The FINANCIAL -- The annual diabetes programme budget in Georgia exceeds GEL 8 million. However the sum does not sufficiently cover all the needs of diabetes patients. Partial covering of the services is leading to the necessity of out-of-pocket and co-payments, with a relatively high percentage for patients. The Georgian state diabetes programme needs perfection to make vital services available for all people living with diabetes. Well-managed diabetes can prevent many complications reducing further healthcare costs, subsequently covered by the universal healthcare programme.
Non-communicable diseases or NCDs represent a relatively new challenge for Global Health. The prevalence and incidence of NCDs is being increased from year to year, causing approximately 70% of all deaths globally, according to WHO. The four big “monsters” accounting for most of these deaths are cardiovascular diseases causing 17.7 million dead people worldwide. Cancers are in second place - with 8.8 million deaths; respiratory diseases - 3.9 million; followed by diabetes causing 1.6 annual deaths globally. This “Magnificent Four” accounts for over 80% of premature deaths due to NCD.
The states and authorities agree that NCDs represent a really great problem, that’s why they were included in Sustainable Development Goals. SDGs target 3, 4 aims to “reduce by one third premature mortality from NCDs through prevention and treatment, and promote mental health and wellbeing”.
All NCDs are important, but as 14th November was a World Diabetes Day, I want to speak about this disease. It may be ridiculous for someone, as diabetes isn’t considered a big public health problem like cancer, or AIDS, or even Ebola. But nobody pays attention to the fact that it’s a kind of silent killer, as a person may live with increased blood sugar for years or decades, without ever even suspecting that s/he has diabetes. And this increased blood sugar, or hyperglycemia, leads to cardiovascular diseases, neurological or mental disorders, also a large share of foot amputations, more than due to traffic accidents. That’s why diabetes is an issue worth paying attention to.
The American Diabetes Association defines diabetes mellitus as a group of metabolic disorders, which are characterized by hyperglycemia, caused by impairment of insulin secretion and/or its action. Three major types of diabetes exist. They are: diabetes type 1 – which develops due to an autoimmune condition causing insulin deficiency; diabetes type 2 – causing glucose tolerance, which means that the body can’t digest the existing glucose and it circulates in the bloodstream; and gestational diabetes – which develops exclusively in pregnant women by the 24th week of pregnancy and prevents the body from tolerating glucose intake.
Nowadays 382 million people diagnosed with diabetes live worldwide. And there are approximately 175 million of people living undiagnosed. The numbers of diabetes patients increases from year to year and it is considered that they will be 55% more by 2035. This disease affects mostly those of the population aged 40-59, the most “profitable” cohort, generating income worldwide.
But doctors have good news, as diabetes is a manageable disease. That means people with diabetes can control their blood sugar even without specific effort, just having a healthy lifestyle, including healthy diet, physical activity, etc.
The state of Georgia takes on the obligation to help people with diabetes. That’s why a state diabetes programme exists. It includes a number of services for diabetes care and basic management. All Georgian citizens with diabetes can be involved in this programme, as well as people with permanent residency of Georgia. The state diabetes programme provides some medical services, including consultations with endocrinologists and other specialists, some tests essential for diabetes monitoring, providing insulin and glucagon to patients with diabetes type 1; as well as diabetes management education for all people living with diabetes, etc.
While working on projects with the financial support of the World Diabetes Foundation, aimed at diabetes prevention and treatment improvement, I acknowledged the numbers of problems which diabetes patients face in Georgia. In spite of the fact that the annual programme budget is more than 8 million GEL, it doesn’t sufficiently cover all of the needs that diabetes patient have.
Experts working on diabetes consider that the state diabetes programme only partially covers the services patients actually need. This leads to the necessity for out-of-pocket and co-payments, with a relatively high percentage for patients. That’s why people living with diabetes frequently refrain from comprehensive or even basic testing beyond the programme-covered services, as they lack the adequate finances for it.
Many regional medical facilities are not involved in the state diabetes programme as participating in it is not profitable for clinics. This affects accessibility and affordability for the patients from rural places. They lack the opportunity to receive even those services provided by the state programme.
Although the programme provides analytical and technical means including glucometer and test-sticks for blood glucose monitoring only to patients under 18, adults have to purchase equipment and consumables by themselves. Ideally, every patient should monitor blood glucose before and after each meal, approximately 8 times a day. This means that patients should spend a large amount for this purpose.
But an undoubtable ‘pro’ of the state diabetes programme is the fact the insulin-therapy is free of charge for all patients. Many people couldn’t afford to purchase insulin on their own if it wasn’t free. This saves a numbers of lives of patients with diabetes type 1 or other types of diabetes, which need management with insulin.
To conclude, the state diabetes programme needs perfection to make vital services available for all people living with diabetes. Well-managed diabetes can prevent many complications reducing further healthcare costs, subsequently covered by the universal healthcare programme.