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  1. 1

    Access to drugs. UNAIDS technical update.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]; World Health Organization [WHO]. Action Programme on Essential Drugs

    Geneva, Switzerland, UNAIDS, 1998 Oct. [12] p. (UNAIDS Best Practice Collection)

    The World Health Organization (WHO) estimates that over one-third of the world's population has no guaranteed access to essential drugs. There are various reasons for this lack of access. Worldwide, the most important is affordability (drugs cost more money than is available to pay for them) but legal, infrastructural, distribution and cultural factors are also serious obstacles. The influence of each of these factors is different from country to country, just as frequencies of diseases also vary greatly. Among its activities aimed at improving drug access in developing countries (including technical services such as help in drug procurement and performance of needs estimates), WHO has drawn up a Model List of Essential Drugs, which is updated every two years. The tenth list (1997) has 308 priority drugs that provide safe, effective treatment for the infectious and chronic diseases which affect the vast majority of the world's population. The drugs are selected on the basis of cost-effectiveness within each drug class (e.g. of the dozens of penicillins only eight appear on the Essential Drugs list). With WHO's encouragement, more than 140 countries have developed their own national essential drug lists taking into account local needs, costs and available resources. (excerpt)
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  2. 2
    Peer Reviewed

    WHO's HIV/AIDS strategy under the spotlight.

    Marshall SJ

    Bulletin of the World Health Organization. 2004 Jun; 82(6):474-476.

    Since its introduction in 1996, highly active antiretroviral therapy (ART) has enabled people with HIV/AIDS in industrialized countries to live healthier, longer lives and to continue to contribute to the social and economic well-being of their families and societies. However, although 95% of the world's 40 million HIV-positive people are living in developing countries, only about 400 000 of the six million people requiring treatment actually received it in 2003. To address this treatment gap, at the UN General Assembly Special Session on HIV/AIDS in 2001, UN Member States unanimously committed to scaling up ART within their national HIV/AIDS programmes. In late 2003, WHO and UNAIDS declared the inequity in access to HIV/AIDS treatment a global public health emergency and launched the initiative, dubbed "3 by 5", which aims to treat three million people living with HIV in developing countries by the end of 2005. In a special interview with the Bulletin, WHO's Director of HIV/AIDS explains the principles behind the strategy, describes the challenges to its success and recounts the progress made towards achieving the target to date. (excerpt)
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  3. 3

    Implementing treatment programs with Mectizan: reports from the field.

    de Raadt P

    In: Mectizan (Ivermectin) and the Control of Onchocerciasis: Strengthening the Global Impact. A symposium sponsored by Merck and Co., Inc. marking the fifth anniversary of the donation of Mectizan for the treatment of onchocerciasis and held with the technical cooperation of the World Health Organization at the Hudson Theater in New York on September 23, 1992. Summary proceedings of the symposium. Rahway, New Jersey, Merck and Company, 1992. 29-30.

    Developing a good drug is a great achievement. However, delivering a particular drug to a target population can be a complex and expensive undertaking. So is delivering a drug such as Mectizan, when the majority of its users live in developing countries where the economic, political and social determinants are unfavorable for health care services. The success or failure of drug delivery systems for tropical diseases depends on: 1) regular production, 2) adequate local administration and management, 3) timely ordering and supply, 4) appropriate storage, 5) good transport facilities, 6) reasonable case identification, and 7) correct prescription and use. Specialized drugs for tropical diseases are often produced in limited batches according to orders received. As a result, critical delays in delivery can occur. In the case of Mectizan, there seems to be no problem with prompt delivery by Merck & Co. once a request for donation has been approved. The multi-disease approach for delivering Mectizan may be one way of economizing on personnel and transport costs. In the Central African Republic, using the established transport network for immunization programs has produced good results. However, since the range of coverage for vaccination purposes does not extend as far as the village level, bicycles had to be provided to take over from the dispensaries. In Uganda, orderlies trained for sleeping sickness surveillance offer potential staff for distributing Mectizan, as do the staff of successful leprosy programs, which are beginning to show interest in combined approaches. In the meantime, the role of the World Health Organization (WHO) is mainly to set internationally acceptable technical standards applicable to the distribution and use of Mectizan and to support research through the UN Development Programme/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.
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  4. 4

    How to estimate chloroquine requirements for the first time.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    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.
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  5. 5

    How to estimate requirements for the first time.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    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.
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  6. 6

    How to control quality of stocks.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    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.
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  7. 7

    Oral rehydration salts: an analysis of AID's options.

    Elliott V

    [Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26, [13] 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.
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  8. 8

    Application of WHO Essential Drugs in practice.

    Gotnik MH; Faber DB

    Tropical Doctor. 1984 Jan; 14(1):8.

    Enormous problems in developing countries concerning drug supply, such as inadequate control of money spent on drugs, insufficient government supervision of the importation and distribution of drugs, dumping, and so on, prompted the World Health Organization to set up an expert committee to compile a list of drugs which would provide adequate health care. This Essential Drug list is intended to extend the accessibility of the most necessary drugs to those populations whose basic health needs could not be met by the existing supply system. In cooperation with Medicus Mundi Nederland the use of this basic list is investigated in a population of medical doctors in Africa, sent out by Medicus Mundi. Investigated were: actual use of the essential drug; use of other drugs in the same pharmacotherapeutical group; priority; availability; and suppliers. In addition, insight into a number of other factors, such as the number of patients, beds, stocklists, local production, and supply of information, was obtained. The total number of patients in the combined areas was about 3,500,000. It was found that 3% of WHO's suggested drugs were not used at all, 22 essential drugs were used by only 5% of the doctors, and 41 essential drugs were used by more than 95% of the doctors. In the 1979 Revised List 25 drugs had been added and 10 deleted, compared with the 1st list, although it should be remembered that the differences were not always great. Several essential drugs mentioned for the 1st time in the Revised List are little used. Some complementary drugs scored better than the essential drugs from the same group. A number of drugs not mentioned in the List of Essential Drugs have a high priority. The results of the inquiry will be useful to evaluate the list further.
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