Vol. 2007 No. 1 (2021)
Insulin Access and Essential Medicines: A Commentary on East African Policy and its Implications for Egypt
Abstract
**Background:** Access to insulin is a persistent public health challenge in low- and middle-income countries. Inclusion on national essential medicines lists (NEMLs) is a foundational policy step, but implementation is governed by political and economic factors.
**Purpose and objectives:** This commentary analyses the political economy of insulin access. It compares recent NEML policies in East Africa with the evolving context in Egypt to clarify the policy drivers and barriers affecting insulin listing and procurement.
**Methodology:** The analysis uses a comparative policy review framework. It examines publicly available NEML documents, health policy reports, and procurement data from 2021–2026 for Kenya, Uganda, Tanzania, and Egypt, focusing on insulin formulations and procurement mechanisms.
**Findings/Key insights:** A key finding is divergent policy adoption. By 2021, the East African countries had updated NEMLs to include newer analogue insulins. In contrast, Egypt’s list remained primarily reliant on human insulin during the 2021–2026 period, despite a high diabetes burden. This disparity underscores the influence of domestic manufacturing capacity and procurement bargaining power on policy decisions.
**Conclusion:** Formal NEML inclusion does not guarantee access. Insulin security is contingent on navigating the political economy of pharmaceutical procurement, pricing, and supply chain governance.
**Recommendations:** Recommendations include fostering regional pooled procurement initiatives in Africa, strengthening transparency in pricing negotiations, and advocating for policy alignment that prioritises patient-centred outcomes alongside cost considerations.
**Key words:** insulin access, essential medicines, political economy, policy analysis, diabetes, procurement, East Africa, Egypt.
**Contribution statement:** This commentary provides a comparative analysis of insulin policy, linking NEML status to broader political and economic determinants to inform health system strengthening in the region.