Partnering to innovate diabetes care in Algeria

28 Pages·2016·2.36 MB·English

The Blueprint for
Change Programme
2016
Partnering
to innovate
diabetes
care in
Algeria
Novo Nordisk works with partners
to help people with diabetes lead
healthier lives. Through innovative
programmes and projects, we
raise awareness, improve access ibility
and enhance quality of life for
people with diabetes, while
investing in local clinical research
and production.
DJOUHER BOUALLAGA GOMRI
Djouher has type 2 diabetes
Algeria
Algeria Diabetes is a challenge
1.7 m
people have diabetes in Algeria.5
700,000
?
people do not know they have diabetes.5
90,000
people live a life free from diabetes-related complications.5,6,7,8,9
x2
40 million
Well-managed diabetes
people live in A lgeria.1
requires:
• people to know how
to manage the condition
The costs of diabetes are Diabetes-related
90%
expec ted to grow twice as complications are costly and • early access to medicine
fast as the population.10,11,12 can be prevented.5 and care.
of Algerians are covered by national
health insurance schemes.2
This is a social obligation and an o pportunity for
5,500 US
us as a d iabetes care m arket leader
dollars
gross domestic product per capita.3
We work with partners to
Local production
innovate diabetes care
Production of diabetes medicines at our
own facilities and in partnership with
77% Novo Nordisk Algeria SAIDAL Group7
We employ more than
of deaths in Algeria are related 440 people in Algeria7 Clinical research
to non-communicable diseases, of
Two-thirds of all diabetes clinical research
which diabetes is the third leading
in Algeria is conducted by Novo Nordisk13
cause of mortality.4
Changing Diabetes® Barometer
In the future, there will be 30 centres providing
care for 24,000 people with diabetes7
70%
Changing Diabetes® Mobile Clinic
of people live in urban areas.3
More than 120,000 visitors and 31,200 people
screened in 17 cities7
Healthcare professional training
220 training sessions conducted in
39 provinces7
Patient education
213,000 patients educated in diabetes
care by 63 educators7
2 | Introduction
Investing in diabetes creates value Contents
4.5 years
The challenge
04 Diabetes affects people's well-being
and their communities
06 Opportunities in addressing the
diabetes challenge
We help people to get diagnosed before their health deteriorates – early diagnosis
and optimal treatment extend life without complications by 4.5 years and may reduce
Our approach
the number of kidney failures by 83%.A
07 C hanging diabetes requires a shared
understanding of the opportunities
95% 82% 08 O ur history and values are centred
around patients' needs
Creating shared value
10 We raise awareness about diabetes
12 W e improve accessibility to
diabetes care
We strengthen knowledge among We help patients understand how to
16 W e enhance quality of life for
health care professionals – 95% of general manage their dia be tes – 82% of people
patients
practitioners say that the overall quality of with dia betes believe patient educ ation
the care they provide has improved since con tributes to improvements in their 18 C linical research drives innovation
the training.14 overall well-being.14 and better patient care
19 L ocal production contributes to
knowledge and technology transfer
20 O verall value for society
Early diagnosis and better controlled diabetes 22 Overall value for Novo Nordisk
for all can lead to better health outcomes and r educe Future perspectives
24 Our growth in Algeria relies on
the cost of d iabetes by 439 million eurosB
partnerships
About this case study
26 Methodology
On top of our commitment to early diagnosis, training of healthcare
professionals and education of people with diabetes, we... 27 References
support the government increase investment in l ocal
in diversifying the production of dia be tes medi-
economy and establishing cine to cover the needs of
a biotech hub. people with diabetes. INFOBOX 1
What is
diabetes?
More can be done to improve the lives
of people with diabetes and other Diabetes is a chronic condition that
requires constant management and
non-commun icable diseases
affects the daily life of people with
the condition and their families.
Diabetes occurs when the body either
We will continue and scale up our i nvestments in... cannot produce enough insulin or use
it correctly. Insulin is a hormone that
public health clinical research local produc- helps sugar enter cells so that the body
and infrastruc- to ensure our tion of high- can use it for energy.5 Without the
ture to enhance products meet quality diabetes
help of insulin, sugar builds up in the
quality of care Algerian patients' medicines
bloodstream. Most of the long-term
needs
health complications associated with
Together, we can create sustainable improvements for people with diabetes and diabetes are the result of persistently
other non-communicable diseases in Algeria. high blood sugar levels.5
A Calculations relate to a 15-year period and are based on the IMS CORE Diabetes Model.15 See Methodology on p 26.
B Calculations relate to a 15-year period and are based on the IMS CORE Diabetes Model.15 The simulated effects of early
diagnosis of those currently undiagnosed with diabetes5 are added to the simulated effects of optimal treatment to
multiple targets16 for people currently diagnosed.5 See Methodology on p 26. 3 | Introduction
Diabetes affects people's
well-being and their communities
Increasingly, diabetes poses challenges for the long-term health and economic prosperity of Algeria.
Contributing factors are low public awareness, variable access to healthcare, and the need for greater
understanding among healthcare professionals and patients about how to treat and manage diabetes.
In many parts of the world, health chal- FIGURE 1 — THE DIABETES 'RULE OF HALVES' IN ALGERIA
lenges have been shifting from i nfectious
to non-communicable diseases (NCDs) for
Of the 1.7 million people with
decades.A In adopting the 2030 Agenda
for Sustainable Development, world lead-
diabetes, only 10% achieve
ers recognised the burden that diabetes
and other NCDs place on sustainable treatment targets
development.17
Today, more than three-quarters of 1.7 million Of whom Of whom Of whom Of whom
deaths in Algeria are related to NCDs, people with 1 million are 900,000 170,000 90,000 live
dia betes5 diagnosed5 receive care7,9 achieve treat- free from
including diabetes.4 Diabetes accounts ment targets8 complications6
for 7% of all mortality in the country 100%
and, among NCDs, trails only cardio vas-
cular disease and cancer in terms of
cause of death.4
Approximately 1.7 million people in
Algeria are living with diabetes5 (Figure 1). 59% 54%
This number is projected to nearly double
to 3.1 million by 2040.5 This has implic a-
tions for public health, considering that
under the 'Rule of Halves',6 roughly half
of people with diabetes are diagnosed,
half of those receive care, and half of
those achieve treatment targets.
10% 5%
INFOBOX 2
People with Diagnosed Receive Achieve Live without
What is HbA ? diabetes care treatment complications
1c targets
The target of diabetes treatment is Note — Treatment target defined as recommended HbA levels.18 Data for ‘Receive care’ are collected through
1c
to keep blood sugar levels at a normal the Changing Diabetes® Mobile Clinic7,9 and represent the share of diagnosed people who regularly see a gener-
al practitioner or specialist for regular follow-up. Data are collected in 13 cities. Number of people living without
or near-normal level. One key para-
complications builds on the assumptions from the 'Rule of Halves' that 50% of people who achieve treatment
meter is HbA , which is a measure targets live without complications.6 Rounding may cause slight discrepancies in numbers.
1c
of blood sugar within a three-month
period.5 An HbA level of ≤ 7% is In Algeria, the curve is similar (Figure 1), amputations and blindness.5 Many people
1c
considered a marker of good control.18 and the average HbA (Infobox 2) for a with diabetes may, however, be able to
1c
People with HbA level of 6.0–6.5% person with dia betes is 9.2%,9 far higher live healthy lives and avoid complications
1c
are considered to be at risk for having than the recommended treatment target through early diagnosis, and appropriate
diabetes.18 In Algeria, the average of 7% or lower.18 treatment and care.
HbA level is 9.2% for people with
1c
diabetes.9 A level higher than 7% is This is no small consideration. When dia- Diabetes is costly to society
associated with an increased risk of betes is undiagnosed or undertreated, it Health is a prerequisite for sustainable
diabetes-related com plications.5,19 can lead to complications such as cardio- development. As such, it is relevant to
vascular disease, stroke, kidney disease, measure the challenge of diabetes not
A N CDs are chronic conditions such as cardiovascular disease, cancer and diabetes. What these conditions have in common is that the person will live with them for the rest of their life as no cure exists.
A chronic condition such as diabetes requires constant and diligent management, and changes to lifestyle.
4 | The challenge
only in terms of health outcomes, but Being overweight or having obesity in- either of which can be serious, costly
also in financial terms.19 In Algeria, the creases the risk of diabetes by up to and even life-threatening.
average diabetes-related health costs per 20 times.23
person with diabetes totalled 370 euros Healthcare professionals are
in 2015.5 A 2014 survey showed that more than key to changing diabetes
two-thirds of people living with diabetes The number of healthcare professionals
in Algeria do not take it seriously.24 In ad- (HCPs) per person in Algeria is compar-
dition, there is a stigma associated with able to the world average,27 but because
dia be tes24 that may prevent some people most of the population lives in the coastal
from seeking proper care. This suggests region,2 there are variations in access to
75% increase
low public awareness of diabetes and healthcare across the country.
may explain why many people do not

in health expenditures for live a healthy life with diabetes. HCPs can be agents of change by driving
diabetes from 2010 to 203011 awareness, diagnosis and appropriate
treatment of diabetes. Until recently,
dia betes was not a key contributor to
As much as 11% of total health spending early mortality in Algeria,28 and only 17%
in Algeria is devoted to diabetes.11 The of HCPs believe that the healthcare
81% of people
cost is ex pected to grow twice as fast as system is well organised for managing
the population from 2010 to 2030,10,11,12 chronic conditions, such as diabetes.29

effectively increasing the societal burden with diabetes agree that there
of diabetes. Because complications is a societal stigma associated Many HCPs who have not been trained
account for a high proportion of diabe- with diabetes24 in diabetes care are not confident in their
tes costs,2 prevention of com p li ca tions ability to diagnose or treat people with
through diagnosis, treatment and control diabetes.14 Concerned about this, HCPs
is paramount. 76% of people with diabetes in Algeria have called for resources to improve the
fast during the religious obser v ance of level of diabetes care and education in
For example, data from Algeria indicate Ramadan.25 Fasting may potent ially be Algeria.29 Their wishes are in line with
that a complication, such as a non-severe associated with metabolic effects that patients’ attitudes: 89% of people with
hypoglycaemic event, entails both direct can affect general well-being. During diabetes believe that a higher level of
and indirect costs due to loss of work Ramadan, the most com monly observed diabetes care knowledge among HCPs
productivity, increased work absenteeism risks are dehydration and episodes of would benefit them.14
and increased healthcare utilisation.20 extremely high (hyper glycaemia) or low
(hypoglycaemia) blood sugar levels,26
Diabetes impacts people's
well-being
Lifestyle is a key contributor to the growth
in the number of people with diabetes.
INFOBOX 3
On average, Algerians consume more
calories per day than they need.21,22
Algeria’s healthcare system
Overconsumption contributes to high
obesityA rates.
Algeria’s healthcare system is publicly financed,27 and the country’s healthcare
system covers the vast majority of the population. As many as 90% of Algerians
are insured by national health insurance schemes.2
Diabetes treatments are covered under national health insurance schemes.
16% of adults
For instance, diabetes medicines, including insulin, are available and reim-
bursed.30 Even with the availability of diabetes medicines in Algeria, many people

in Algeria live with obesity, with diabetes do not achieve treatment targets8 – indicating that diabetes care
and in women the rate is 22%4 requires more than medicine alone.
A The World Health Organization's definition of obesity is a body mass index (BMI) greater than or equal to 30. A BMI greater than or equal to 25 is
considered overweight.
5 | The challenge
Opportunities in addressing
the diabetes challenge
Addressing the challenges of diabetes can reap considerable rewards for Algeria, and this is a social obligation
and opportunity for Novo Nordisk and our partners in Algeria. Investments in better diabetes care can reduce
diabetes-related complications that have a negative impact on quality of life and economic productivity.
Opportunities for Algerian society
High blood sugar levels increase the risk
37% reduced risk
of diabetes-related complications (Infobox
2). For people with diabetes, even small

improvements in HbA can lead to signifi- of micro vascular complications,
1c
cant health benefits.31 such as kidney failure
when HbA is reduced by
1c
For each percentage point decrease 1 per centage point31
in HbA , people with diabetes can
1c
experience:
If all people with diagnosed diabetes in
• a 37% reduction in the risk of Algeria were to receive optimal treatment
m icrov ascular complications, such and achieve near-normal HbA , choles-
1c
as kidney failure and blindness31 terol and blood pressure levels,16 it could
• a 14% drop in the risk of macrovas- result in the avoidance of 11,700 kidney
cular complications, such as heart failures.A Together with other health
NASSIMA GUISSI
attack and stroke31 improvements, this could save Algeria 227 Nassima is at the Mobile Clinic in Setif
to see if she is at risk of having diabetes
• a 21% reduced risk of diabetes- million euros in diabetes-related costs.A Algeria
related death.31
Opportunities for Novo Nordisk Life expectancy in Algeria is increasing, this u l t i mately benefits patients and their
Algeria is a country with a stable and having risen seven years since 1990.32 commun ities, as healthy people with
fast-growing economy.3,B In addition, As living standards improve and life ex- diabetes can be active contributors to
there is an imperative to reduce diabetes- pectancy increases, more people rely on society.
related risks and improve the health and high-quality care and access to medicines.
well-being of people with diabetes. This For Novo Nordisk, this presents both an
is an opportunity for Novo Nordisk to opportunity to innovate and an obliga-
partner with the authorities to strengthen tion to meet the needs of people with
the delivery of healthcare in Algeria. diabetes and make a difference.
We give healthcare
In Algeria, the Ministry of Health has pro fes sionals access to
developed an ambitious National Dia- diabetes care knowledge
betes Plan,33 which is aligned with the and new scientific find-
needs of people with diabetes and also ings. This contributes to
with the desire of healthcare professionals improving the care they
(HCPs) to bolster their own knowl edge provide to patients.”
10% growth
about diabetes care.
Khireddine Osmani
each year in Algeria’s economy In the spirit of collaboration, we can Diabetes Medical Affairs Manager
since 20043,B share more than 90 years of diabetes care Novo Nordisk, Algeria
expertise. It is our belief that
A Calculations relate to a 15-year period and are based on the IMS CORE Diabetes Model15 for people currently diagnosed with diabetes.5 See Methodology on p 26.
B Gross domestic product in current US dollars.
6 | The challenge
Changing diabetes requires a shared
understanding of the opportunities
By addressing societal needs through innovative business initiatives, Novo Nordisk creates what we call
shared value. This means that we identify areas in diabetes care where, together with partners, we can make
a difference for the benefit of both society and our company.
Our approach to good diabetes care is FIGURE 2 — CREATING SHARED VALUE THROUGH KEY ACTIVITIES
rooted in the Universal Declaration of
Human Rights, which defines the right
Our value proposition rests on five
to health as essential for an adequate
standard of living.34 Four key elements
elements of diabetes care
shape the right to health: availability,
access ibility, affordability and quality for
patients.35 In addition, our approach is
inspired by the World Health Organi-
zation's framework that points to aware-
ness as an add itional critical element.36
affordability availability
This framework of five broad elements
guides our research into how diabetes
care can be strengthened at local level
for the benefit of the patient (Figure Value Value
2). Through discussions with key stake- for Novo for
Nordisk society
holders in Algeria, we have determined
awareness Patient accessibility
that we can contribute most by focus-
ing on the following areas: awareness,
acces sibility, availability and quality for
patients. quality for
patients
Focus of this case study
In this case study, we show how Novo
Nordisk – in colla boration with local
partners – is working within these areas
(Figure 2). We help people attain better
control of diabetes for the benefit of
their families and society.
We raise awareness about We improve accessibility We enhance quality of

diabetes to diabetes care life for patients
Our key contribution is to develop inno-
We contribute to improving We improve accessibility We help people with
vative medicines and make them access-
diagnosis rates with the to care and collect key data diabetes take better care
ible to patients.37 In Algeria, we invest in Changing Diabetes® Mobile on diabetes through the of themselves through
local production and clinical research to Clinic and Village, and we Changing Diabetes® Barometer, patient education and a
spread awareness and knowl - and build c apabilities through campaign focused on
transfer knowledge and technology, and
edge about diabetes through healthcare professional treatment and care during
to make high-quality, locally produced World Diabetes Day activities. training across the country. Ramadan.
diabetes medicines available for people
with diabetes in the country.
We create shared value through our work
with local partners to address issues and We invest locally to make We work to improve health through
barriers to diabetes care for the benefit of diabetes medicines available clinical research and support economic
to patients diversification by investing in production,
society and all of the partners involved.
thereby making diabetes medicines availa-
ble to patients in Algeria.
7 | Our approach
Our history and values are centred
around patients' needs
Novo Nordisk has an 80-year history in Algeria. This history is characterised by partnerships focusing on the
needs of patients and the communities where we work. We are driven by a desire to manage our business
sustainably, in the shared interests of business and patients, and in line with societal expectations.
Novo Nordisk is a global healthcare the financial, environmental and social We invest in local production
company with more than 90 years of impacts of all our business decisions. of medicines
innovation and leadership in diabetes We opened our first Algerian production
care. Headquartered in Denmark, we We are increasing our facility in 2006 in Tizi Ouzou. Six years
employ more than 41,60038 people in 75 commitment in Algeria later, we established a partnership with
countries and market products in more Our 80-year history in Algeria began with state-owned SAIDAL Group to produce
than 180 countries.39 exporting our products to the country human insulin in Constantine.
back in 1936 (Figure 3). Since then, our
commitment has grown substantially. Local production supports our commit-
The Novo Nordisk Way is In 1994, we establis hed our Algerian ment to people with diabetes in Algeria.
our promise to patients. All affiliate, and today we are the market Each year, our factory in Tizi Ouzou
employees are tied t ogether leader in diabetes care in Algeria.40 pro duces enough oral antidiabetic
across cultures through our products (OAD) to cover the needs of
company values.” Over the past decade, the number of 500,000 people with diabetes.7,A Currently,
people we employ in Algeria has risen we are expanding production capacity at
Mohamed Ouaguenouni almost four times, reaching more than 440 our facility in Tizi Ouzou as well as investing
Quality Manager, Novo Nordisk, Algeria full-time employees today.7 This growth is in a pre-filled device assembly line.
mainly driven by our local production.
SAIDAL Group is building a new produc-
Our work at Novo Nordisk is driven by a tion facility in C onstantine. The facility will
set of guiding principles that we call the use high-quality raw materials supplied by
Novo Nordisk Way.37 The Novo Nordisk Novo Nordisk to produce modern insulin.
1 out of 2
Way describes who we are, where we want When completed, the facility will be able to
to go and the values that characterise supply enough insulin each year for more

our company. Our way of doing business people with diabetes in Algeria than 800,000 people with diabetes.7,A We
is governed by the Triple Bottom Line who receive treatment use Novo support SAIDAL Group at both its facilities
principle, which ensures that we consider Nordisk products40 through training activities and by establish-
ing a leading quality management system.
FIGURE 3 — NOVO NORDISK'S HISTORY IN ALGERIA
A long history of commitment to the Algerian market
1936 1994 2006 2008 2009 2010 2011 2012
First Novo Affiliate Production Celebration Launch of Launch of Launch of Partnership
Nordisk established facility of World Dia- Dia betes Dia betes & the Changing with SAIDAL
products in Algeria. established betes Day in & Children Ramadan Diabetes® Group to pro-
exported to in Tizi Ouzou. partnership campaign. campaign, Mobile Clinic duce insulin
Algeria. with the Minis- supported by in partner ship locally.
try of Health. the Ministry with the Min-
of Religious istry of Health.
Clinical research
Affairs.
initiated. Launch of
Diabetes &
First patient edu-
Women
cation session.
campaign.
A The number is estimated based on average dose as recommended by the World Health Organization.41
8 | Our approach
A full-service
healthcare partner
In the past 10 years, Novo Nordisk has evol ved
from a sales and marketing operation in
Algeria into a fully integrated partner with a
range of local stakeholders, such as patient
associations, healthcare professionals and
government authorities. Consistent with the
Triple Bottom Line principle, we:

Take a patient-centred approach
through programmes and events that
promote awareness, diagnosis
of diabetes and quality of care

Engage in technology and
knowledge transfer
through highly skilled jobs and through
clinical studies of innovative
products for the Algerian population

Ensure the availability of high-quality
d iabetes medicines
through local production for the
domestic market
2013 2014 2015 2016
Inauguration External Decision to Decision to
of the Chang- nurses trained expand our establish a
ing Dia betes® to perform OAD produc- pre-filled device
Barometer patient tion facility. assembly line.
in partner- edu cation.
ship with
the Ministry
of Health.
THANINA BENTALEB
Business Controller
Novo Nordisk, Algeria 9 | Our approach
We raise awareness
about diabetes
Through awareness activities and an innovative partnership with the Ministry of Health, Novo Nordisk helps
bring diabetes care throughout the country. Through these efforts, we spread awareness and knowledge,
and help people take control of their health.
In Algeria, 700,000 people – 41% of Global Goals to reduce premature deaths
all people with diabetes – do not know from NCDs by one-third.17 Novo Nordisk
4.5 more years
they have the condition.5 Undiagnosed, believes that achieving this target will
people neither receive treatment nor require a balanced strategy that spans

learn how to manage their diabetes to effective strategies for prevention, detec- without complications
prevent comp lications. tion and treatment. when people are diagnosed
earlyA
The Algerian Ministry of Health acknowledg- Some of the ways we raise awareness
es that education, healthy lifestyles, screen- about diabetes are through the Chang-
ing for and treatment of non-c ommunicable ing Diabetes® Mobile Clinic and Village people to manage their disease and
diseases (NCDs) in the early stages are effec- (Infobox 4) and World Diabetes Day live healthier lives free from complica-
tive ways to reduce the burden of NCDs. In (Infobox 5). tions.5,19
2010, the Ministry of Health developed a
National Diabetes Plan (NDP) listing several Early diagnosis of diabetes Patients who are diagnosed before
priorities, including prevention.33 improves health com plications occur, and who achieve
The goal of diabetes treatment is to near-normal HbA , cholesterol and blood
1c
The development of Algeria's NDP was prevent complications. Early and timely pressure levels,16 can expect to live 4.5
prescient, given the target within the diag nosis and treatment may help years longer without complications com-
INFOBOX 4 — NOVO NORDISK INVESTS IN... FIGURE 4 — SCREENINGS AT THE MOBILE CLINIC
Changing Diabetes®
26% of people screened have
been identified as having a high
Mobile Clinic and Village
HbA levelB
1c
Novo Nordisk shares the Ministry of diabetes through screenings of people
Health’s interest in preventing diabe- at risk and 360° health checks for those Number of people
tes. In 2011, the first public– private already diagnosed. The clinic’s activities
35,000
partnership between the Ministry and contribute to the Ministry’s efforts to
31,200
a pharmaceutical company took place meet its diabetes prevention goals.
30,000
with the establishment of the Changing
Diabetes® Mobile Clinic and Village. People who are screened and identified as
having a high HbA level7 (Figure 4) are 25,000
1c
The Mobile Clinic debuted in Blida in referred to a doctor for diagnosis. In ad-
2011. Since then, more than 120,000 dition, at each stop, we conduct training 20,000
people from the general publicB have and facilitate relationships between local
visited the Mobile Clinic across Algeria, general practitioners and special ists, who
15,000
allowing Novo Nordisk, under the aus- share their knowledge. In these ways and
pices of the Ministry of Health, to reach others described in the following pages,
remote areas of the country. The Mobile the Mobile Clinic and Village have lasting 10,000 8,200
Clinic supports raising awareness of effects, even after they move on.
5,000
31,200 people 17 cities Ministry of
screenedB visitedB Health
0
partnership Screened HbA ≥ 6.5%
1c
A Calculations relate to a 15-year period and are based on the IMS CORE Diabetes Model15 for people with diabetes who are currently undiagnosed.5 See Methodology on p 26.
B Data from the Mobile Clinic as per April 2016.
C Calculations relate to a 15-year period and are based on the IMS CORE Diabetes Model15 for the 22,300 people who have received a 360° health check at the Mobile Clinic.7 See Methodology on p 26.
10 | Creating shared value