Monitoring The Right To Health in Venezuela Newsletter Nro 1

CONVITE - Newsletter Nยบ 1. September, 2017.

An Approximation based on Medicine Shortages, Preventable Deaths and Hospital Infrastructure.

Newsletter Nro 1 1

XLaSalud XLaSalud

SEP. 2017

CONVITE - Newsletter Nº 1. September, 2017.

MEDICINE SHORTAGE INDEX

FOR THE FOUR (4) MOST RECURRENT CAUSES OF MORBIDITY IN VENEZUELA. • Rationale and Relevance of Measurement: Concerned for the widespread shortage

situation that we are facing, including a shortage of medicines, we have devised a Medicine Shortage Index (MSI) in order to raise awareness of the vulnerability of people affected by ailments such as high blood pressure, type 2 diabetes, diarrhea, and acute infections of the respiratory tract.

• Concept: The Medicine Shortage Index is defined as the “percentage of establishments in the

sample where a product cannot be found, in any presentation or form, by the patient.” It takes into account the temporary unavailability of specific drug products (unavailability or shortage indicator) and of all their substitutes or replacements (products that may be used instead of the one specifically requested) on establishment shelves, with a view to determining whether or not there is a shortage of supply of said products.

• Background: At its first stage, the collection of information on the MSI was aimed at high-

lighting the shortage of the essential medicines to treat the most common morbidity causes in the elderly, namely high blood pressure and type 2 diabetes. Health professionals were summoned for advice in order to determine the protocol and treatment applicable to each case.

Data were collected only in the Metropolitan Area of Caracas (MAC), with a sample of 40 pharmacies from a universe of 164 retail pharmacy chain stores. The project began with a pilot test on April 2016, and has been in place uninterruptedly ever since. The most recent measurement was conducted on June 14, 2017, where the index revealed an alarmingly high shortage percentage of 100% for high-blood pressure drugs and 96% for diabetes medication, and the trend is likely to remains unaltered.

• Scope of Measurements: Within the framework of a project entitled “Monitoring the Right

to Health in Venezuela: An Approximation based on Medicine Shortages, Preventable Deaths and Hospital Infrastructure”, we have decided to broaden the scope of the index’s measurement from several dimensions: first, the number of morbidities under study was increased: as of the second semester of 2017, it will include the four (4) most recurrent causes of morbidity in Venezuela; in that connection, diarrhea and acute infections of the respiratory tract (AIRTs) were also measured; second, the age group was broadened to include 2 new causes of morbidity that are not exclusive of elderly people and affect the Venezuelan population in general; third, the geographical area monitored now includes four other capital cities: Barquisimeto, Mérida, Maracaibo and Porlamar, thereby depicting the medicine shortage situation in the inland cities of the country, and fourth, the periodicity of data collection was increased to 2 measurements, on the second and fourth weeks of each month, respectively.

• The inclusion of the ailments aforementioned is not an arbitrary or personal decision by our team: it was essentially made based on information from the World Health Organization (WHO) according to which acute infections of the respiratory tract (AIRTs)

2

XLaSalud

CONVITE - Newsletter Nº 1. September, 2017.

and diarrheal illnesses are the major causes of morbidity and mortality in developing countries.

They warn that out of the 15 million annual deaths of children under 5-years old in the world, 14 million, that is, 93%, occur in developing countries, and that out of said 14 million deaths, approximately ¼ or 1/3 are caused by diarrheal diseases, and a similar proportion by AIRTs.

• About the Morbidities: According to an epidemiology profile of Venezuela, the major caus-

es of morbidity include high blood pressure, non-insulin-dependent diabetes or type 2 diabetes (in the case of elderly people), diarrhea, and acute infections of the respiratory tract (AIRTs).

The World Health Organization (WHO) defines the different causes of morbidity included in the survey, as follows: HIGH BLOOD PRESSURE Also known as raised blood pressure, is a disorder in which pressure in blood vessels is persistently high, which may lead to damage. When the heart beats, it pumps blood to the vessels, which carry blood through the entire body. Blood pressure is the force of blood pushing against the walls of the vessels (arteries) as pumped by the heart. The higher the pressure, the more work the heart has to do to pump blood. Most people with high blood pressure show no symptoms at all. Occasionally, high blood pressure causes symptoms such as headache, difficulty breathing, vertigo, chest pain, palpitations, and nose bleeding, though not always. If left untreated, high blood pressure may lead to myocardial infarcts, an enlarged heart, or cardiac failure.

DIABETES Is a chronic disease that occurs when the pancreas is no longer able to produce enough insulin or when the body is not able to efficiently use the insulin that it produces. The main effect of untreated diabetes is hyperglycemia (increased levels of glucose in the blood). Type 2 diabetes (formerly known as non-insulin-dependent diabetes or adult-onset diabetes) is caused by the body’s inability to efficiently use insulin, which is more than not the result of excess body weight or a sedentary lifestyle.

3

XLaSalud

CONVITE - Newsletter NÂş 1. September, 2017.

DIARRHEA The WHO defines diarrhea as the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual. It is usually a symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person to person as a result of poor hygiene. Alarmingly, diarrheal diseases are the second leading cause of death in children under 5-years old.

AIRTs Acute infections of the respiratory tract (AIRTs) are a set of communicable diseases of the respiratory tract, including the common flu, as well as severe pneumonia, ear infections, tonsillitis, sinusitis, acute bronchitis, etc.

Among the germs responsible for their communication are bacteria (particularly pneumococcal and haemophilus) and viruses. However, it is frequently impossible to distinguish the microorganism responsible therefor based on clinical or radiological data only. On average, children suffer from 6 to 8 acute infections of the respiratory tract on an annual basis until the age of 5. This group of illnesses account for 30%-50% of pediatric visits in poor countries, and 20%-40% of hospital pediatric entries.

Taking into account the protocol for treatment of these four ailments, the results of consultations with physicians who performed as advisors in the project, and the list of essential drug products proposed by the World Health Organization and the Ministry of the People’s Power for Health, we have generated a basic basket of medicines, including: a)

High Blood Pressure: Six (6) active principles: Enalapril, Valsartan, Atenolol, Nifedipine, Amlodipine and Losartan, in fourteen (14) different dosages.

b)

Diabetes: For type 2 diabetes, three (3) active principles: Metformin, Glyclazide, and Glibenclamide, in six (6) different dosages.

c)

Diarrhea: Five (5) active principles: Ciprofloxacin, Trimethoprim, Sulfamethoxazole, Ceftriaxone, and Metronidazole, in nine (9) different dosages.

d) Acute Infections of the Respiratory Tract (AIRTs): Nine (9) active principles: Penicillin, Amoxicillin, Clavulanic Acid, Clarithromycin, Cefuroxime Axetil, Moxifloxacyn, Levofloxacyn, Clindamycin, and Doxycylin, in thirteen (13) different dosages.

IN SHORT, THIS IS THE BASIC BASKET OF MEDICINES ON WHICH THE SURVEY OF SHORTAGE OF MEDICINES CONDUCTED BY CONVITE, A.C. IS BASED. 4

XLaSalud

CONVITE - Newsletter Nº 1. September, 2017.

GEOGRAPHICAL DISTRIBUTION of the MSI for Measurement Purposes Metropolitan Area of Caracas Consisting of forty (40) drugstores from a universe of 164 retail pharmacy chain stores1 covering the Greater Caracas2. These 40 drugstores3 in the sample are distributed by municipality and number, proportionally, as follows: Municipality of Baruta: 7 establishments. Municipality of Chacao: 5 establishments.

Municipality of El Hatillo: 2 establishments. Municipality of Sucre: 5 establishments.

Municipality of Libertador: 21 establishments.

NOTES: 1. Locatel, Farmatodo, Farmahorro, Fundafarmacia, Farmacias SAAS and Farmaplus.

2. Municipalities or Libertador, Baruta, Chacao, El Hatillo and Sucre.

3. Click on this link to view a digital version of the sample, broken down by municipality and establishment. https://www.google.com/maps/d/viewer?mid=1KeU8ZyT8gvWg9fAO-ewNQ49lnW0&ll=8.237409969479915%2C-65.7686405&z=5

Barquisimeto The population for the city of Barquisimeto1 consisted of one hundred and two (102) establishments covering the municipalities of Iribarren and Palavecino, in a sample of twenty-seven (27) drugstores to be surveyed. The 27 drugstores in the sample are distributed by municipality, parish, and number, as follows: Municipality of Palavecino Parish Cabudare

1 establishment

Municipality of Iribarren Parish: Cabudare Parish: Concepción Parish: Juan de Villegas

1 establishment 14 establishments 3 establishments

Parish: Catedral 8 establishments Parish: Unión 1 establishment

NOTES: 1. Municipalities of Iribarren and Palavecino.

Mérida The population for the city of Mérida1 consisted of eighty-six (86) establishments covering the Municipality of Libetador, in a sample of twenty-five (25) drugstores to be surveyed. The 25 drugstores in the sample are distributed by parish and number, as follows:

Municipality of Libertador Parish: Antonio Spinetti Dini Parish: Domingo Peña Parish: Juan Rodríguez Suárez Parish: Milla Parish: Sagrario

1 establishment 2 establishments 3 establishments 2 establishments 5 establishments

NOTES: 1. Municipality of Libertador.

5

Parish: Caracciolo Parra Pérez 3 establishments Parish: El Llano 5 establishments Parish: Mariano Picón Salas 2 establishments Parish: Osuna Rodríguez 2 establishments

Ally: PROMEDEHUM.

XLaSalud

CONVITE - Newsletter Nº 1. September, 2017.

Maracaibo The population for the city of Maracaibo1 consisted of two hundred and fourteen (214) establishments covering the Municipality of Maracaibo, in a sample of thirty-one (31) drugstores to be surveyed. The 31 drugstores in the sample are distributed by parish and number, as follows:

Municipality of Maracaibo Parish: Antonio Rojas Romero 1 establishment Parish: Bolívar 2 establishments Parish: Cacique Mara 1 establishment Parish: Caracciolo Parra Pérez 2 establishments Parish: Cecilio Acosta 1 establishment Parish: Chiquinquirá 4 establishments Parish: Coquivacoa 1 establishment Parish: Cristo de Aranza 2 establishments Parish: Francisco Eugenio Bustamante

NOTES: 1. Municipality of Maracaibo.

Parish: Juana de Ávila Parish: Manuel Dagnino Parish: Olegario Villalobos Parish: Raúl Leoni Parish: Santa Lucía Parish: Venancio Pulgar

3 establishments 2 establishments 4 establishments 2 establishments 1 establishment 1 establishment

3 establishments

Ally: Asociación Civil Mulier.

Porlamar The population for Porlamar1 consisted of one hundred and seventeen (117) establishments covering all the municipalities in the state, in a sample of twenty-eight (28) drugstores to be surveyed. The 28 drugstores in the sample are distributed by municipality, parish, and number, as follows: Municipality of Antolín del Campo Municipality of Arismendi Municipality of Díaz Municipality of García Municipality of Gómez Municipality of Maneiro

Parish: Antolín del Campo Parish: Arismendi Parish: San Juan Bautista Parish: García Parish: Sucre Parish: Aguirre Parish: Maneiro Municipality of Marcano Parish: Juan Griego Municipality of Península de Macanao Parish: Boca del Río Municipality of Tubores Parish: Tubores

2 establishments 4 establishments 2 establishments 2 establishments 1 establishment 1 establishment 3 establishments 2 establishments 2 establishments 2 establishments

NOTES: 1. Municipalities of Antolín del Campo, Arismendi, Díaz, García, Gómez, Maneiro, Marcano, Península de Macanao, Tubores.

Ally: STOP VIH

6

XLaSalud

XLaSalud Con el apoyo de:

Créditos de traducción:

YAZMINE LIVINALLI FERNÁNDEZ, B.A.

Bachelor of Arts in Translation and Interpretation, English-French-Spanish, Universidad Central de Venezuela, Caracas, Venezuela, 1985; Legal Translator Degree, Universidad Metropolitana, Caracas, Venezuela, 2006.

ATA member. Registered with and accredited by the Ministry of the Interior and Justice, Venezuela. yazlivi@gmail.com.

@conviteac

@conviteac

Convite Asociación Civil

https://conviteblog.wordpress.com/