Non-communicable diseases (NCDs) are the leading cause of death, with heart disease, stroke, cancer, and chronic lung disease accounting for approximately 74 per cent of all deaths worldwide, according to the World Health Organization (WHO). NCDs are chronic conditions that can last for years or even a lifetime. According to 2016 estimates by the WHO, NCDs were responsible for 44 per cent of annual deaths in Rwanda. This number highlights the significant burden of NCDs in Rwanda and the need for effective strategies to manage and treat these conditions. Multi-month dispensing (MMD) policies have primarily been associated with the treatment of communicable diseases, such as HIV/AIDS. MMD policy for people living with HIV (PLHIV) allows for the provision of three to six months of antiretroviral drugs (ARVs) and other medications needed for their treatment. However, the benefits of MMD can be extended beyond this population and also be applied to people living with NCDs. People with NCDs require medication for extended periods, and some may even require lifelong medication. As such, regular refills and visits to healthcare facilities are essential to avoid exacerbation of the disease. By implementing MMD practices for NCDs, patients with these conditions could experience significant benefits. One of the most significant benefits of an MMD policy for people living with NCDs is increased convenience. Moreover, implementing an MMD practice for people living with NCDs in Rwanda would play a significant impact on those living in rural areas. The majority of Rwanda’s population lives in rural areas, and many may face financial challenges in travelling to healthcare facilities. MMD practices for NCDs could, therefore, reduce the need for frequent refills, and visits to healthcare facilities. This not only saves patients time and money but also reduces the burden on healthcare systems. MMD practices can benefit healthcare workers by reducing their workload, improving job satisfaction, and reducing burnout. When the number of visits needed to dispense medication is reduced, healthcare workers can spend more time providing care and counselling to patients, which can lead to improved health outcomes. However, it is important to note that while MMD policies for people living with HIV typically provide three to six months of antiretroviral (ARV) medication, the duration of MMD for NCDs may vary depending on several factors, including the type of medication, the severity of the condition, and the patient’s adherence to treatment. Therefore, the duration of MMD practices for people living with NCDs may be shorter. In some cases, two to three months of medication may be sufficient. However, for conditions, such as asthma, a longer duration of MMD may be necessary. Thus, to establish the appropriate duration of MMD practices for NCDs, prior research and consultation with healthcare professionals would be important. By providing patients with a longer supply of medication, MMD policies reduce the need for frequent visits to healthcare facilities, which can be time-consuming and costly. This not only saves patients time and money but also reduces the burden on healthcare systems, freeing up resources to provide care for other patients. The government of Rwanda has made significant strides in expanding access to healthcare through the national health insurance scheme, Mutuelle de Santé, whereby 97 per cent of the population has medical insurance as of the 5th Rwanda population and housing census. However, for MMD practices to be feasible and effective for people living with NCDs, medical insurance could need to agree with covering the cost of medications for the entire duration of the MMD practices. This is especially important for patients who cannot afford to pay for their medication out-of-pocket. Acceptance of medical insurance to cover MMD for NCDs can help to reduce the financial burden on patients and their families, especially those living in rural areas with hardship to travel to healthcare facilities. If concerns about the safety of keeping medications at home for extended periods arise during the implementation of MMD practices for people living with NCDs, an alternative solution could be medical insurance authorising partnering private retail pharmacies to refill prescriptions two to three times without the patient requiring a new prescription from the authorised prescriber. This would provide significant benefits, including improved medication adherence, reduced healthcare costs, and improved access to healthcare, particularly for those living in rural areas. Amon Nsengimana is a pharmacist, and public health and research enthusiast.
