Diabetes patients in Cote d’Ivoire are appealing for help, as a lack of insulin in the country’s public pharmacies has put the medicine out of reach for most, adding to the burden diabetics already face in fighting their disease in one of the poorest countries in the world.

“The situation has become so critical,” said Jonas Yao, vice president of the national association of diabetics. “People are going to die.” The national stock of insulin ran out in March, making the medicine available only at more than double the price at private pharmacies, Yao told IRIN.

Diabetes patients said the lack of affordable insulin is just one example of the government’s failure to help care for people with the disease.

Health experts say chronic illnesses like diabetes, despite their heavy human and socioeconomic toll, tend to lose out in competing for scarce resources with communicable diseases like tuberculosis, HIV/AIDS and malaria.

Diabetes patients in Cote d’Ivoire say they are frustrated about a general disregard for diabetes in comparison to other more visible illnesses. “People neglect diabetes because it is not contagious like HIV,” said Hortense Nouama, treasurer of the national association of diabetics.

Pointing to national programmes that provide treatment at little to no cost for HIV/AIDS patients, she said, “I would be better off with HIV. I could get my medicines for a couple of dollars.”

In Cote d’Ivoire a supply of insulin available in public pharmacies for about 3,500 CFA francs (US$7.25) costs 17,000 CFA francs (US$35) in the private pharmacies, Yao said, saying the government must be better able to supply affordable medicines for diabetes patients. Other kinds of medicines used by people with type 2 or adult-onset diabetes – the most common type in Cote d’Ivoire – have been shown in World Health Organization (WHO) studies to cost the equivalent of up to one week’s wages for a one-month supply in some African countries.

Diabetes is a chronic disease occurring when the pancreas does not produce enough insulin – a hormone that regulates blood sugar. The illness can also manifest by the body’s inability to use the insulin it produces. While diabetes has long been associated with developed countries, it is increasingly becoming a problem in sub-Saharan Africa and other areas of the developing world. WHO estimates that by 2025 75 percent of the world’s diabetics will be in developing countries.

Chronic diseases need attention

Health experts say developing countries neglect chronic illnesses like diabetes, heart disease and cancer at their peril. “With all the focus on HIV/AIDS, malaria and other communicable diseases, countries are not getting ready for the next challenge – chronic illnesses like diabetes,” said David Beran, project coordinator at the International Insulin Foundation at the University College of London’s Centre for International Health and Development. “And these are expensive, life-long diseases that have a huge financial impact on individuals but also on health systems.”

WHO’s Africa office in a June 2007 strategy paper on diabetes said chronic, non-communicable diseases do not receive the attention they deserve, “despite their social, human and economic repercussions.” Generally geared toward “acute”, sudden onset illnesses, “health structures are not adapted to give proper care to people with chronic diseases,” WHO says.

Government must do more

In Cote d’Ivoire, the health ministry in 2006 announced it would launch a national programme to fight diabetes, and again in June this year the National Institute of Public Health said it would boost services for diabetics. But patients are still waiting for action.

“We have no idea why this is not moving forward,” said Nouama of the national association of diabetics. Association members say when they have asked the health ministry they are told the hold up is due to “administrative problems”.

Diabetes patients say a government programme that would subsidise critical medicines – insulin as well as other treatments type-2 patients use – and facilitate access to testing and consultations - would go a long way to easing the burden of diabetes, as well as help keep the illness in check.

Health ministry sources contacted by IRIN would not comment on the national programme or the lack of insulin in public pharmacies.

Nouama told IRIN she has seen many people suffer greatly or die from diabetes-related complications. “Diabetes is a dangerous illness,” she said. “If they don’t hear us and do something soon, we’ll have to take drastic measures like go on a hunger strike,” Nouama said. “It would make us sick, but we’re already sick.”