Insulin to GLP-1 in Guyana's public system: what is covered

Free in principle: how public medicines work

In Guyana, medicines are dispensed free of charge to patients in the public sector; in the private sector patients pay out of pocket or through insurance co-pays, and the national social insurance scheme can subsidise medicines up to 80 % of the cost, but only for conditions developed before age 55, according to a 2022 regional assessment by the Healthy Caribbean Coalition⁷. What the public sector buys is set by the national Essential Medicines List (EML), which informs procurement, is revised by the National Therapeutics Committee and is guided by standard treatment guidelines and the WHO Model List⁷. When the Ministry and PAHO/WHO met in March 2019 to finalise the revision, then-Chief Medical Officer Dr Shamdeo Persaud said the previous list had been signed off in 2015⁸.

The 2022 assessment checked Guyana's 2020–2022 EML against a regional list of essential NCD medicines. It included 68.5 % of the indicator medicines overall, 85 % of cardiovascular medicines, but only 62.5 % of the medicines for diabetes⁷. No GLP-1 receptor agonist was on Guyana's public list at the time, and we found no published update that adds one.

Insulin: a record of near-misses

Insulin is the backbone of public diabetes care, and its supply has been tested more than once. In July 2018 the Ministry of Health denied a shortage after patients in several regions said they had been turned away and told to buy insulin; the head of the Materials Management Unit pointed to a 40-foot container of 70/30, soluble and lente insulin held in cold storage at Diamond, and the Director of Pharmacy Services said insulin was being sold for $3,000 to $5,000 a vial². In 2017 the president of the Guyana Diabetic Association, asked about an insulin shortage, said: "The number of cases is growing so I can understand if there is a drug shortage for insulin"³.

In April 2023 the Ministry put out an emergency tender for 39,224 vials of lente insulin and 10,628 vials of 70/30 insulin. Health Minister Dr Frank Anthony said: "We have 152 children who require insulin Type 1 without which they have problems and risk of death," calling the purchase a way to "bridge the gap" until larger tenders were awarded¹. A 2021 HGP report put the number of children and adolescents living with diabetes at 186¹⁵, and the Ministry's Type 1 Diabetes Programme says it provides medical supplies and support to these children¹⁴.

By World Diabetes Day 2024 the Ministry said: "Insulin and other drugs are now more accessible at public health facilities, reducing the financial burden on patients"⁴. In a letter published the same day, Dr Leslie Ramsammy, chair of the Presidential Commission on the Prevention and Control of NCDs, credited the progress, including pen insulin delivery for children with type 1 diabetes, but added: "Still the supply chain sometimes experience shortages. This must end once and for all"⁵.

The case for GLP-1s in the public sector

Ramsammy's letter went further. It said the Commission had, in 2023, urged the public health sector to consider introducing newer medicines, and described GLP-1 receptor agonists and SGLT-2 inhibitors as medicines that "lower blood sugar levels, can help with weight loss, and protect the heart and kidneys"⁶. It acknowledged that "These are expensive medicines" and that Guyana might not be able to give them to every patient, and argued that "a strategy must begin now for the introduction for some patients"⁵⁶.

WHO moved in the same direction in September 2025. Its 24th Essential Medicines List added semaglutide, dulaglutide, liraglutide and tirzepatide for glucose-lowering therapy in adults with type 2 diabetes who also have established cardiovascular disease or chronic kidney disease and obesity, while warning that "High prices of medicines like semaglutide and tirzepatide are limiting access" and that generic competition is key⁹. Guyana Times carried the news locally¹⁰. A narrow, high-risk target group like WHO's is exactly the "some patients" strategy the Commission described⁵⁹.

Why the numbers matter

Guyana's 2016 Pan American STEPS survey found 23.6 % of adults aged 18–69 obese, 61.8 % of women with a BMI of 25 or more, and 11.5 % with raised blood sugar or on diabetes medication; NCDs caused 68 % of deaths, diabetes alone 8 %¹¹. A nationally representative analysis put diabetes prevalence at 18.1 %, and 24.1 % among rural women¹². On the private side, the Health Minister said in May 2026 that a manufacturer of Ozempic had applied to register it and that the application was under review, insisting it would need a prescription¹³. That would create a legal private supply; it would not, by itself, put the class on the public list.