1. Asthma situation and the “Asthma Drug Facility” response Providing access to affordable quality assured essential asthma medicines

2. Global Burden of Asthma 300 million cases worldwide, still increasing Common chronic disease among children Majority in low- and lower-middle income countries Prevalence higher in urban areas Number of DALYs lost 15 million/year Asthma accounts for about 1 death in every 250 deaths worldwide Health cost of asthma increases with ineffective management Masoli M et al. Burden of asthma. http://www.ginasthma.com

3. CK W Lai et all, Thorax.2008.106609

4. Challenges and barriers for management of asthma in poor countries Prevalence of asthma increasing in urban areas Major cause of unplanned visits to health facilities in urban centres Low income and low health expenditure per capita and priority is given to communicable diseases Poor access to health services particularly for long-term management Lack of trained health personnel Low or non-affordability of asthma medicines for patients

5. Improve affordability of essential asthma medicines in developing countries Improve skills of health personnel by the development of a training package Assess quality of care by regular monitoring and evaluation The Union’s response Ait-Khaled N et al. Allergy 2007;62:230-36.

6. Why create the Asthma Drug Facility? Improve affordability High cost (=low affordability for patients) of essential asthma medicines, particularly inhaled corticosteroids, has been demonstrated since 1998 in The Union studies: –Majority of patients cannot afford the essential medicines –Minority of rich patients are purchasing very costly unnecessary medicines

7. Why create an ADF? Low affordability Cost for the patient of 1 inhaler in US$ % of countries < $515 $5-911 $10-2948 $30-55 Do not know 4 22 Survey (46 countries), The Union and ADF, 2005 e.g. Inhaled beclometasone 250µg

8. Why create an ADF? The health costs arguments Low and middle-income countries cannot afford to not treat asthma Costs increase when asthma not treated or incorrectly treated. We need to:  Reduce unnecessary expense of emergency visits, hospitalisation, and ineffective and inappropriate medicines  Reduce indirect costs on patients, families, governments

9. How does the ADF work? ADF organises qualification of manufacturers and products (as part of its Quality Assurance system), since asthma inhalers are not part of the WHO Prequalification Programme ADF establishes contracts with selected manufacturers for qualified products and proposes these products to countries, organisations, programmes Countries purchase generics at affordable prices ADF provides training materials and EpiData information system Additional services in collaboration with The Union: Training courses and technical assistance

10. ADF Client Criteria The client must agree to: Take the responsibility for the importation of medicines into the recipient country Sell the medicines with a minimal mark-up or to provide them free of charge to patients Not re-export or resell these medicines Make a full payment in advance to ADF Use the products supplied according to international guidelines for diagnosis and treatment Identify an individual responsible for providing monitoring reports to the ADF Submit routine monitoring reports, as specified in the Technical Agreement with the ADF

11. ADF Products *Recommended in WHO Essential Medicines List 2010 ** Add to this: the costs of transport and insurance, preshipment inspection and 10% fees for ADF services (including quality control) ProductPrimary Supplier (Country) Price per unit FCA** (Euro) Beclometasone 100µg/puff, 200 doses, HFA inhaler* Beximco (Bangladesh) 1.07 Salbutamol 100 µg/dose, 200doses, HFA inhaler* Beximco (Bangladesh) 0.83 Budesonide 200µg/puff, 200 doses, HFA inhaler* Cipla/Medispray (India) 2.69 Fluticasone 125µg/puff, 120 doses, HFA inhaler Cipla/Goa (India) 3.23

12. ADF Clients Countries that have already received their orders Pilot Projects in Benin (NTP), El Salvador (NTP), Sudan (Epi-Lab) Kenya (KAPTLD) funded by World Lung Foundation Current orders Burundi (NTP) funded by Global Fund Vietnam (CHRDI) funded by The Union’s staff and board fundraising Potential clients 30 PAL countries receiving funds from Global Fund Other contacts through asthma, TB, NCD networks

13. Reduction in yearly cost for a case of severe asthma when purchasing through ADF (in euros)

15. What else needs to happen for improved access to quality asthma care? Commitment from respiratory specialists, public health specialists, health workers, communities Convince governments to define an asthma strategy and buy essential medicines for the majority of patients Convince donors to finance asthma medicines Country adoption / adaptation of international asthma guidelines

16. Contact Asthma Drug Facility International Union Against Tuberculosis and Lung Disease (The Union) 68, Boulevard Saint-Michel 75006 Paris, France Tel: (+33) 1 44 32 03 75 Fax: (+33) 1 43 29 90 87 ADF@theunion.org Website: www.GlobalADF.org (in English, French and Spanish)

17. Asthma Drug Facility Improving the management of asthma patients in low- and middle-income countries