physicians are not available in 77 Member States, meaning that access to health care could be even lower. Furthermore, the data on access to essential medicines are poor in most low-resource settings. Another major problem faced by many patients suffering from NCDs, including psoriasis, is inadequate public funding for health care and high out-of-pocket costs. Funds allocated by many countries for providing basic health care to their citizens are still insufficient. According to the WHO Global health expenditure atlas, a minimum of US$ 44 is required per person per year to provide basic, life-saving health services (165). According to the World health statistics 2015, 25 WHO Member States spent less than this in 2012 (164). The above data reflect perfectly a fundamental problem faced by patients suffering from psoriasis. Lack of adequate access to health professionals means no diagnosis, no treatment, uncontrolled development of the disease and disability. Lack of a sufficient number of health professionals to some extent also contributes to low public awareness of psoriasis and the exclusion and discrimination of patients diagnosed with the disease. Lack of awareness of health professionals An insufficient number of health professionals results in a lack of specialist support to general practitioners, who are the lone providers of health care. Lack of adequate training of general practitioners and other health-care providers results in a low awareness of psoriasis (166). Ultimately, lack of awareness about psoriasis and its associated co-morbidities results in under-diagnosis and ineffective therapy, inappropriate to the needs of the patient. The need for increased awareness has been emphasized by the European White Paper on Psoriasis Care (167). In circumstances where there is limited access to health professionals, the lack of access to medical specialists, including dermatologists, rheumatologists, psychiatrists, cardiologists and paediatricians, is even more likely. In an ideal situation, contact with such specialists is needed to ensure the optimal treatment of psoriasis and prevention and management of attendant co-morbidities. Dale, a man in his fifties in North Carolina, United States of America, struggles daily with his severe plaque psoriasis. As a skilled construction worker, he has had to give up working due to the severe pain affecting his swollen hands. He now lives in his brother’s back yard and does odd jobs to make ends meet. He has applied for disability several times, and has been denied. While many effective treatments exist, he lacks access to them because he is uninsured. Source: National Psoriasis Foundation, United States. Global report on psoriasis 25 Lack of standardized tools for diagnosis and treatment Lack of guidelines and tools, which are necessary for a prompt diagnosis of psoriasis and providing appropriate treatment, is another issue faced by patients. It results in unnecessary suffering, uncontrolled disease and irreversible deformities of the joints and disability. Furthermore, patients are often deprived of comprehensive, individually adapted or personalized care. Even in countries where guidelines exists, their uptake is low (167). However, there is evidence that when health-care providers are aware of guidelines and implement them in daily practice, the quality of care for psoriasis patients is increased (171,172). Cost and availability of essential medicines The treatments used for various skin disorders, including psoriasis, can be expensive, life-long and often not financed by universal health coverage schemes. Self-funding of treatment is often ruinous for the patients and their household budget, particularly as many people suffering from psoriasis cannot undertake professional work for health reasons or because of discrimination. According to the WHO Global health expenditure atlas, 100 million people are pushed into poverty every year because they have to pay directly for their health care (165). In many countries, most treatments for psoriasis are either unavailable or are not reimbursed, even those on the WHO Model List of Essential Medicines (166). The prices of psoriasis medications vary considerably – from the relatively inexpensive topical corticosteroids to the more costly biologic