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The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management.
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006-2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF's unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes' standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF's key plans and strategies for the future, and the challenges associated with implementation. (author's)
ENTRE NOUS. 1999 Spring; (42):8.The alarming increase of STDs, particularly syphilis (from 378 cases in 1990 to 2520 cases in 1997), has been identified as a high priority area in Bulgaria, where Doctors Without Borders has been working since 1997. In July 1998, DWB Switzerland set up a pilot project that supported the implementation of an innovative treatment procedure and encouraged the Bulgarian Minister of Health to adopt a new ordinance on syphilis treatment. The treatment procedure is recommended by WHO and is based on delayed-release penicillin; it is less expensive and requires no hospitalization, which makes it more acceptable to patients. An assessment conducted in January 1999 to evaluate the evolution of the project showed that of the total 274 patients treated, approximately half of them were in the primary stage, which indicates a high incidence of primo-infections. An increase in the cost of treatment was noted due to the different treatment procedures used. Lack of understanding of the criteria on the part of the physician and resistance to adopting a new treatment procedure were among the problems encountered. Thus, an appeal to annul the old ordinance of 1978 regarding syphilis treatment, which requires hospitalization, was made in order to ensure the rapid implementation of the new procedures. Furthermore, DWB is planning to implement a program that will give emphasis to the training of Bulgarian professionals to respect the patients and their rights to confidentiality, reinforce therapeutic services and health education, distribution of condoms, and access to HIV testing and counseling.