips, i.e. increasing numbers may not be testing at all.
  • Taxes are still a significant factor affecting the price of insulin, and other diabetes supplies in a large number of countries even though WHO essential drugs guidelines state that there should be no taxes on insulin.

1997 Survey

The 'Access to Insulin' survey in 1997 concluded that up to 20% of people with type 1 diabetes did not always have access to all the insulin they required. It showed that a number of different factors combined to make insulin inaccessible or unavailable to many people with diabetes who required it for survival. The reasons most often cited for lack of access to insulin, syringes and needles were affordability, and distribution and transportation problems. For instance, the costs of outpatient healthcare for type 1 diabetes in Tanzania was estimated at USD229 per person per year, of which some two-thirds was made up by the cost of insulin. This was equivalent to about six months of a family's income in most developing countries. Other obstacles to insulin access included customs duty, lack of health insurance, government policy, storage and doctors not prescribing insulin1.

The survey of 120 countries found that only 48 countries could offer insulin at all times to people in urban areas who needed it. Results showed that continual access to insulin, syringes and needles (i.e. 100% of the time) was greater in urban than in rural areas. Lack of access (less than 25% of the time) was more common in rural than in urban areas. The chronic lack of access to insulin was more common in Africa while the lack of access to syringes and needles was apparent in Africa, and South and Central America. These problems were least common in Europe.

1992 Survey

The first survey, in 1992, revealed that 15 countries out of 60 had severe problems with access to insulin while two countries reported that access to insulin was extremely poor, i.e. less than 25% of the time. However, 47 countries reported continual and uninterrupted availability of insulin in urban areas2.

References:
1. 1997 Access to Insulin report. International Diabetes Federation, Brussels, 1998.
2. Meng Tan, Larry Deeb and KGMM Alberti, 1992 Access to Insulin report. International Diabetes Federation, Brussels, 1992.