Vanuatu: caring for people with diabetes

Sitting under the shelter of her home in Port Vila, Sera is one of more than 25 000 people in the Pacific Island State of Vanuatu who lives with diabetes.

On average across the state, one in eleven people are living with the condition.

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. It is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.

Sera has lost sight in her right eye due to her condition. Lower limb amputation is also common among people living with diabetes in Vanuatu.

In 2019, 61 people in the country lost all, or part of, their lower limbs from amputations needed because their diabetes was not adequately controlled. Such operations are largely avoidable, and they cause considerable distress to patients and families alike. They are also considered unacceptably frequent by the Government of Vanuatu.

Insulin: why supply and access are crucial

With its population scattered across 83 islands, reaching everyone in Vanuatu who lives with a noncommunicable disease (NCD), such as diabetes, has been both a long-standing ambition and a logistical challenge. To help achieve this goal, WHO has worked with the Government of Vanuatu to introduce a package of interventions to prevent and control noncommunicable diseases through the primary health care system.

This package, known as "WHO PEN”, sets out the best-practice care for people living with type 2 diabetes in low-resource settings. Having reliable access to insulin is a core part of the recommended pharmacological approach; adherence to oral medication, physical activity and healthy diets is not enough.

Acting on diabetes forms a core part of Vanuatu’s national health sector strategy. Alongside WHO PEN, Vanuatu’s “Fight Sik Suka” initiative seeks to reduce the incidence and impacts of diabetes through national media campaigns, programmes for healthy villages and schools, and efforts to increase community-based screening.

As part of these efforts, increasing access to insulin is a crucial piece of the puzzle. When asked why insulin is important to her care, Sera is clear: “Diabetes is taking its toll on my life. But I know that insulin is keeping me going.” It also encourages her to consider other aspects of her health: “When I depend on insulin, I have to know what I’m eating, and how can I survive in a day.”

Across town, Rose is another Vanuatu resident who requires ongoing care from nearby health services for her diabetes. A major challenge for her is the continual visits to hospital. Although being able to self-monitor blood glucose is only one element of managing diabetes, for Rose, having the equipment at home to enable her to do that would have made a difference: “In order for me to stay home and test myself, I need access to a blood glucose machine. Otherwise, I spend lots of the money I have on bus fare to come to hospital. If there was an opportunity to be given a machine, I would certainly like to be taught how to use it.”

For Sera, the visits to the health clinic create another challenge  ̶  fatigue: "When I visit the NCD clinic, sometimes I feel really tired and I have to hang onto my carer who takes me through. I get tired, and I only wish I could receive my medication at home.”

The supply of medication is crucial. As Rose tells us, the demand for insulin across Vanuatu means she is only able to access small quantities at a time: “If it was possible to provide more than one bottle of insulin at a time, it would make my life much easier. My medication works, but I can only get so much at a time, around one month. I cannot get more because there are so many people on those drugs. It would be good to have more supplies, so I could stay home, and save money rather than have to come back and forth, back and forth.”

Sera and Rose’s testimonies highlight why strong primary health care that integrates care for NCDs is so important. Ensuring equitable and local access to medicines can lead to better patient care, and less need for expensive treatment to treat painful complications.

Despite the challenges of living with diabetes, Sera keeps a positive mindset: “Whatever diabetes has done to my life, I have to accept it in some ways. I’m enjoying life. I had better not let it slip through my fingers. I've got to grab hold of it, and count every day as a blessing.”


Photo Credit: WHO/T. Bayandorj Caption: Rose, who lives with diabetes, would prefer to be able to control her condition from home