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New York, New York, United Nations Commission on Life-Saving Commodities for Women and Children, 2012 Sep.  p.The United Nations Commission on Life-Saving Commodities for Women and Children presents a new plan and set of recommendations to improve the supply and access of life-saving health supplies.
Lancet. 2002 Jun 8; 359:2009.Carol Bellamy, head of UN Children's Fund (UNICEF), warned that immunization programs worldwide are threatened by the gross reduction of routine childhood- vaccines despite the fact that the risk of vaccine-preventable diseases is increasing. Although production of childhood vaccines normally requires about 2 years, countries funding such programs only commit funds for 1 year at a time. This makes it difficult for their poorer counterparts to make multiyear purchase commitments. As a consequence, UNICEF has been unable to sign long-term contracts with vaccine manufacturers. Thus UNICEF has been calling for long- term commitments from donors.
TROPICAL DOCTOR. 1988 Oct; 18(4):155-8.Based on suggestions made by Simmonds and Walker in 1982, The World Health Organization developed a standard Emergency Health Kit intended for use in refugee camps during the first 3 months of an emergency, by populations of 10,000. The complete kit had a weight of 858 kg and a volume of 2.6 cubic meters. Among its contents was a list of the drugs and equipment it contained. The list was divided into drugs that could be used by health workers with minimal training; drugs to be prescribed only by doctors and senior health workers; and simple laboratory and clinic equipment. The kit was used in many relief settings, some of which were quite different from those it was intended for. In 1986 WHO commissioned a survey of representatives of relief organizations, on their experiences with the kit. 153 questionnaires were sent to 128 organizations. Based on the 55 responses from 50 organizations (36% return), the advantages of the kit were its ease of transport, time savings, the use of drugs familiar to most volunteers, guaranteed quality, and usability in establishing a national basic health unit. Disadvantages included unfamiliarity of some national staff with drug names and doses, ethical dilemmas where refugees might receive better health care than native populations, long receipt times, high costs of transport, use and storage (sometimes = to cost of kit, c. US$4800), incompatibility with some national emergency drug lists, a size too large for small countries or scattered populations, and non-adaptability to varying local situations. Recommendations of kit revision cover decreasing kit size, provision for cold storage, purchase of most liquids locally and elimination of glass containers, more detailed labelling, and better customs and shipment procedures. The list of drugs proved to be the most valuable item for those surveyed. A WHO committee is currently implementing these suggestions and a draft document of a revised kit has been prepared.
Geneva, Switzerland, WHO, EPI, 1984 Oct. 14 p. (Logistics and Cold Chain for Primary Health Care 7; EPI/LOG/84/7)The objective of this module is to enable the users to estimate the 1st requirement for chloroquine tablets. This could be for a new health center or an existing center receiving chloroquine tablets for the 1st time. The 5 steps are as follows: estimate the size of the target population; estimate the incidence of malaria; estimate the coverage; decide on the standard treatment; and calculate the amount of chloroquine tablets needed for the 1st month's supply. Exercises are included.
Geneva, Switzerland, WHO, EPI, 1985 Feb. 9 p. (Logistics and Cold Chain for Primary Health Care 6; EPI/LOG/83/6)The objective of this module is to enable the user to estimate the supply requirements for 5 supply items: chloroquine tablets, oral rehydration salts (ORS) for diarrhea, vaccines for 6 diseases, maternal and child health supplies -- contraceptives and iron tablets, and 34 essential drugs. The method is presented in outline form. A detailed explanation for each of these 5 items is given in 5 other modules. This module thus should be used first and 1 or more of the 5 detailed modules should be read subsequently. These 6 modules describe a method for calculating how much stock should be ordered for the 1st time. The method given in all of these modules can be used for any of the 5 supply items and it can be used in the health center store, the district store, or the regional store. A figure provides an example of the 5 steps for each of the main headings of this course. The 5 steps are: estimate the size of the target population; estimate the disease incidence; estimate the coverage; decide on the standard treatment; and calculate the amount required for each month's supply.
Geneva, Switzerland, WHO, EPI, 1984 Oct. 12 p. (Logistics and Cold Chain for Primary Health Care 3; EPI/LOG/84/3)This booklet considers 4 important aspects of good distribution of supplies: decide a delivery interval; decide a delivery method; choose the transport; and make a timetable. In a system that works well, supplies never run out, there is never too much of any supply, the expiration date is never passed, the cost of the distribution is as low as possible; and in the case of vaccines, they are kept cold all the time. The design of a good delivery depends on: what storage facilities exist; what transport exists; how many people can be trained in the different skills needed; what volume and weight of supplies need to be delivered; and many other factors that only can be decided locally. It is necessary to estimate the volume and the weight of the supplies required in order to make a decision about the distribution means. There are 2 ways of distributing supplies: collection and delivery. In many places, both methods are used. There are 3 types of transport that may be chosen: public, project vehicle, and hired vehicle. The type of transport is not limited to motor vehicles. Boats, trains, carts, bicycles, and walking may be used. In certain cases, it may be justified to use domestic air service. However the distribution system is planned, it is important to make a timetable so that it will operate regularly and properly. The module includes diagrams and exercises.
Geneva, Switzerland, WHO, EPI, 1985 Mar. 12 p. (Logistics and Cold Chain for Primary Health Care 9; EPI/LOG/84/9)This module's objective is to enable the user to estimate the 1st requirements for vaccines. This could be for a new health center or for an existing center providing vaccines for the 1st time. With each calculation an empty column has been left entitled "Your area." In this space one can change the assumptions given in the module and put in the figures for his/her own area. This module concentrates on how to estimate the requirements for vaccines, and the method used is the same as that described in the module entitled, "How to Estimate Requirements for the First Time." The following steps are covered: estimate the size of the target population; estimate the vaccine needs for the 6 Expanded Program for Immunization (EPI) diseases; estimate the coverage; decide on the standard treatment; and calculate the amount of vaccine needed for the 1st month's supply. Exercises are included.
Geneva, Switzerland, WHO, EPI, 1985 Feb. 21 p. (Logistics and Cold Chain for Primary Health Care 5; EPI/LOG/84/5)This module provides instructions for controlling the quality of the supplies in a store and for distributing or dispensing supplies. The module advises the user on how to decide if a product (a condom, pill, or a vaccine) is still good to use. Simple tests can be performed to determine if a product is still good. These tests are described under the headings of: vaccines; oral rehydration salts (ORS) packets; maternal and child health supplies; essential drugs; and chloroquine. There are 4 ways of controlling the quality of vaccines: by regularly monitoring the storage temperature; by potency testing; by checking if it has been frozen; and by using a cold chain monitor. Vaccines should not be used if they have passed their expiration date; if they have been exposed to high temperatures; if a vial has been partly used in a previous session; if the cap on the vial is leaking or damaged; if the label has come off and the vaccine cannot be identified; if they have been to the field 2 or 3 times without being used; and if DPT, DT, or TT have been frozen. ORS in sealed laminated aluminum foil can be kept for about 3 years. If the content of ORS packets is brown, dark brown, or liquified, it should not be used. Tables provide information on when one's stock of maternal and child health items is still good to use and when to throw away drugs.
In: National Council for International Health [NCIH]. Pharmaceuticals and developing countries: a dialogue for constructive action. Washington, D.C., NCIH, 1982 Aug. 27-33.The Pharmaceutical Program of the Center for Public Resources encourages cooperation among the leaders of the pharmaceutical industry in Europe and the US, the bilateral and international public agencies, and the ministries of health of the developing world in addressing issues relating to the availability of pharmaceutials in primary health care systems. Incentives for cooperation among the parties include a professional incentive to discuss common concerns, an economic incentive to find additional financial and technical resources for health care activities within development assistance, a political incentive to avoid public conflict, and a public relations incentive. The barriers to sustained cooperative resolution of pharmaceutical problems are: 1) 3rd world countries account for a very small part of the business of must US companies, 2) corporate structures lack clear foci of responsibility and are difficult to work with, 3) corporate goals and short-term time perspectives discourage cooperation, and 4) the vagaries of the international economy affect the ability of companies to put money into cooperative efforts. Trade associations hamper cooperation because they interject themselves between the company and the country, introducing problems of communication and decision making. Barriers involving the public sector also impede effective partnerships on pharmaceutical issues: 1) public agenices must be willing to take risks and to take public positions on controversial issues, difficult tasks for developing country leadership; 2) it is difficult for public agencies to modify positions already taken on issues; 3) health lacks status in the national economies of developing countries and it may be financially difficult to implement whatever is discussed; and 4) it is difficult to achieve consensus within national bilateral public agencies and international agencies. Prerequisites to overcoming these barriers include agreeing that the participants cannot seek to defeat one another; carefully choosing issue areas so that issues with some mutual understanding are intially chosen; identifying and cooperating with the individuals able to make decisions within each organization; maintaining the neutrality of the forum; and following through on decisions to show that they can be implemented.
Geneva, Switzerland, WHO, EPI, 1983. 18 p. (Logistics and Cold Chain for Primary Health Care 4; EPI/LOG/84/4)This module tells the user how to keep good records and how to analyze them, for however well planned a supply chain is it will only work efficiently if there is accurate record keeping. It is necessary to record the number of immunizations given, the number of contraceptives dispensed, and the number of tablets and injections delivered. These records are kept for 2 reasons: to provide information so that the success or failure of a health program can be monitored; and to provide information necessary to run an efficient cold chain, e.g., calculation of immunization coverage and vaccine wastage. Records are kept and used at all levels of the supply chain. They generally collect information on the amount of items received or issued and the balance held in stock. Some extra records may be used for some items supplied, e.g., vaccines. These extra records include: a record of immunizations performed; a temperature record for the cold chain; a record on a cold chain monitor; and a vehicle record. There are 4 reasons to keep records: to calculate coverage; to calculate dropout rate; to calculate stock levels; and to calculate wastage. High wastage rates can be caused by faults in the supply system or by management problems. A few examples of different causes of wastage include: expiration of vaccines; cold chain failure due to improper handling and equipment breakdown, physical damage to vials, and disposal of unused vaccine from an open vial at the end of the day. If supply reports are carefully monitored and studied each month, abnormal wastage rates can be detected and corrected quickly. There is no set figure for a "good" wastage rates, but once a "normal" wastage rate has been calculated over a period of time, any change from this figure should be investigated. The module includes 7 examples of forms that can be used to collect information and exercises that accompany the instructions.
Geneva, Switzerland, WHO, EPI, 1983 Jun. 14 p. (Logistics and Cold Chain for Primary Health Care 10; EPI/LOG/84/10)This module enables the user to estimate the 1st requirements for contraceptives. This could be for a new health center or an existing center providing contraceptives for the 1st time. With each calculation an empty column has been left entitled "Your area." In this space one can change the assumptions given in the module and put in the figures for his/her own area. The module covers 5 steps for estimating requirements for a new store: estimate the size of the target population; estimate the needs for contraceptives; estimate the coverage; decide on the standard treatment; and calculate the amount of contraceptives needed for the 1st month's supply. Exercises are included as is a summary table.