Accessibility and availability of insulin: A survey by International Diabetes Federation-Middle East and North Africa Region (IDF-MENA) Member Associations

Introduction: One hundred years after its discovery, insulin is still inaccessible for many people living with diabetes. In the recent World Health Organization (WHO) 2021 report on Barriers to Insulin Availability, WHO highlights the alarming state of global access to insulin. According to International Diabetes Federation (IDF), as reported in IDF Atlas, 10th edition, 73 million adult people with diabetes (PWD) live in Middle East and North Africa (MENA) Region. Materials and Methods: A survey was conducted in the International Diabetes Federation (IDF) MENA Region through its Member Associations in 2021. Eighteen countries out of 21 participated. Questions were about insulin support, beneficiaries, local production, insurance coverage, average cost, minimum wage, and barriers to access. Results: Fifty percent of countries had full government support and 44% had partial. In 56 % of countries, support is limited to human insulin, and the majority is restricted to citizens. Some PWDs have difficulties accessing insulin: low-income persons, refugees, noncitizens, or living in remote areas. Approximately 61% of countries have national social security funds and 61% private insurance coverage for insulin. In five countries, there is a law prohibiting nongovernmental organizations to receive international donations of insulin. Local production exists in only five countries surveyed. There is a wide variation in the cost of insulin from $1.42 to 100 and in the minimum wage ($7–2667). Additional barriers to access were delivery, storage, cost, electricity, war conditions, displacements, and sanctions. Conclusion: Although government support is available in the majority of countries, it is still mainly through the provision of human insulin and restricted to citizens. Many barriers affect access to insulin and its costremains unaffordable. Disparities exist between countries within the same classification of income. Mapping the current situation will help to improve it and monitor change. This document can be informative for PWD living or visiting any of these countries and can help understand cross-border travel for medical treatment, and local and regional policies.