1. 1 What do we know about access to chronic disease medicines ? Dr Shanthi Mendis Coordinator Chronic Diseases Prevention and Management Department of Chronic Diseases and Health Promotion World Health Organization

2. 2 Noncommunicable Diseases Cost effective interventions Cardiovascular disease Cardiovascular disease Chronic lung disease Chronic lung disease Diabetes Diabetes

3. 3 Global mortality Cardiovascular diseases 30% Cancer 13% Other NCDs, injuries Other NCDs, injuries & mental health 18% Communicable maternal maternal infant 30% infant 30% Respiratory7% Diabetes 2%

4. 4...... Essential Complimentary Strategies for NCD prevention and control NCD prevention and control Population- wide Primary prevention in high risk groups Secondary prevention

5. 5 Overall Percentage in 10 countries Secondary Prevention of Heart Disease WHO PREMISE 2003 Bulletin of the WHO 2005;83;820-828 Percentage Drugs

6. 6 Affordability and Availability of 32 medicines for NCDs in 6 LMIC< 7.5% of the medicines available in public sector Cost of medicines in the private sector high Affordability and Availability of 32 medicines for NCDs in 6 LMIC< 7.5% of the medicines available in public sector Cost of medicines in the private sector high

7. 7 Affordability Number of days' wages for 1 month medicines after a heart attack WHO 2006 Days

8. 8 Access to medicines for diabetes, asthma, CVD Is it equitable ? Do patients with Type I diabetes die because they are too poor to get insulin? Do asthma get hospitalized with acute attacks because they cannot afford asthma medicines? Can heart disease patients e who earn a daily wage afford to buy medicines?

9. 9 Thank You