September 6, 2018
September 6, 2018
In Zimbabwe, people with diabetes are cutting their dosages of vital insulin and feeling the adverse health consequences. Unable to get credit, the country’s pharmaceutical companies are increasing drug prices and can’t keep up with demand.
HARARE, ZIMBABWE — Bernard Mujeyi was diagnosed with diabetes in 2017.
Today, he is sitting with other patients, listening attentively as a nurse offers advice on how to live with diabetes. But learning to give himself insulin shots and managing his diet are not the difficult part, he says.
It’s becoming impossible for him to find and afford the insulin he needs.
“I inject myself every day,” he says. “But there are times where the prices for drugs are too high, and l don’t have the money to buy [insulin].”
He is supposed to inject 15 milliliters of insulin with each shot. But on most days, he reduces that to seven and a half.
“I reduce to half the units, so it lasts me longer,” he says.
But there are consequences to reducing the dosage. He says his eyes are failing, and his legs are swollen and sore.
According to the American Diabetes Association, skipping insulin injections can have numerous harmful effects, including damage to the eyes, heart, kidneys, teeth, gums and nervous system.
“Diabetes is damaging my health slowly, and the shortage of drugs worsens it,” Mujeyi says.
He is not alone.
The price of insulin has skyrocketed in the past year. In Harare, Mujeyi says, he’s seen a 38-percent increase.
“Since 2017, the prices have just been going up,” he says. “The drugs that l used to buy for $18 are now costing around $25.”
Linda Mujuru, GPJ Zimbabwe
Price hikes are severe and common here, because the country’s ongoing cash shortage has continued to worsen since the introduction of bond notes in 2016. Representatives from pharmaceutical companies that sell drugs in Zimbabwe say the shortage of U.S. dollars has affected the import and supply of critical drugs, because foreign companies don’t accept bond notes, and the pharmaceutical companies have reached their credit limits.
Portifa Mwendera, president of the Pharmaceutical Society of Zimbabwe, says he is aware of the devastating impact of the insulin shortage. But without access to U.S. dollars, the pharmaceutical industry has few options.
Most of the 12 pharmaceutical companies in Zimbabwe are operating at 10 to 60 percent of capacity because of the currency shortage, Mwendera says.
From manufacture to distribution, “we have shortages that are occurring throughout the whole supply chain,” he says. “There is a serious shortage of forex [foreign currency], which has caused lot of concern in our industry; basically, we are getting inadequate forex to continue running.”
The shortages began in early 2017 and have continued to worsen as Zimbabwean pharmaceutical companies have reached their credit limits with foreign companies that sell and manufacture drugs.
“We are no longer able to access credit facility, because there is a huge debt that needs to be settled first,” he says, adding that the pharmaceutical industry managed to buy $15.3 million worth of drugs from vendors in the first quarter of 2018, but the pharmaceutical companies needed more than $44 million.
In addition to insulin, there is also a pronounced shortage of insulin syringes, hypertension drugs, inhalers and antibiotics that patients need.
Addmore Mugobela, 31, has had diabetes since 2012, when insulin was just $5. He says he has had to pay as much as $37 for the same dosage in recent months.
“The drugs are in short supply, and those that you can find are expensive,” he says. “So many people l know can’t find drugs to treat their diseases.”
The Zimbabwe Diabetic Association (ZDA) says the cash shortage is having a dire impact on the diabetes community.
Simion Jamanda, administrator of the ZDA, says the association has been able to provide free insulin at local hospitals to some patients under the age of 25. “But for patients over 25, the situation is dire, as some end up injecting themselves once instead of three times a day, in order to save on drugs.”
While some drugs are manufactured locally, the pharmaceutical sector is heavily dependent on imports.
“We do manufacture some drugs locally, but even the manufacturer of medicines here needs active pharmaceutical ingredients; we get those raw materials from India and China,” Mwendera says.
“We really need a lot of support from the central government,” Mwendera says. “We need them to seriously consider the impact of not funding this sector.”
The newly elected government has promised “systematic measures” to reduce the cash shortage soon. No new plans have been announced.
Linda Mujuru, GPJ, translated some interviews from Shona.