Monitoring The Right To Health in Venezuela Newsletter Nro 5

CONVITE - Newsletter Nยบ 5. January, 2018

Newsletter No 5

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XLaSalud XLaSalud

JAN. 2018

Medicine Shortage Index, December 2017.

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Overview

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Cause of Morbidity: Diabetes.

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Cause of Morbidity: High-Blood Pressure.

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Cause of Morbidity: Acute Infections of the Respiratory Tract.

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Cause of Morbidity: Diarrhea.

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Convite strongly denounces:

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Health in Times of a Complex Humanitarian Crisis in Venezuela.

Appendices: Overview by City.

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Location: Metropolitan Area of Caracas.

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Location: Barquisimeto.

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Location: Maracaibo.

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Location: MĂŠrida.

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Location: Porlamar.

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MEDICINE SHORTAGE INDEX Analysis and interpretation of aggregate results of medicine shortage index measurements for december 2017 vis-à-vis the first six weeks surveyedn1.

Diabetes

High Blood Pressure

MAC

86.3%

82.4%

94.1%

95.1%

Barquisimeto

96.3%

83.3%

94.9%

92.6%

Mérida

84.0%

62.3%

97.2%

97.5%

Maracaibo

78.5%

73.7%

90.3%

68.8%

Porlamar

94.3%

91.4%

97.8%

92.0%

86.6%

80.4%

93.7%

88.2%

TOTAL

AIRTs Diarrhea

Table Nº 1: Medicine Shortage Indexby Cause of Morbidity per City Surveyed

100.0% 95.0% 93.1% 90.0% 85.0% 80.0%

91.4%

88.0% 88.5%

75.0%

1st Sep.

2nd Sep.

1st Oct.

2nd Oct.

89.4%

1st Nov.

90.2% 89.2%

2nd Nov.

1st Dec.

87.2%

2nd Dec.

General SI

93.1% 91.4% 88.0% 88.5% 89.4% 90.2% 89.2% 87.2%

Diabetes

90.7% 87.6% 89.3% 88.6% 88.2% 89.8% 88.3% 85.6%

High-Blood Pressure

92.8% 80.9% 80.6% 79.6% 81.6% 82.6% 82.8% 80.4%

Acute Infections of the Respiratory Tract

94.0% 94.8% 95.5% 96.5% 96.8% 97.1% 95.1% 93.7%

Diarrhea

95.6% 87.2% 86.7% 89.2% 91.2% 91.4% 90.4% 88.2% Graphic Nº 1: Medicine Shortage Indexby Cause of Morbidity (Time Series)

At the aggregate level (nationwide), the General Shortage Index saw a reduction, albeit marginal, of 3%, fluctuating between 1% and 2% in the morbidities surveyed. Thus, the first measurement of the month reveals that the GSI remained unchanged as compared against the same week in the month of November, whereas the second measurement shows a 3% reduction vis-à-vis its counterpart in the previous month.

However, it is important to note that the foregoing measurements are far from depicting normalcy; rather, they indicate that the Complex Humanitarian Crisis that we are facing is only worsening. It is alarming to observe how the indicator of shortage of essential drugs is dangerously approaching the highest threshold (above 80%) just two weeks shy of the end of the year 2017.

The sustained trend towards 100% shortage of medication to treat acute infections of the respiratory tract (ARTIs) is still disturbing, with 93.7%shortage of active ingredients that are used in products prescribed to treat said ailments.

As for the medications included in the basic baskets of drugs to treat the rest of the morbidities surveyed, the shortage indicator was below 90%, which is far from encouraging, considering that 80% shortage is alarming in a country where 1 in 3 people suffers from high-blood pressure and more than 8 million are at risk of becoming diabetic. This is all the more serious in a country such as Venezuela, with a population of around 30 million inhabitants.

1 Period and Frequency of Data Collection: The survey consisted of two measurements made in December 2017 between the 5th and 6th and between the 12th and the 13th, which dates fall on the first and second weeks of the month, respectively, in order to detect variations that could be measured and circulated regarding medicine supply protocols in pharmaceutical establishments. For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter Nº 2, October, 2017. https://goo.gl/Vrh1EJ.

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It is discouraging that, after 8 weeks during which results were measured and published, the General Shortage Index only decreased by 5.9% in the second week of December as compared against the first week of the month of September, which is when the survey formally begun. The situation is

daunting, particularly in light of our repeated monthly calls on the competent authorities to focus on finding an immediate solution to the medication shortage crisis.

Health, and hence the life of its citizens, is not a priority for the Venezuelan State, but it is in the State that lies the responsibility of designing and implementing effective and efficient policies aimed at guaranteeing its nationals’ wellbeing.

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AGGREGATE RESULTS BY CAUSE OF MORBIDITY AT THE NATIONAL LEVEL SEPTEMBER-DECEMBER 2017

100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0%

General SI

Porlamar

1st 2nd 1st 2nd 1st 2nd 1st 2nd Week, Week, Week, Week, Week, Week, Week, Week, Sep. Sep. Oct. Oct. Nov. Nov. Dec. Dec. 90.7%

87.6%

89.3%

88.6%

88.2%

90,3%

88.3%

86.6%

91.9%

90.8%

93.1%

93.1%

93.1%

94.1%

87.9%

86.3%

87.7%

90.1%

92.6%

100.0%

93.8%

96.3%

97.4%

96,3%

79.0%

96.3%

92.6%

88.9%

91.4%

93.8%

86.4%

84.0%

74.2%

78.5%

78.5%

71.0%

73.1%

76.3%

80.6%

78.5%

80.0%

90.8%

96.6%

90.8%

90.8%

90.8%

95.4%

95.4%

94.3%

70.0%

Graphic Nยบ 2: Medicine Shortage Indexfor Diabetes, per City

100.0% 90.0%

60.0% 50.0%

1st 2nd 1st 2nd 1st 2nd 1st 2nd Week, Week, Week, Week, Week, Week, Week, Week, Sep. Sep. Oct. Oct. Nov. Nov. Dec. Dec.

General SI

Porlamar

Graphic Nยบ 3: Medicine Shortage Indexfor High Blood Pressure, per City 100.0% 95.0% 90.0% 85.0% 80.0% 75.0%

1st 2nd 1st 2nd 1st 2nd 1st 2nd Week, Week, Week, Week, Week, Week, Week, Week, Sep. Sep. Oct. Oct. Nov. Nov. Dec. Dec.

General SI

105.0% 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 65.0% 60.0%

Porlamar

Graphic Nยบ 4: Medicine Shortage Indexfor Acute Infections of the Respiratory Tract, per City

1st 2nd 1st 2nd 1st 2nd 1st 2nd Week, Week, Week, Week, Week, Week, Week, Week, Sep. Sep. Oct. Oct. Nov. Nov. Dec. Dec.

General SI

Porlamar

Graphic Nยบ 5: Medicine Shortage Indexfor Diarrhea, per City

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DIABETES • Shortage Trend: Over 80% in all cities surveyed, with the exception of Maracaibo (a border city).

• Total shortage in all retail pharmacy chains nationwide.

• Main Alerts: Porlamar, Barquisimeto, Mérida, and the municipalities of Sucre, Baruta and Libertador in the Metropolitan Area of Caracas.

Global SI Independent Retail Chain, National Retail Chain, Local

Retail Chain, Local Retail Chain, National

Independent

Global SI

Porlamar

Graphic Nº 6: Medicine Shortage Index for Diabetes, per Establishment Category and City

95.0% 90.0%

93.3%

90.5% 87.5%

85.0%

86.3%

83.3%

80.0% 75.0% 70.0%

66.7%

ta Baru

r o cao atill bertado H Cha l E Li

e AC Sucr s, M e t e ab r Di o f I S

M

Graphic Nº 7: Medicine Shortage Index for Diabetes, per Municipality, in the Metropolitan Area of Caracas

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HIGHBLOOD PRESSURE • Shortage Trend: Over 70 % in all cities surveyed.

• Main Alerts: Porlamar, Barquisimeto, and the municipalities of Baruta and Sucre in the Metropolitan Area of Caracas.

Global SI Independent Retail Chain, National Retail Chain, Local

Retail Chain, Local

Retail Chain, National

Independent

Global SI

Porlamar

Graphic Nº 8: Medicine Shortage Index for High Blood Pressure, per Establishment Category and City

95.0% 90.0%

88.1%

85.0%

83.3%

83.3%

80.2%

80.0%

82.4%

75.0%

75.0% 70.0% 65.0%

ta Baru

cao Cha

r o atill bertado H l E Li

e Sucr

for MSI

h Hig

, sure s e r d P MAC Bloo

Graphic Nº 9: Medicine Shortage Index for High Blood Pressure, per Municipality, in the Metropolitan Area of Caracas

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT • Shortage Trend: Over 90% in all cities surveyed.

• Main Alerts: Porlamar, Mérida and Barquisimeto, and all municipalities in the Metropolitan Area of Caracas.

Global SI Independent Retail Chain, National Retail Chain, Local

Retail Chain, Local Retail Chain, National

Independent

Global SI

Porlamar

Graphic Nº 10: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Establishment Category and City

95.0% 92.9%

93.8%

93.8%

95.0%

94.5%

94.1%

90.0% 85.0% 80.0%

ta Baru

r o cao atill bertado Cha i El H L

e C Sucr , MA s T R r AI SI fo

M

Graphic Nº 11: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Municipality, in the Metropolitan Area of Caracas

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DIARRHEA • Shortange trend: Over 90% % in all the cities covered by the investigation, except Maracaibo (border city).

• Main Alerts: Mérida, Metropolitan Area of Caracas, (specially the municipalities of Baruta, Chacao and El Hatillo).

Global SI Independent Retail Chain, National Retail Chain, Local

Retail Chain, Local Retail Chain, National

Independent

Global SI

Porlamar

Graphic Nº 12: Medicine Shortage Index for Diarrhea, per Establishment Category and City

100.0%

100.0%

100.0%

100.0% 95.1%

95.0% 91.7%

90.0%

93.3%

85.0% 80.0%

ta Baru

cao

Cha

r o atill bertado H l E Li

e AC Sucr a, M e h r ar r Di o f I S

M

Graphic Nº 13: Medicine Shortage Index for Diarrhea, per Municipality, in the Metropolitan Area of Caracas

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Strongly Denounces Health in Times of a Complex Humanitarian Crisis in Venezuela We are determined to speak out and raise awareness of the status of the right to health in a country that faces the worst complex humanitarian crisis in its history, whose authorities have decided to turn a blind eye, ignoring and denying a reality that affects its citizens, particularly those in vulnerable groups and unprivileged sectors.

The latter sectors and social groups, in addition to having to deal with the rampant violence that has unleashed all across the country, must face food shortages that cause child and adult deaths associated with malnutrition and undernourishment.2 They must also cope with a situation where they lack quality health care, a timely supply of drugs and/or decent hospital infrastructure to treat chronic or terminal illnesses.

Accordingly, it is safe to say that, at the close of 2017, Venezuela’s health outlook is daunting, considering that: 1. Access to health has been politicized and is the subject of discrimination by the national Government through the implementation of the so-called “Carnet de 2 Victims of this situation were “Joangelis Estrada, a 2-year-old girl who lost her corneas due to undernourishment; Johan Fajardo, 13, who died in Guanare weighting only 11 kilograms; and Gilberto Mendoza, aged 3, who could not overcome a case of pneumonia because he was severely malnourished”.

Please refer to http://www.el-nacional-com/noticias/gda/epidemia-escasez-marcan-mavidad-mas-sombria-venezuela_215888

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la Patria”(an ID card created by the government to track the identity and number of recipients of benefits within the framework of social and subsidized-food state programs) as a requisite for access to medication via the 0800SaludYa call center.

2. Venezuelans are being hit by a triple epidemic of malaria, diphtheria and measles that spreads and consolidates as a consequence of wrong health policies and mismanagement of health by the revolutionary government.

3 4 5 6 7 8

In 2017, measles returned to Venezuela and accounted for 71.83% of all measles cases across the continent; as of the month of November, 319,765 cases of malaria or “paludismo”3 had been recorded, which represents a 33% increase as compared against the same month in 2016; also, 277 cases of diphtheria were confirmed, 21% out of which resulted in death4. This situation was warned by epidemiologist Julio Castro, a renowned medical doctor of our research team at Convite. Thus, we Venezuelans lived the Christmas and New Year holidays in a dying country that is in intensive care.5

3. Malnourishment figures are the highest in the country in over 25 years. As a matter of fact, around 300,000 children are at risk of dying from causes associated with malnourishment.

4. There is 88% shortage of diarrhea medication, despite the fact that 31 Venezuelans under the age of 12 months died in 2016 from causes associated with the disease.6 5. There is an imminent threat of a scabies outbreak,with cases already recorded in the states of Lara, Miranda and Vargas.

6. On December 26, 2017, a little girl died in the State of Anzoátegui from diphtheria, and one man died from malaria, and 10 persons remained hospitalized by that date with malaria, 3 of which are minors.7 7. The minister of health bluntly stated that that they ARE NOT going to accept humanitarian aid, adding that “We will not bend our knees before the empire, much less are we going to allow the right to impose upon an alleged humanitarian aid, when our people is being taken care of by president Nicolás Maduro”, in a message broadcasted in Caracas over the state-owned VTV television channel.8

It should be noted that malaria and “paludismo” are the same disease, a fact of which the Minister of the People’s Power for Health seems to be unaware.

These two endemic diseases had been eradicated in the country for more than 20 years, which means a terrible setback in health terms.

Please refer to http://www.el-nacional-com/noticias/gda/epidemia-escasez-marcan-mavidad-mas-sombria-venezuela_215888 Please refer to http://www.lapatilla.com/site/2017/06/28/desnutricion-y-mortalidad-infantil-avanzan-peligrosamente-en-venezuela-fotos/ Please refer to http://www.el-nacional-com/noticias/sucesos/murio-una-nina-por-difteria-hombre-por-paludismo-anzoategui_216777 Please refer to http://www.el-nacional-com/noticias/gobierno/ministro-salud-dice-que-permitira-apertura-canal-humanitario_213888

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METROPOLITAN AREA OF CARACAS DIABETES Metformin

Glyclazide

Glibenclamide

MSI Diabetes MAC

APPENDICES

MUNICIPALITY

MSI Diabetes MAC Chart Nº 2: Medicine Shortage Index for Diabetes, per Active Ingredient, in the Metropolitan Area of Caracas

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The MSI for diabetes rose in the Metropolitan Area of Caracas for all active ingredients contained in drugs to treat the disease.

•

In the Municipality of Baruta, the shortage of Metformin and Glibenclamide was total, whereas in the Municipality of El Hatillo, no Metformin or Gliclazide could be found. The shortage was really severe in the Municipality of Sucre, where only 2 of 10 patients could find Gliclazide.

•

In the municipalities of Baruta, Chacao, El Hatillo, and Sucre, the lack of medication to treat diabetes was total.

HIGH BLOOD PRESSURE MUNICIPALITY

SI Enalapril

SI Valsartan

SI Atenolol

SI Nifedipine

SI Amlodipine

SI Losartan

MSI High Blood Pressure MAC

MSI High Blood Pressure MAC Chart Nº 3: Medicine Shortage Index for High Blood Pressure, per Active Ingredient, in the Metropolitan Area of Caracas

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•

The municipality with the largest access to drugs for high blood pressure was El Hatillo, with a discouraging shortage index of 75%, with some supply of Losartan (for this municipality only), Enalapril and Amlopidine.

•

The shortage of Atelonol was total in all municipalities.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT SI Penicillin Benzatinica

SI Amoxicillin

SI SI SI Cefuroxime Clarithromycin Levofloxacyn Axetil

SI SI SI Moxifloxacyn Clindamycinand Doxycylin

MSI AIRTs MAC

APPENDICES

STRATUM

MSI AIRTs MAC Chart Nº 4: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Active Ingredient, in the Metropolitan Area of Caracas

• 6 out of 8 of the active ingredients to treat acute respiratory infections of the respiratory tract surveyed were totally absent from pharmaceutical establishments, and there was some supply of Clarithromycin.

• Shortage indexes for the month in question were cross-sectional in all municipalities in the Metropolitan Area of Caracas.

DIARRHEA MUNICIPALITY

SI Ciprofloxacin

SI Trimethoprim

SI Metronidazole

MSI Diarrhea MAC

MSI Diarrhea MAC Chart Nº 5: Medicine Shortage Index for Diarrhea, per Active Ingredient, in the Metropolitan Area of Caracas

• In December, treating diarrhea and associated syndromes was a true ordeal.

• The shortage of the three active ingredients surveyed was TOTAL in the municipalities of Baruta, Chacao and El Hatillo.

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BARQUISIMETO9 DIABETES Metformin

STRATUM

Glyclazide

Glibenclamide

MSI Diabetes BARQUISIMETO

APPENDICES

Retail Chain, Local Retail Chain, National Independent MSI Diabetes BARQUISIMETO Chart Nº 6: Medicine Shortage Index for Diabetes, per Establishment Type, in Barquisimeto

•

No variations were observed in the shortage index as compared against the data available for the month of November, which means that the shortage index is dangerously approaching 100%.

•

Only marginal amounts of the various active ingredients surveyed could be found through local retail pharmacy chains.

HIGH BLOOD PRESSURE STRATUM

SI Enalapril

SI Valsartan

SI Atenolol

SI Nifedipine

SI Amlodipine

SI Losartan

MSI High Blood Pressure BARQUISIMETO

Retail Chain, Local Retail Chain, National Independent MSI High Blood Pressure BARQUISIMETO Chart Nº 7: Medicine Shortage Index for High Blood Pressure, per Establishment Type, in Barquisimeto

•

This time, Barquisimetans were lucky to find 5 of the 6 active ingredients surveyed. The lack of Atenolol, however, was total.

9 In the State of Lara, our survey covered the Municipality of Irribarren, where the city of Barquisimeto is included, and a drugstore in the Municipality of Palavecino, to which Cabudare belongs. In this case, instead of a municipality stratification approach, a per-establishment-type approach was adopted.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT STRATUM

SI SI SI SI Cefuroxime Penicillin Amoxicillin Clarithromycin Axetil Benzatinica

MSI SI SI SI SI Levofloxacyn Moxifloxacyn Clindamycinand Doxycylin

AIRTs BQM

APPENDICES

Retail Chain, Local Retail Chain, National Independent MSI AIRTs BQM Chart Nº 8: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Establishment Type, in Barquisimeto

•

Only 3 of the 8 active ingredients surveyed were supplied to pharmacies in Barquisimeto.

Availability was the highest for Amocixillin (with a shortage indiex of 70.4%). Levofloxacyn and Clarithromycin could also be found, albeit in small amounts.

DIARRHEA STRATUM

SI Ciprofloxacin

SI Trimethoprim

SI Metronidazole

MSI Diarrhea BQM

Retail Chain, Local Retail Chain, National Independent MSI Diarrhea BQM Chart Nº 9: Medicine Shortage Index for Diarrhea, per Establishment Type, in Barquisimeto

•

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There was some availability of Ciprofloxacin and Trimethoprim; however, the shortage index for the latter approached 100% (96.3%). As for Metronidazole, the shortage was total.

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MARACAIBO10 DIABETES Metformin

STRATUM

Glyclazide

Glibenclamide

MSI Diabetes MARACAIBO

Retail Chain, Local

APPENDICES

Retail Chain, National Independent MSI Diabetes MARACAIBO Chart Nº 10: Medicine Shortage Index for Diabetes, per Establishment Type, in Maracaibo

•

The shortage of blood-glucose-lowering medication in Maracaibo was 78.5%, slightly higher than in November.

•

The shortage index for Metformin was 50% or below, as in November, closing this time at 48.4%, which is the lowest ever recorded for this active ingredient in all measurements made in the month of December; this means that diabetics in Maracaibo were luckier than those living in other regions in the survey.

HIGH BLOOD PRESSURE STRATUM

SI Enalapril

SI Valsartan

SI Atenolol

SI Nifedipine

SI Amlodipine

SI Losartan

MSI High Blood Pressure MARACAIBO

Retail Chain, Local Retail Chain, National Independent MSI High Blood Pressure MARACAIBO Chart Nº 11: Medicine Shortage Index for High Blood Pressure, per Establishment Type, in Maracaibo

•

In December, patients with high blood pressure in Maracaibo were able to find 5 of the 6 active ingredients surveyed. Nevertheless, as with Barquisimetans, it was impossible for Maracuchos to find Atenolol.

10 In the State of Zulia, our survey was conducted in the Municipality of Maracaibo, to which the city of Maracaibo belongs. Instead of a municipality stratification approach, a per-establishment-type approach was adopted.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT SI SI SI Penicillin Amoxicillin Clarithromycin Benzatinica

STRATUM

SI Cefuroxime Axetil

MSI SI Levofloxacyn

SI Moxifloxacyn

SI Clindamycinand

SI Doxycylin

AIRTs MARACAIBO

APPENDICES

Retail Chain, Local Retail Chain, National Independent MSI AIRTs MARACAIBO Chart Nº 12: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Establishment Type, in Maracaibo

•

Maracaibo does not escape the reality facing the rest of the country as far as the treatment of acute infections of respiratory tract is concerned. Only 3 of the 8 active ingredients surveyed were found in Maracaibo, namely Amocixillin (a shortage index of 51.6%),Doxycycline (a shortage index of 77.4%), and Moxifloxacin, but in marginal amounts (a shortage index of 93.5%).

•

Accordingly, in December there was NO Benzathine Penicillin, Clarithromycin, Cefuroxime Axetil, Levofloxacin, or Clindamycin to be found for Marabinos.

DIARRHEA STRATUM

SI Ciprofloxacin

SI Trimethoprim

SI Metronidazole

MSI Diarrhea MARACAIBO

Retail Chain, Local Retail Chain, National Independent MSI Diarrhea MARACAIBO Chart Nº 13: Medicine Shortage Index for Diarrhea, per Establishment Type, in Maracaibo

•

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In the basic basket of medication to treat diarrheal cases, the shortage index approached 68.8%, with some presence of the three active ingredients included in the survey.

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MÉRIDA11 DIABETES Metformin

MUNICIPALITY

Glyclazide

Glibenclamide

MSI Diabetes MÉRIDA

APPENDICES

Retail Chain, Local Retail Chain, National Independent MSI Diabetes MÉRIDA Chart Nº 14: Medicine Shortage Index for Diabetes, per Establishment Type, in Mérida

•

The shortage of blood-glucose-lowering medication in Mérida was 84%. People had to visit local independent retail chains to find diabetes drugs.

•

The three active ingredients surveyed for this cause of morbidity could be found in some amounts. Metformin was the most available, with a shortage index of 77.8%.

HIGH BLOOD PRESSURE MUNICIPALITY

SI Enalapril

SI Valsartan

SI Atenolol

SI Nifedipine

SI Amlodipine

SI Losartan

MSI High Blood Pressure MÉRIDA

Retail Chain, Local Retail Chain, National Independent MSI High Blood Pressure MÉRIDA Chart Nº 15: Medicine Shortage Index for High Blood Pressure, per Establishment Type, in Mérida

•

The most encouraging measurements of the general shortage index for medication to treat high blood pressure were those found in Mérida, with a reduction of 10.5% in the city of Mérida.

•

Availability of Enalapril, which is one of the active ingredients that are most prescribed for this disease, was below 30%, that is 22.2%, whereas that of Valsartan was 37%. The active ingredients that were the most difficult to find were Atenolol and Losartan.

11 In the State of Mérida, our survey was conducted in the Municipality of Libertador, to which the city of Mérida belongs. Instead of a municipality stratification approach, a per-establishment-type approach was adopted.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT SI SI SI Penicillin Amoxicillin Clarithromycin Benzatinica

STRATUM

SI Cefuroxime Axetil

SI SI Levofloxacyn Moxifloxacyn Clindamycinand SI

SI Doxycylin

MSI AIRTs MÉRIDA

Retail Chain, Local

APPENDICES

Retail Chain, National Independent MSI AIRTs MÉRIDA Chart Nº 16: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Establishment Type, in Mérida

•

The general shortage index for medication to treat acute infections of the respiratory tract was 97.7%, which is similar to the situation nationwide.

•

In December, Merideños were able to find some amounts of Penicillin, Amoxicillin, Moxifloxaxin and Clindamicyn, but could not find Clarithromycin, Cefuroxime-Axetil, Levofloxacin or Doxycycline.

DIARRHEA STRATUM

SI Ciprofloxacin

SI Trimethoprim

SI Metronidazole

MSI Diarrhea MÉRIDA

Retail Chain, Local Retail Chain, National Independent MSI Diarrhea MÉRIDA Chart Nº 17: Medicine Shortage Index for Diarrhea, per Establishment Type, in Mérida

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•

Although the shortage indicator dangerously approached 100%, there was some supply, albeit marginal, of 2 of the 3 active ingredients surveyed for this cause of morbidity.

•

During the last month of the year, there was a TOTAL SHORTAGE of Trimethoprim in Mérida.

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PORLAMAR

APPENDICES

DIABETES STRATUM

Metformin

Glyclazide

Glibenclamide

MSI Diabetes PORLAMAR

Retail Chain, Local

100%

100%

100%

100%

Retail Chain, National

100%

100%

100%

100%

Independent

91.3%

95.7%

91.3%

92.8%

MSI Diabetes PORLAMAR

93.1%

96.6%

93.1%

94.3%

Chart Nº 18: Medicine Shortage Index for Diabetes, per Establishment Type, in Porlamar

•

The shortage of blood-glucose-lowering medication in Porlamar was 94.3%, approaching 100%.

•

In contrast, small amounts of the three active ingredients surveyed were available through retail pharmacy chains.

HIGH BLOOD PRESSURE STRATUM

SI Enalapril

SI Valsartan

SI Atenolol

SI Nifedipine

SI Amlodipine

SI Losartan

MSI High Blood Pressure PORLAMAR

Retail Chain, Local

100%

100%

100%

100%

100%

100%

100%

Retail Chain, National

100%

100%

100%

100%

100%

100%

100%

Independent

78.3%

95.7%

100%

95.7%

82.6%

82.6%

89.1%

MSI High Blood Pressure PORLAMAR

82.8%

96.6%

100%

96.6%

86.2%

86.2%

91.4%

Chart Nº 19: Medicine Shortage Index for High Blood Pressure, per Establishment Type, in Porlamar

20

•

As for medication to treat high blood pressure, 1 of 10 Neospartans was lucky to find one of the 5 or 6 active ingredients prescribed for this cause of morbidity. There was a larger supply of Enalapril on shelves.

•

However, the trend remains unchanged as in Caracas, Barquisimeto and Maracaibo, due to a total shortage of Atenolol.

XLaSalud

CONVITE - Newsletter Nº 5. January, 2018

ACUTE INFECTIONS OF THE RESPIRATORY TRACT SI Penicillin Benzatinica

STRATUM

SI SI Amoxicillin Clarithromycin

SI Cefuroxime Axetil

SI Levofloxacyn

SI Moxifloxacyn

SI Clindamycinand

SI Doxycylin

MSI AIRTs PORLAMAR

100%

100%

100%

100%

100%

100%

100%

100%

100%

Retail Chain, National

100%

100%

100%

100%

100%

100%

100%

100%

100%

Independent

100%

78.3%

100%

100%

100%

100%

100%

100%

97.3%

MSI AIRTs PORLAMAR

100.0%

82.8%

100.0%

100.0%

100.0%

100.0%

100.0%

100.0%

97.8%

APPENDICES

Retail Chain, Local

Chart Nº 20: Medicine Shortage Index for Acute Infections of the Respiratory Tract, per Establishment Type, in Porlamar

•

The general shortage index for medication to treat this cause of morbidity was 97.8%, approaching 100%.

•

Only 1 of the 8 active ingredients to treat AIRTs could be found. In December, Penicillin, Clarithromycin, Cefuroxime-Axetil, Levofloxacin, Moxifloxaxin and Clindamicyn, and Doxycycline disappeared from the shelves.

DIARRHEA STRATUM

SI Ciprofloxacin

SI Trimethoprim

SI Metronidazole

MSI Diarrhea PORLAMAR

Retail Chain, Local

100%

100%

100%

100%

Retail Chain, National

100%

100%

100%

100%

Independent

82.6%

95.7%

91.3%

89.9%

MSI Diarrhea PORLAMAR

86.2%

96.6%

93.1%

92%

Chart Nº 21: Medicine Shortage Index for Diarrhea, per Establishment Type, in Porlamar

21

•

The shortage index for products to treat diarrheal symptoms was 92%, approaching 100%.

•

Nevertheless, there was some supply of the three active ingredients prescribed to treat this ailment through independent pharmacies in the city.

XLaSalud

XLaSalud With support of:

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.

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