Management

Asthma Drug Facility

Prof Nadia Aït-Khaled, representative of Working Group 4

Karen Bissell, DrPH, representative of Asthma Drug Facility, The Union

Essentials of Asthma CareFor low- and middle-income countries

• Objective: quality and cost-effective asthma care

for the majority of asthma patients

• Good essential practice from GINA guidelines

• Organisation of care in general services

• Standardised diagnosis with simple tools

• Standardised treatment with essential drugs

• Evaluation to assure quality of care

Ait-Khaled N, Enarson D. Guide 1996, revised in 2005

Ait-Khaled N et al. Workshop report. Int J Tuberc Lung Dis 2001; 5(10):973-7.

Efficiency of The Union model Routine cohort analysis after 1 year*

100310TOTAL

1135Failure

13Transfer

35116Default

2061Control

3195Success

Per centPer centNumberNumberOutcomeOutcome

* Outcome after one year in Algeria, Morocco, Syria and Vietnam

Aït-Khaled N et al. Int J Tuberc Lung Dis. 2006 ;10(8):911-6.

Results under routine conditions*Evaluation of quality of care

0

20

40

60

80

100

120

140

160

Before After

ER visits

Hospitalization

* Outcome after one year: Union guide in Algeria, Morocco, Syria and Vietnam

Nb events

N=126

Main challenges for asthma care

Comprehensive approach for lung health*

• Lack of political commitment: priority in infectious diseases, no national guidelines

• Lack of organisation of services: patients treated only for attacks

• Diagnosis based only on symptoms, lung function not available

• No standardised long term treatment and use of inadequate oral drugs or ineffective drugs such as antibiotics and mucolytics

• Inhaled steroids not affordable for the majority of patients

* Implemented in several sites of Sudan, China and Benin, 2006-2007

Why create an Asthma Drug Facility?

The Union created the ADF

• to provide access for low and middle-

income countries to affordable good quality

essential asthma medicines

• to promote standardised management of

asthma with evaluation of quality of care

How does the ADF work?

• ADF organises qualification of manufacturers and

products (as part of its Quality Assurance system)

• Countries purchase generics at affordable prices; ADF

provides training materials and EpiData information

system.

Additional services in collaboration with The Union:

• Training courses and technical assistance

ADF requirements:

• implement The Union’s standardised 4 step approach (or

local adaptation) and report on outcomes of persistent

asthma cases treated with drugs purchased through ADF

Qualification of manufacturers

and their products• 4 manufacturers submitted Expressions of Interest

for HFA inhaled steroids and short-acting beta

agonists

• Panel examining submissions (incl. 2 pharmacists)

Next steps

• site visits: to evaluate site and products

• list of qualified manufacturers & qualified products

• limited international tender

• publish prices and receive orders (Oct 2008)

ADF in 2008

Assuring quality

ADF will work to:

• ensure that quality of drugs is never compromised in the search for low prices

• ensure that standardised management is understood to be key for evaluating quality

• promote use of CFC-free drugs

• promote rational and accountable drug purchasing and distribution by national and international actors

ADF in 2008

Orders and collaboration with countries

• ADF and The Union will envisage regional and/or national training courses and technical assistance, if funds are available

• ADF will work with countries towards optimal conditions for delivery of drugs and monitoring of outcomes

• Countries need to have budget and political

commitment for asthma

ADF in 2008

Role of Practical Approach to Lung health

• PAL included in the Stop TB Partnership’sstrategic plan 2006-2015: at least 50% of countries must have implemented PAL before2015

• Number of countries adopting PAL is increasing each year. Governments are committing to purchasing asthma drugs

• Growing number of countries are receiving budget for PAL through GFATM; some have obtained budget for purchasing asthma drugs

Role of GARD

GARD will play a decisive role in obtaining

commitment from low-income country

governments by encouraging them to:

• identify asthma as a new public health priority

• allocate a budget line for the purchase of

essential asthma medicines

Addressing challenges for organisation

of services for CDR management

Implementation of complementary strategies for the integrated management for tuberculosis and other respiratory diseases according to the country priorities:

• Practical Approach to Lung Health (WHO): syndromic approach at the level of primary health care

• and Comprehensive Approach to Lung Health (CLH) implemented by The Union at the first referral level

Asthma Drug Facility and GARD partners

Improving the management of asthma patients

in low and middle income countries