Availability and Affordability of Essential Medicines and Diagnostic Tests for Diabetes Mellitus and Cardiovascular Diseases in Sub-Saharan Africa: A Systematic Review

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Abstract
Background: Diabetes mellitus (DM) and cardiovascular diseases (CVD) pose a significant health challenge in sub-Saharan Africa (SSA). Interventions to improve access to affordable essential medicines and diagnostic tests are needed to reduce morbidity and mortality due to these conditions. We performed this systematic review to evaluate the availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA, where health resources are particularly scarce. Methods: PubMed, Scopus and African Journal Online databases were searched for original research articles conducted in SSA between 2000 and March 2018 with information about availability and affordability of essential medicines and diagnostic tests for DM and CVD. Findings: Twenty cross sectional studies were identified with the majority performed in East African countries (n=12, 60%). Availability of insulin and oral hypoglycaemic agents (OHA) widely ranged from 0-100%. Angiotensin converting enzyme inhibitors, anti-platelet drugs and statins were available in 0-96.5%, 20.8-100% and 3.1-84% of surveyed health facilities respectively. Availability of blood glucose testing, glycated haemoglobin (HbA1c), electrocardiography (ECG) and troponin testing ranged from 6-100%, 20-43.5%, 9.1-81.8% and 0-43.2% respectively. The monthly cost of the majority of the lowest priced generic medicines and diagnostic tests was <3.5 days' wages. The cost of insulin, statins and unfractionated heparin widely ranged from 3.85-18.7 days' wages, 6.5-30.51 days' wages and 38.5-182.36 days' wages respectively. Interpretation: The availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA is suboptimal. Pragmatic solutions are urgently needed to address this challenge. Funding Statement: The authors declare: "No funding was received for this work." Declaration of Interests: The authors declare no competing interests.

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