Overview
The National Health System (NHS) of Paraguay provides health services through the public, private, and mixed subsectors, health insurance programs, and universities. The health system is highly segmented and lacks coordination among the various subsectors. However, for diabetes it has the National Diabetes Program where insulin, test strips, glucometer and glucagon are distributed for free to those enrolled. However, it is not always possible to get the free insulin or other medicine because they only give around 40 tickets per day, so you have to go very early to get one of the tickets which you can use at the pharmacy. Some months they do not have insulin in stock.

What happens if you need to see a doctor?
If it is urgent, you must to go to the Public Health Center and ask for attention. It is never known if they will have all the necessary supplies. Otherwise you need to have an appointment with the specialist in advance and you have to wait a long time to get an appointment. In Paraguay we only have four specialists for paediatric diabetes patients and two of them work for the Public Health care system. On the day of your appointment, you will also wait for many hours.

Who decides what doctors can prescribe?
The Ministry of Public Health and Welfare decides which drugs are safe and available in our country. In every neighbourhood there is a health center, and only the specialists hired by the government can prescribe the medication there, which is delivered with a prescription in the Pharmacy of the Center. Every time you need medicine it is at least another half day of waiting.

Practically, what is it like to live with type 1 diabetes in Paraguay?
Type 1 diabetes is mostly unknown and not understood. It is mostly associated with type 2 diabetes. In a country with 7 million people, I figured out that my child had diabetes due to my own investigation of the symptoms of diabetes.

It is impossible to get the existing technology for better treatment, and the only pump available is the Medtronic, but it is very expensive. There is no continuous glucose monitoring. The school is not prepared for children with diabetes and you depend on the willingness of the teacher to help with good control. We have a good doctor, but they are only accessible every three months. There is also a foundation here that helps people who are low income.

Even with insurance, short acting Insulin costs around USD $25 for every pen. Long acting costs around $50 per pen. Fifty blood glucose test strips are about $25. If you want a private consult with a paediatric endocrinologist, it costs about $60. In a typical month, we spend around $300 for our insulin and supplies.

What about getting admitted to hospital?
We must pay for private insurance if we want to attend private hospitals. We paid USD $150 per month for a family of four for insurance, but keep in mind that the minimum salary in Paraguay is around $350 per month. The admission to public hospitals depends on the number of beds available and there are a few specialist centers for children.

How does diabetes care vary throughout Paraguay?
I do not know much about what it is like outside the capital, Asuncion, but I don't think it is a very efficient system because we are a country with a lot of corruption where health was never a priority for the public spending.

Many thanks to Vanella Barbieri for sharing this information with us.