Objective: The objective of this study was to assess the barriers to care for
patients with insulin-requiring diabetes in Mozambique and Zambia.
Research Design and Methods: We used the Rapid Assessment Protocol for Insulin Access to collect information through interviews, discussions, site
visits, and document reviews. Government organizations, health facilities, care givers, and patients
were asked about care for people with insulin-requiring diabetes. Between 100 and 200
interviews/discussions per country were undertaken in and around the capital city and the regional capital
and in a rural area.
Results: Insulin was present in both countries in sufficient quantities,
although the financial burden for health services and patients meant that problems with supply exist.
There are problems with quantification of needs and equitable distribution of insulin.
Problems with availability of syringes and testing equipment were noted, particularly in
Mozambique. This lack of tools and infrastructure for diagnosis and follow-up coupled with low levels
of health care worker training and lack of diagnostic reagents resulted in a substantial risk
of misdiagnosis or failure to detect diabetes. The estimated prevalence of insulin-requiring
diabetes differs more than 10-fold between urban and rural areas in Mozambique and 4-fold between
Mozambique and Zambia, suggesting that problems in diagnosis and care result in substantial
worsening of prognosis for such patients.
Conclusions: Insulin is necessary but not sufficient to improve prognosis for
diabetic patients. A Rapid Assessment Protocol methodology can be used to define problems
in health care delivery for diabetes. Proper care for insulin-requiring diabetes
necessitates health systems able to provide trained personnel, medicines in sufficient quantity, and
diagnostic and monitoring facilities.