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Background: All people with type 1 diabetes and 30% of people with type 2 diabetes require insulin to live. Nonetheless, access to insulin is not warranted. Health authorities and workers; caregivers and patients; all experience challenges and limitations to acquire, provide and use insulin. Also, the COVID-19 pandemic worsened these constraints, hampering access to insulin and diabetes care in low-and middle- income countries (LIMCs). Aim: To explore the perspectives from the macro, meso and micro level stakeholders regarding access to insulin and diabetes care in Peru. Method: A qualitative study was conducted in 3 geographically diverse regions. Fifty-five interviews were performed by telephone from February 18 to May 14, 2021; with key stakeholders such as health authorities, primary care workers, caregivers and patients. The Rapid Assessment Protocol for Insulin Access (RAPIA) methodology was used to explore health system structure; Policy background; Financing; Data collection and information systems; Healthcare workers; Patient empowerment; and Community participation. Results: Only few facilities at the primary health level (PHC) can treat patients who require insulin. The lack of supplies for glucose tests is frequent at PHC, as well as the insufficient skills of health workers to provide adequate management. Although there are clinical practice guidelines at the national level, they are not adequate for PHC. Hospital workers reported inadequate budget allocation. Some hospitals do not have endocrinologists, burdening internal medicine and general practitioners. Patient education varies greatly between the level of care: hospital vs. PHC. Access to a glucometer for self-monitoring at home varies greatly between regions and patients need help from caregivers to operate the glucometer. Almost all patients informed they had not received information about hypoglycemia and how to manage it. Conclusion: Overall, stakeholders responses reflect the needs and constraints of a LMIĆs health system regarding access to insulin and diabetes care. These should be considered when designing future interventions. |
