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Washington, D.C., World Bank, Knowledge and Learning Center, 2005 Nov.  p. (Findings Infobriefs No. 118; Good Practice Infobrief)The Mali Multi-sectoral AIDS Project (MAP) began implementation in late 2004 and is in the preliminary phases of the project cycle. This project has been commended by the World Bank's Board for its innovation and the involvement of the private sector to address HIV/AIDS. Mali is one of the poorest countries in the world due to factors such as its limited resource base, land-locked status and poor infrastructure. According to the 2001 Demographic and Health Survey (DHS) published by the Ministry of Health, Mali's HIV/AIDS prevalence rate is estimated at 1.7% in 2001. The project objective is to support the Government of Malis efforts to control the spread of the HIV/AIDS epidemic and provide sustainable access to treatment and care to those infected with or affected by HIV/AIDS. While Mali currently has a low HIV prevalence rate by Sub-Saharan African standards, it runs a high risk of experiencing an increase in prevalence rates. (excerpt)
SCIENCE. 1991 Mar 15; 251:1312-3.AIDS scientists met in February 1991 to discuss international trials of AIDS vaccines because of the urgency in conducting such trials since the US Food and Drug Administration approved 6 vaccines for trails. Major problems discussed were how to insure access to potential AIDS vaccines to developing countries, where to conduct future tests of vaccine efficacy, and which of the leading institutions should coordinate such an effort. The most difficult issue centered around who assumes the risks and who benefits. Many researchers considered conducting AIDS vaccine trials in developing countries since they have a large population varied in age and gender at high risk of HIV infection. Assuming an HIV vaccine is effective, additional questions must be addressed: How can a developing country afford a vaccine at free market prices? If that country does get the vaccine should not other developing countries also get it? Who will pay for it and distribute it? WHO has already contacted ministries of health about AIDS trials. Other organizations, e.g., the US Centers for Disease Control and the US National Institutes of Health, also already involved in international AIDS vaccine research do not want to be kept out of the Phase III trials. Some recommended that WHO be the international umbrella, others suggested that no organization control all the research. Nevertheless the vaccine will be produced in a rich country, and if left to the free market, it will be too expensive. 1 suggestions is a 2-tiered pricing plan in which rich countries pay higher prices thereby subsidizing the price in poor countries. Another is a patent exchange where the vaccine developers donate the vaccine patent to an international organization and they in turn can get an extension on an existing patent. Another alternative includes removing AIDS vaccines from the private sector altogether.
In: ICORT II proceedings. Second International Conference on Oral Rehydration Therapy, December 10-13, 1985, Washington, D.C., [edited by] Linda Ladislaus-Sanei and Patricia E. Scully. Washington, D.C., Creative Associates, 1986 Dec. 83-5.At a recent international conference on Oral Rehydration Therapy (ORT) there were discussions on policy issues. Advances in oral rehydration solution (ORS) local production, and the use of private sector and public sector distribution. It was agreed that the roles of ORS packets and home solutions must be carefully thought through and the be the basis of the program. If ORS is going to be available at the household level then the use of the private sector should be considered. The policy to use informal distribution channels and traditional healers has shown to increase public access to ORS. Also, donor support of ORS commodities may not lead to self sufficiency. Governments should plan for self sufficiency in advance and should manage donor support. Advances in local ORS production include factors that promote low cost production such as efficient personnel, economical procurement of materials, appropriate choice of equipment, minimizing duties, and using existing production facilities. The adoption of a citrate ORS formula allows the use of cheaper packaging material. The private sector can and should be used to make ORS available on a wide scale. Product pricing is a highly complex problem and the mothers ability to pay must be balanced against the profit incentives in the distribution system. Subsidies have been necessary to encourage the private sector and mass media campaigns have proven to be a useful subsidy. The key factor in gaining wide coverage is the person who contacts the mother. Competition can be useful in gaining greater effective usage but there are tradeoffs. The high costs of import licenses and hard currency have been stumbling blocks for the private sector production in some countries. It was found that it is inadvisable to set up a separate distribution system for ORS and it should not be given priority over other child survival interventions. Also a policy of cost recovery can make a program more viable in the absence of donor assistance and has increased confidence in the product and therapy.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.
Tropical Doctor. 1984 Jan; 14(1):3-7.On April 27, 1982 the Ministry of Health of the government of Bangladesh, set up an 8-man expert committee to evaluate all the registered pharmaceutical products presently available, and to formulate a draft National Drug Policy. Objectives are: 1) to provide support for ensuring quality and availability of drugs; 2) to reduce drug prices; 3) to eliminate useless, nonessential, and harmful drugs from the market; 4) to promote local production of finished drugs; 5) to ensure coordination among government branches; 6) to develop a drug monitoring and information system; 7) to promote the scientific development and application of unani, ayurvedic, and homeopathic medicines; 8) to improve the standard of hospital and retail pharmacies; and 9) to insure good manufacturing practices. 16 criteria were agreed on as guidelines for evaluating the drugs on the country's market. Drugs in Bangladesh have been classified into 3 categories. The 1st is drugs that are positively harmful. They should be banned immediately and withdrawn from the market. There are 265 locally manufactured drugs and 40 imported drugs in this category. The 2nd, drugs to be slightly reformulated by eliminating some of their requirements. There are 134 drugs in this category. The 3rd is drugs that do not conform to 1 or more of the 16 criteria/guidelines. There are over 500 drugs in this category. The new drug policy will produce a saving of 800 million taka (US $32.4 million). Drug supply in Bangladesh is a problem. The public sector distributes 20% of the total. In the private sector, drugs are supplied through import and local production. Investment for research by the pharmaceutical companies is essential. The principles laid down by the International Federation of Pharmaceutical Manufacturers Associations for the supply of good medicine needs to be put into practice.
In: Zatuchni GI, Sobrero AJ, Speidel JJ, Sciarra JJ, ed. Vaginal contraception: new developments. Hagerstown, Md., Harper and Row, 1979. 66-81.Although condoms are still produced from a variety of materials, the popularity of the condom increased mainly after the dipped latex process was developed in the 1930s. Condoms went with US troops all over the world during World War Two. It is only in recent years that strict quality standards were established. Many countries, including the US, measure quality in the number of pinholes acceptable per unit, the number of acceptable holes varying considerably between countries. Japan has made a standard based on leakage as measured by sodium ion concentration. Various types, colors, names, and sizes of condoms are popular in different countries. Large scale distribution in recent years has raised the question of shelf life. It is generally thought that a condom kept in a sealed tinfoil package will stay good indefinitely. Nonetheless, for management as well as safety purposes smaller shipments are preferred over large shipments in mass distribution programs. Condom popularity is partly associated with the number and accessibility of distribution points; therefore, it has become more prevalent to use both government units and regular commercial distribution points for popularizing the condom, and there is reason to believe that this type of program will grow. In light of the current interest in integration of contraceptive programs with health care and development efforts, population specialists should look closely at the condom and the commercial resources available for its distribution. A series of tables gives gross numbers of condoms supplied by international donor agencies in the developing countries, 1975-78.
Problems of distribution, availability, and utilization of agents in developing countries. A. Industry perspectives.
In: Institute of Medicine. Division of International Health. Pharmaceuticals for developing countries. (Conference proceedings, Washington, D.C., January 29-31, 1979) Washington, D.C., National Academy of Sciences, 1979. (IOM-79-001) p. 211-227A spokesman for the drug industry emphasizes that the health and well-being of the peoples of the developing world are far more dependent on political and economic decisions than on scientific and technological developments. The following tables provide evidence for the superiority of private sector drug distribution vs. public: 1) leading therapeutic classes by sales through retail pharmacies in selected developed and developing markets (e.g., all of Latin America together consumes less antidiabetic drugs than Holland); 2) national expenditure on health as a percentage of gross national product (i.e., GNP; in general, developed countries spend 5-8% of GNP on health care, of which 10-20% represents expenditure on drugs; whereas in low-income countries drug expenditure rarely rises to 2 U.S. dollars and often accounts for up to 50% of total health care); 3) distribution of public finance in selected developing countries (1975); 4) health care and development aid provided by major donor nations (1976); 5) structure of aid to health in capital aid only; 6) comparative rankings of the leading 10 therapeutic classes in selected developing countries; and 7) patent protection for pharmaceuticals in selected developing countries. It is pointed out that policies which restrict activities in multinational corporations, especially patent and trade name restrictions, have resulted in a heavy pull-out of multinationals from participation in drug delivery in developing countries. This is seen as further debilitating the already woeful, by industry standards, state of public sector health care delivery in developing nations.
Proceedings of the Royal Society of London, B. 1976 Dec 10; 195(1118):187-198.In the past 15-20 years there have been advances in fertility regulation. These advances are modest gains that frequently involve a bioengineering input, include collaboration between public agencies and industry, and are closely related to the needs of developing nations. They are the result of the existence of specialized programs whose major goal is the development of new technology. However, a similar specialized public mechanism to undertake the wide range of activities related to product development and introduction of the new technology into family planning does not exist. The 3 major phases of the contraceptive development process are biomedical development, product development, and product introduction-market development. There are 4 areas that require more attention. The 1st of these is a product development laboratory that would accept responsibility for dosage form development, stability testing, quality control procedures, product and packaging modifications, and the production of supplies for biomedical research. Such a laboratory would increase the acceptability of existing methods and promote new developments. Also needed is a contraceptive information service, offering ''full disclosure'' product-related information to managers of family planning programs. A 3rd need is for a patent and licensing administration for the public sector; this would assure that new contraceptives developed with public funds would be made widely available to family planning programs at a reasonable cost. Finally, there is a need to establish a contraceptive introduction planning unit that would consider the program implications of new methods of fertility control and aid countries in planning for their introduction. The availabiltiy of a specialized capacity to take responsibility for public leadership in these 4 areas would contribute greatly to the development of new contraceptive methods that are appropriate to the needs of developing countries and to the success of present international contraceptive research and development efforts.(Authors', modified)
In: Inter Governmental Coordinating Committee. Southeast Asia Regional Cooperation in Family and Population Planning. A Report on the IGCC Regional Expert Meeting between Family Planning Administrators and Commercial Marketing Executives held in Penang, Malaysia, 22-24 September 1974. Kuala Lumpur, Malaysia, IGCC Secretariat, 1975. 53-4.The IPPF Central Medicine Committee has concluded that non-medical distribution of oral contraceptives is appropriate, and that such methods of distribution can and should be devised. Accordingly, the Committee recommends Member Associations to 1) devise and introduce new schemes for distribution of oral contraceptives, along with other contraceptives; 2) persuade governments and the medical profession of the health benefits to mothers and children of non-medical distribution of oral contraceptives; 3) establish educational and informative programs which describe the use of oral contraceptives, relative contraindications, and possible side effects; and 4) reorganize clinic facilities to ensure easy access to trained personnel in the event that a woman is uncertain about the use of oral contraceptives, needs reassurance, or has a complicated medical condition. The Committee deems these measures appropriate because the limitation of oral contraceptives to doctors' prescription is geographically, economically, and culturally discriminatory and results in more deaths and sickness to women and children than would be the case if fertility were voluntairly controlled.
People. 1975; 2(4):5-11.A survey of selected countries to illustrate the variety of approaches used in supplying contraceptives through the community is presented; and the agencies involved are listed. The various types of community-based distribution schemes in 33 countries of Latin America, Africa and Asia are identified and briefly described. The personnel and methods utilized in individual countries include rural community leaders, fieldworkers, satisfied contraceptive users, paramedical and lay distributors, women's organizations, commercial marketing, education programs, market day strategies, and government saturation programs. The community-based program for distributing oral contraceptives with technical assistance from BEMFAM, an IPPF affiliate, in northeastern Brazil is described in detail, with emphasis onsocial marketing techniques and the mobilization of resources. In addition to IPPF, other agencies working in community-based distribution include Family Planning International Assistance, International Development Research Centre, Population Services International, The Population Council, UNFPA, USAID, and Westinghouse Health Systems Population Centre.
Costa Rican Demographic Association (Asociacion Demografica Costarricense (ADC): the coupon system controversy.
Managua, Nicaragua, Instituto Centroamericano de Administracion de Empresas, 1973. 43 p. (INCAE Management Case No. 9-575-601)This case study was developed as a teaching tool for administrative family planning personnel. The Costa Rican Demographic Association (ADC) assumed responsibility for the distribution of oral contraceptives (OCs) through commerical outlets in a program started by Alberto Gonzalez. Gonzalez had organized a rural distribution system of OCs by recruiting local women to sell OCs to friends and relatives at reduced prices. The number of women involved grew so rapidly, Gonzalez, who was a founder of ADC and its first Executive Director, expanded the distribution system to urban areas. In 1964, however, stiff opposition to the distribution system was made by the College of Pharmacists, for OCs were being sold at greatly reduced prices through noncommerical outlets. After difficult negotiation, the College agreed, in 1967, to allow the ADC to import and distribute contraceptives providing a pharmacist supervised the distribution, a doctor's prescription was obtained, and the ADC disburse OCs in pharmacies. The latter provision forced ADC to abandon its highly successful system of individual distributors. Instead, a woman had to go to a clinic, obtain a doctor's prescription as well as a blue (minimal charge) or green (no charge) coupon and then find an authorized outlet to purchase the OCs at a reduced price. The pharmacist had to keep special inventories and maintain a coupon system in order to obtain credit from ADC. ADC had to make sure inventories were maintained and that proper controls were placed on the distribution process. By 1971, 233,309 cycles of OCs were distributed through the coupon system. Nonetheless, questions were raised by USAID and other organizations about control procedures and pricing. It was suggested that it might be more convenient for the patient if the clinics themselves could assume the responsibility of supplying OCs to patients.