Overview
Burkina Faso has a population of 16 million people. There is not country level-specific data available for type 1 diabetes cases, but it was reported in 2018 that around 130 patients with type 1 diabetes were managed solely at the principal National Hospital, located in the capital city, Ouagadougou.
The public healthcare system is based on a 3-level pyramid model. The primary level encompasses community health centers, providing Primary Health Care (PHC). Most of these centers do not host medical doctors. They are often run only by paramedical staff. The secondary level comprises health district hospitals and regional hospitals, where one can find paramedical staff and general medical practitioners as well. Medical specialists can be found in regional hospitals, and also a few numbers of health district hospitals, especially in the major urban settings such as Ouagadougou and Bobo Dioulasso. The tertiary level comprises National Hospitals and University Hospitals, which offer high ranked medical specialist care. These hospitals are mainly located in the capital city, Ouagadougou, and the second city, Bobo Dioulasso.
This public healthcare system is run by the Ministry of Health agencies at all levels. Outside of this public system, many private medical clinics exist in the principal cities. Many private drugstores also exist, and they supply a large network of private and public healthcare centers and hospitals.
Medical management of type 1 diabetes is only available at secondary and tertiary levels. A National Non-Communicable Diseases Control Program (NNCDCP) created recently by the Ministry of Health has been collaborating so far with Santé Diabète (opens in a new tab) and Life For a Child (LFC). In practice about 200 patients with type 1 diabetes under age 23 were benefiting from the LFC programs throughout the country.
What happens if you need to see a doctor?
Every patient presenting with symptoms of diabetes or formally diagnosed with type 1 diabetes is referred to a healthcare center where medical staff able to manage the disease can be found.
A certain number of diabetologists from Burkina Faso have been trained over the last ten years, through a university-based regional training program developed by the University of Bamako in Mali, supported by Santé Diabete and its partners in West Africa. However, access to these centers and to effective diabetes care services still remains an issue that needs to be improved.
Who decides what doctors can prescribe?
What doctors can prescribe is basically decided by the health authorities through the National Drug Supplies Strategy. Basic Insulins, restricted to Regular (Actrapid*) and NPH (Insulatard*) vials, are the only types of Insulin registered on the National Essential Drugs list. Vials and syringes are supplied by CAMEG, the National Drug Supply Agency, and usually found at drug stores in the principal cities. However, access to insulin is limited in certain rural areas, because of the drug supply chain coverage limitations.
Retail prices are also a common barrier doctors need to care about, given that almost all patients with type 1 diabetes are required to buy out of pocket. The average price for a vial is $10, and one syringe costs around 15 cents. This is hard in a country where most of the people are living with less than $1/day.
Hospitals partnering with Santé Diabete, through the LFC program, benefit from insulin and insulin supplies directly provided as donations. Insulin analogs are only available from time to time in some private drug stores in the capital, but at a cost definitely out of reach for most of the patients with type 1 diabetes and their families.
Practically, what is it like to live with type 1 diabetes in Burkina Faso?
There has been a slight improvement of type 1 diabetes care since the beginning of the joint efforts from NNCDCP, LFC, and Sante Diabete. We have noticed a relative improvement of diagnosis rates and survival outcomes through the extension of the network of diabetes management units and the recent significant increase in the number of either trained physicians or diabetes specialists. But again, there is still the problem of access and coverage, and for these reasons, only a few patients can benefit from the interventions sponsored by Life for a Child compared to the total population of patients with type 1 diabetes in need of adequate care.
For many patients with type 1 diabetes and their families, this disease still represents a great social, psychological, and economic challenge because of:
- out of pocket payments for insulin and insulin-related supplies, given that there are no social or private insurance schemes covering these costs
- very restricted access or no access to insulin analogs, insulin pens, insulin pumps, etc.
- lack of diabetes education and self-management training facilities and supplies
- very limited access to personal glucose monitoring devices for insulin dose management and management of hypoglycemia
- issues regarding the adequate conservation of insulin vials
Moreover, many patients have a low to medium education level, and most of them are not able to understand the educational contents available. There is a need to improve culturally competent and educational skills for diabetes care providers, and to develop culturally adequate materials for diabetes education purposes.
What about getting admitted to hospital?
All healthcare workers should be able to recognize the clinical symptoms of diabetes and its related important complications, although there is a need to improve the knowledge and skills of these healthcare workers in primary care settings, for an adequate diabetes primary care management. When in need of diagnosis or specific diabetes care, patients are normally referred to hospitals where they can find trained physicians and diabetes specialists.
Emergency cases are directed to emergency rooms and other patients are addressed to diabetes outpatients services, or to diabetes hospitalizations units.
How does diabetes care vary throughout Burkina Faso?
Some patients with type 1 diabetes still need to travel a very long distance to see a doctor, and most of the time, out of pocket payment for services and drugs are limiting access to effective diabetes care for the rural population and at large for people coming from low- socioeconomic status settings.
Overall, access to healthcare services is also limited in Burkina Faso by the lack of a Universal Health Coverage (UHC) system. The Ministry of Health is still working on the agenda of UHC. Although there is a UHC-like approach directed to specific populations with a type of waiver for out of pocket individual payments at public healthcare centers and public hospitals, this does not include diabetes-related drugs and treatments.
Recent political and security crises in the northern and eastern regions of the country, because of the terrorist attacks, have forced some populations from these areas to migrate, and this also presents a threat to good access to diabetes services and to an optimal continuation of diabetes care for many patients with type 1 diabetes coming from there.
Thank you to Rayangnewinde Donald Auguste Yanogo, MD, MPH, Endocrinologist from Tengandogo University Hospital, Ouagadougou, Burkina Faso for providing this information.
Last updated 2019