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  1. 1
    306471
    Peer Reviewed

    Access to modern contraception.

    Welsh MJ; Stanback J; Shelton J

    Best Practice and Research Clinical Obstetrics and Gynaecology. 2006; 20(3):323-338.

    Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. (author's)
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  2. 2
    305974
    Peer Reviewed

    WHO launches taskforce to fight counterfeit drugs.

    Burns W

    Bulletin of the World Health Organization. 2006 Sep; 84(9):685-764.

    The International Medical Products Anti-Counterfeiting Taskforce (IMPACT) aims to put a stop to the deadly trade in fake drugs, which studies suggest kill thousands of people every year. "We need to help people become more aware of the growing market in counterfeit medicines and the public health risks associated with this illegal practice," said Dr Howard Zucker, Assistant Director-General for the Health Technology and Pharmaceuticals cluster of departments at WHO. The taskforce will encourage the public, distributors, pharmacists and hospital staff to inform the authorities about their suspicions regarding the authenticity of a drug or vaccine. In a parallel move, the taskforce will help governments crack down on corruption in the sections of their police forces and customs authorities charged with enforcing laws against drug counterfeiting. Drug manufacturers will be encouraged to make their products more difficult to fake. (excerpt)
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  3. 3
    282176

    Monitoring and evaluation of the 100% Condom Use Programme in entertainment establishments, 2002.

    Chen XS

    Manila, Philippines, World Health Organization [WHO], Regional Office for the Western Pacific, 2002. [61] p.

    A 100% condom use programme (100% CUP), targeting female sex workers in entertainment establishments, is important in prevention and control of STIs, including HIV. Monitoring and evaluation to measure the progress of the programme is one of its essential components, and requires appropriate indicators. An indicator is a way in which to quantify or measure the magnitude of progress toward something one is trying to achieve in a programme, whether it is a process, an outcome or an impact. Indicators are just that - they simply give an indication of magnitude or direction of change over time. They cannot tell managers much about why the changes have or have not taken place. While a single indicator cannot measure everything, knowing the magnitude and direction of change in achieving a programme objective is critical information for a manager. A good indicator for monitoring and evaluation needs to be: relevant to the programme; feasible to collect and analyse; easy to interpret; and able to measure change over time. Identifying an indicator to be followed in a 100% CUP also demands attention to how that indicator will be defined, the source of the information needed for it, and the timeframe for its collection and analysis. (excerpt)
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  4. 4
    274987

    International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control. Summary report of the Third Meeting, Geneva, Switzerland, 8-9 December 1997.

    International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control

    Geneva, Switzerland, World Health Organization [WHO], Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998. 21 p. (WHO/EMC/ DIS/ICG/98.1)

    The Third meeting of the International Co-ordinating Group on Vaccine Provision for Epidemic Meningitis Control (ICG) was held at WHO Headquarters in Geneva on the 8th and 9th December 1997. The meeting was chaired by Dr D. Barakamfitiye, Director, Prevention and Control of Diseases (DDC) of the WHO Regional Office for Africa. Dr M. Hardiman, WHO/EMC, acted as rapporteur. The agenda and list of participants are to be found in the annexes. The Chairman welcomed the participants and outlined the objectives for the meeting. Dr D.L. Heymann, Director EMC, added his welcome and commented that, although meningococcal vaccine was not in such short supply this year, there are still a number of important issues to demand global attention. These include the need to improve the speed of response to epidemic situations, the continued political sensitivity to the issue of meningitis, the relative merits of preventive vaccination versus epidemic response and the impact that the development of a new conjugate vaccine might have on efforts to control meningitis. Dr J.-W.Lee, Director, GPV, in his opening remarks looked forward to the time when preventive actions for meningitis would render epidemic response through the ICG as no longer necessary. (excerpt)
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  5. 5
    274986

    International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control. Summary report. Geneva, Switzerland, 16-17 January 1997.

    International Coordinating Group on Vaccine Provision for Epidemic Meningitis Control

    Geneva, Switzerland, World Health Organization [WHO], Division of Emerging and Other Communicable Diseases Surveillance and Control, 1997. 19 p. (WHO/EMC/ DIS/ICG/97.9)

    This was the first meeting of the International Coordinating Group (ICG) proposed at the 2-3 December, 1996 meeting of the Ad Hoc Working Group on WHO Strategy for Provision of Meningitis Vaccine for Epidemic Prevention and Control. The meeting was chaired by Dr d'Almeida, DPM, AFRO, and the agenda and list of participants are provided as annexes. The objectives of the meeting were to define terms of reference, agree on the membership of the International Coordinating Group (ICG) and its Executive Sub-Group, to establish the criteria for determining priority distribution of vaccine for epidemic control in the 1997 season, for which only 14 million doses of vaccine would be available, and to consider a strategy for ensuring adequate vaccine supplies in future years. The expected outcome of the meeting was to obtain agreement on the responsibilities of the ICG and its Executive Sub-Group, on the criteria for vaccine distribution in 1997, on a funding mechanism for an emergency stock of vaccines and auto-destruct syringes, and on a strategy to address adequate vaccine and syringe supplies for future years. The meeting met these goals. (excerpt)
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  6. 6
    187399
    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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  7. 7
    182447

    WHO looks to ease access to AIDS drugs.

    Donnelly J

    Boston Globe. 2003 Jul 30; A10.

    The World Health Organization announced yesterday that it will create a new model to buy antiretroviral AIDS drugs in hopes of dramatically speeding distribution and reducing the cost of the life-saving medication. The plan comes from a collaboration among tuberculosis experts, foremost among them the new WHO director general, Jong-wook Lee. That program, called the TB Drug Facility, purchases drugs in bulk on behalf of countries and then oversees the distribution. (excerpt)
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  8. 8
    106870

    How to investigate drug use in health facilities. Selected drug use indicators.

    World Health Organization [WHO]. Action Programme on Essential Drugs

    Geneva, Switzerland, WHO, Action Programme on Essential Drugs, 1993. ii, 87 p. (WHO/DAP/93.1; DAP Research Series No. 7)

    The WHO Action Program on Essential Drugs has developed and field tested a core set of drug use indicators capable of describing drug use patterns and prescribing behaviors in a country, region, or individual health facility. These indicators can be used to measure the impact of interventions designed to change prescribing practices, detect performance problems, and compare the performance of providers and institutions. Three categories have been developed: 1) prescribing indicators--average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with antibiotic prescribed, percentage of encounters with injection prescribed, and percentage of drugs prescribed from essential drugs list or formulary; 2) patient care indicators--average consultation time, average dispensing time, percentage of drugs actually dispensed, percentage of drugs adequately labelled, and patients' knowledge of correct dosage; and 3) facility indicators--availability of copy of essential drugs list or formulary and availability of key drugs. All data required to measure the core indicators can be derived from medical records or direct observation. Field testing in developing countries such as Nigeria and Tanzania found these measures both feasible to obtain and informative as first-level indicators. Also presented are descriptions of key issues related to study design and sampling, field methods, analysis, and follow up.
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  9. 9
    007360

    Management of the diarrheal diseases at the community level.

    National Research Council. Committee on International Nutrition Programs

    Washington, D.C., National Academy Press, 1981. 22 p. (Contract AID/ta-C-1428)

    2 essential direct interventions in management of acute diarrheal diseases, oral rehydration and continued feeding, are summarized. Recent estimates of the global problem are that more than 500 million episodes of diarrhea occur yearly in infants and children under 5 years of age in Asia, Africa, and Latin America. 5 million deaths from diarrhea have been reported each year. Dehydration is the major cause of the immediate morbidity and mortality of children with diarrhea. Oral rehydration techniques may assist and reverse progression to severe dehydration and thereby are highly efficient in managing diarrheal disease. Formula selection, preparation of ingredients, distribution of oral rehydration solution, economic considerations, and cost-effectiveness of therapy programs are the primary concerns for those using oral rehydration. Formula selection should take into account the quantity of sodium, potassium, bicarbonate, and glucose in the formula. Preparations should be made so they can be done in the household rather than in national agencies. Centralized national packaging is recommended to standardize the salt/sugar mix. Measuring spoons and containers are also important in the packaging. Distribution should be accomplished by government or private agencies. The home preparation is the most economical. The effectiveness of the program is an important consideration. It is recommended that 2 different formulas be introduced into the community: a simpler lower sodium formula for home preparation and the more complex World Health Organization solution for supervised use in the health center. Continuation of feeding is important during and after diarrheal illness. Anorexia, nausea, vomiting, and abdominal cramps, may accompany acute infection. Cow milk may help produce symptomatic fermentative diarrhea, however breastfeeding should be continued. Fruits, vegetables, and sources of protein should also be fed to patients with diarrhea. Deleterious effects may occur if a patient fails to continue eating. A community system of surveillance and education should be developed to control diarrheal disease.
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  10. 10
    802693

    Logistics. [Training module]

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    [Geneva, WHO, 1980]. 45 p.

    As part of a series of WHO-designed training modules on developing a national program (in a developing nation) for the control of diarrheal diseases, this volume teaches how to determine logistical problems of supply and distribution of therapeutic modules for control of diarrheal disease. In this module, the student is expected to learn how to determine the quantity of oral rehydration salts (ORS) necessary in Fictitia, a wholly made up country, data on which is published in another module in this series called "Fictitia" PIP/802686, to recommend a distribution system for Fictitia, to determine the number of ORS packets the program manager needs to stock for proper inventory in Fictitia, to specify a schedule for reordering ORS packets in Fictitia, to determine the cost of local production of ORS in Fictitia, and to recommend whether Fictitia should produce its own ORS by target date 1986 or import the ORS the country needs.
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  11. 11
    802203

    WHO Expert Committee on specification for pharmaceutical preparations: twenty-seventh report.

    World Health Organization [WHO]. Expert Committee on Specifications for Pharmaceutical Preparations

    Geneva, Switzerland, WHO, 1980. (WHO Technical Report Series No. 645)

    In this report of the World Health Organization (WHO) Expert Committee on Specifications for Pharmaceutical Preparation, focus is on the following: 1) quality assurance in pharmaceutical supply systems; 2) revisions of the International Pharmacopoeia (methods of drug analysis, monographs for pharmaceutical raw materials, monographs for dosage forms, monographs for pharmaceutical aids); 3) international chemical reference substances for pharmaceuticals (reports from the WHO Collaborating Center, certificates, secondary reference substances, international cooperation, revision of guidelines); 4) quality requirements for oral dosage forms (tests for solid oral dosage forms, tests for liquid oral dosage forms, guidelines for in-process control of the manufature of some types of dosage forms); and 5) basic tests (basic tests for pharmaceutical substances, simple tests for the absence of gross degradation, basic tests for tablets and capsules, publication of basic tests). The Committee concluded that the term "quality assessment" was appropriate to the activities of governmental agencies who have been authorized to assess by inspection, surveillance and other means how closely manufacturers and distributers comply with drug quality requirements. Manufacturers are considered fully responsible for the quality of their products.
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  12. 12
    167956

    Public health goes private in Africa. Mosquito nets may become big business.

    Tarmann A

    Population Today. 2000 Feb-Mar; 28:[2] p..

    In sub-Saharan Africa, insecticide-treated materials (ITMs)--primarily mosquito nets or bed nets--have protected pregnant women and reduced mortality among infants and children. According to the WHO, the use of treated bed nets can reduce rates of severe malaria by an average of 45% and decrease childhood mortality rates between 25% and 35%. Since the nets and insecticide have proven so effective that access to them furthers public health, the WHO, UN Children's Fund, and the US Agency for International Development (USAID) have committed in the distribution of ITMs. The international donors have also supported the public sector and nongovernmental organizations in selling health products and services at affordable prices and motivating people to use them. However, Will Shaw, director of international public health with the Academy for Educational Development (AED), pointed out several limitations of donor-funded ITM programs. Hence, under a cooperative agreement with USAID, AED will work with the S.C. Johnson company and other international and local partners on the Africa NetMark regional project, promoting the commercial distribution of ITMs.
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  13. 13
    164726

    Life-saving TB drugs arrive in DPR Korea during WHO Director-General's visit. Press release.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2001 Nov 15 2 p. (Press Release WHO/49)

    The Democratic People's Republic of Korea is one of the 22 "high burden" countries that account for 80% of the global tuberculosis (TB) cases. This high incidence is due in part to past natural disasters, which have created the types of living conditions that fuel TB, and a deteriorating socioeconomic environment that makes purchase of medicines a challenge. In this regard, Korea's National TB Control Programme has expanded the Direct Observation Treatment, Short-course (DOTS) for TB across the country. Part of the Stop TB partnership with WHO, the Global TB Drug Facility (GDF), has made available TB drugs that treat nearly 33,000 people suffering from TB in Korea. Launched in March 2001, GDF is a global purchasing and distribution mechanism to expand access to high-quality TB drugs. Drugs supplied through the GDF will help secure an uninterrupted supply of high-quality drugs for DOTS expansion. In addition to the Democratic People’s Republic of Korea, 11 other countries will receive support through GDF.
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  14. 14
    101015

    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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  15. 15
    068475

    Condom services to prevent HIV transmission: are they workable? [editorial]

    Friel P

    AIDS HEALTH PROMOTION EXCHANGE. 1989; (3):1-2.

    This editorial argues that in order to increase the use of condoms in the fight against AIDS, WHO's Global Program on AIDS (GPA) must address the problems of weak condom distribution and promotion systems. The available data indicates that condom use can protect against HIV transmission. Studies in Zaire, Denmark, Germany, and Australia reveal that seropositivity among prostitutes who use condoms is much lower than among prostitutes who do not use condoms. However, the use of condoms largely depends on whether services are available to the people who practice risk behavior, and whether such people can be motivated to adopt safe sex practices -- including proper and consistent condom use. In order to bring about this desired behavior change, it is essential to have a strongly managed integrated program that combines condom services and health promotion, as well as specific plans and budgets to distribute and promote condoms. In supporting national AIDS programs, GPA's current strategy for condom services includes the following: 1) the provision of high-quality, low-cost condoms; 2) assistance in developing comprehensive program management and technical support plans and budgets for incorporation into subsequent funding cycles; and 3) support for research and development of new methods for preventing the sexual transmission of HIV -- including barrier methods that can be controlled by women.
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  16. 16
    066486

    AIDS vaccine trials: bumpy road ahead.

    Cohen J

    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.
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  17. 17
    059220

    Health economics in developing countries.

    Abel-Smith B

    JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1989 Aug; 92(4):229-41.

    This general discussion on health economics provides an historical overview as well as a discussion of some of the developments and deficiencies in health economics in developing countries, broadly focused on expenditure and financing studies, cost benefit and cost effectiveness, local costing studies and health planning. In 1963, it was found that as GDP rose so did health expenditures, that countries with similar per capita income spent different percentages of GDp on health services, that the private sector involvement was greater than the public, and that hospitals received most of the money. Countries were encouraged to conduct further studies. The World Bank has successfully stimulated discussion. However, lacking the expenditure studies, cost benefits are hampered by the availability of epidemiological data and poor cost information, and geared toward studies on how to cut costs for immediate goals, or specific diseases, rather than on practical advice to governments. 1 such study helped identify that most cost effective allocation of resources. The limited local cost studies are particular to understanding specific costs of immunization versus antenatal visits; however, the usefulness of such preliminary information reveals wide variability between countries. The Health for All initiatives and the limited resources in developing countries have placed health planning in a central position with Ministries of Health. Due to prior mistakes in planning an excess number of trained medical staff are underutilized and present needs have been defined as developing local PHC support staff. The WHO expectation of 5% of GNP for health service was unfulfilled because larger donor aid and local resources have not been sufficient even with strong posturing, and over ambitious plans were made unrealistically. Since 1987, WHO has provided economic strategies but the economic crises changed the needs. Many questions remain and consultants are too few, improperly trained, or unavailable for the appropriate time period: unacceptable solutions, coupled with a confusing World bank prospectus for action when more research is needed. Intersectorial collaboration has not provided answers to priorities or addressed the interactions among nutrition and agricultural policy, education and lifestyle, water and sanitation and the economy. The research agenda should include: the identification of the determinants of health, key elements of primary health care (PHC), cost of delivering PHC, hospital efficiency, health manpower mix, adequate procurement and distribution, appropriate technology, user charges for financing, health insurance, and community financing.
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  18. 18
    050840

    Distribution and logistics.

    Fabricant S

    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.
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  19. 19
    271013

    Essential drugs - a convincing concept.

    Albert C

    CONTACT. 1989 Feb; (107):1-24.

    The 1st part of this report discusses essential drugs for health care programs. In addition to a model list of essential drugs it is felt a clear strategy was needed to implement rational drug policies. The World Health Organization (WHO) launched its Action Program on Essential Drugs and Vaccines in 1981. Advantages to a standard essential drugs list include: 1) selection of drugs can be made based on the best information available and on real needs; 2) correct dosages are easier to remember, increasing safety; 3) it causes less wastage than switching from 1 drug to another, increasing cost-effectiveness; 4) ordering, storage, and distribution of drugs are easier to manage; and 5) it helps to obtain reliable data on drug consumption. Various misconceptions, some related to politics and power, have slowed the acceptance of the essential drugs concept. Steps to implement a rational drug policy include: 1) assess drug needs, not market demand; 2) ban hazardous and irrational drugs; 3) produce and supply adequately essential drugs; 4) use generic names; 5) ensure quality; 6) ensure correct information; 7) ensure ethical marketing; 8) ensure reasonable price; 9) promote indigenous research and development; and 10) plug legal loopholes. Problems with pharmaceutical donations commonly include drugs that: arrive expired or near expiry; are inappropriate and do not cover treatment of diseases which are problems in the country of destination; are sent without asking the recipient about needs; are sent without prior notification or shipping documents; or are inadequately packaged, labelled, and unaccompanied by any prescriber or patient information. To prevent these complaints donations should only consist of drugs included in National Drug Lists in existing, or the WHO model list of essential drugs. They should be of known good quality, and labelled by their generic-international nonproprietary name. If a drug is sent to the same place/program regularly, the strength of the drug should not change. Packaging units of larger quantities are more suitable than small packets. Drugs should have a shelf-life of at least 1 year after estimated arrival in the country. To enable local purchase, a financial contribution will, in many cases, be more appropriate. The WHO model list of essential drugs is included in the back of the report.
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  20. 20
    193420

    Essentials drug lists and health relief management.

    Simmonds S; Mamdani M

    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.
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  21. 21
    051976

    The use of essential drugs. Third report of the WHO Expert Committee.

    World Health Organization [WHO]. Expert Committee on the Use of Essential Drugs

    WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1988; (770):1-63.

    This booklet incorporates both guidelines and criteria for establishing national programs for essential drugs, and a suggested list of approximately 250 essential drugs. It is important to emphasize that it is up to each country to decide whether to implement an essential drug policy, and how to adapt the list to their own changing needs. Guidelines for a national program include accepting recommendations by a local committee; using generic names and providing a cross index; providing a drug information sheet to accompany the list; regulation or constant testing of quality of the drugs; deciding on the level of expertise needed to prescribe each drug; administration of supply, storage and distribution. Choice of drugs is based on quality, bioavailability, safety, price and availability. Criteria for selection of drugs for primary health care involves evaluation of existing medical care systems, the national health infrastructure, trained personnel and available supplies, and the pattern of endemic disease. Each agent is listed by its international nonproprietary name (INN), is accompanied by substitutions and complementary drugs, and is described by its route of administration, dosage form and strength. Listings are by category and alphabetically.
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  22. 22
    047290

    Barrier contraceptives and spermicides: their role in family planning care.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1987. vii, 80 p.

    This WHO manual on barrier contraceptives and spermicides covers all methods, their effectiveness, advantages and disadvantages, non-contraceptive advantages, uses in special cases, family program considerations, the logistics of supply, monitoring shelf-life and quality control, and application of condoms in AIDS prevention programs. Condoms and foaming tablets are the most appropriate methods for developing countries, especially those in the tropics. Other methods present problems such as expense (diaphragms, foams, sponges), unavailability outside the U.K. and U.S. (caps, sponges), bulk and expense (canned foams). Certain individuals are particularly good candidates for barriers and spermicides: lactating women, people using abstinence or natural family planning, adolescents, older women, women waiting to start using other methods, and those at risk for contracting sexually transmitted diseases. Program officials should consider providing supplies in their special environments, with limitations such as transport, reliability of shipments, storage requirements, cultural sensitivity, multiple outlets for supplies, and cost both to the program and to the users. Methods of insuring steady supply and techniques of testing condoms are described. Barrier methods, condoms in particular, help stop the spread of gonorrhea, syphilis, Chlamydia, Candida, Trichomonas and HIV. An appendix describes basic information about AIDS and the relevance of barriers and spermicides, as well as monogamy and abstinence, in preventing AIDS transmission. Other appendices list sources of supply for developing countries, addresses of manufacturers and sources of further information, techniques for using these methods, and teaching methods for illiterates and semi-illiterates.
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  23. 23
    270414

    Health messages on everybody's mail.

    Madsen OA

    WORLD HEALTH FORUM. 1988; 9(1):24-8.

    Health meassages have long been carried on stamps, cancellations and special envelopes. Some postal administrations are particularly active in using stamps as a medium for messages. Others seem to be quite inactive. Perhaps some health ministries, and other interested parties, have not fully understood the enormous potential for health education which exists here. Stamps and frankings can be a major inexpensive source of information about health and other subjects. If those interested in promoting health were to use the full potential of stamps for this purpose, health for all would be 1 step closer to being achieved. The accompanying illustrations show that the health message can take many forms.
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  24. 24
    269291

    International regulation of the supply and use of pharmaceuticals.

    Medawar C

    DEVELOPMENT DIALOGUE. 1985; (2):15-37.

    This paper discusses the principles involved in formulating international standards to regulate the appropriate use of drugs. It focuses particular attention on the role of the World Health Organization (WHO) in organizing this. The following questions are addressed: What is meant by the appropriate use of drugs? What are the main determinants of appropriate drug use that all the main actors agree on? How appropriately are drugs used today? To what extent are the standards agreed on in principle actually observed in practice? Is regulation called for? What kind of regulation is appropriate? What standards would meet the needs of all countries? Appropriate drug use is the provision of drugs to people who really need them and restiction of the supply of drugs to those who don't need them. Primary health care requires a continuous supply of essential drugs. As many as 70% of the pharmaceuticals on the market today are inessential and/or undesirable products, and many pharmaceutical products are marketed today with little concern for the differing health needs and priorities of individual countries. Few countries systematically monitor drug prescribing standards and consumption patterns. There is chronic and serious under-reporting of adverse reactions to drugs. Regulation implies control over the activities of the main drug producers. This requires international initiatives, since an essentially transnational industry is involved. Transnational corporations dominate the world market for drugs. All pharmaceutical products must be approved and registered for use by the competent government authority. All pharmaceutical products shall have full regard to the needs of public health.
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  25. 25
    269289

    The rational use of drugs and WHO [editorial].

    DEVELOPMENT DIALOGUE. 1985; (2):1-4.

    On November 25-29, 1985, the World Health Organization held a Conference in Nairobi of Experts on the Rational Use of Drugs. In the early 1980s, both the International Federation of Pharmaceutical Manufacturers Association (IFPMA) and Health Action International (HAI) had developed codes of pharmaceutical marketing practices in order to come to terms with the malpractices in this field. A more comprehensive approach was needed, however. Prime responsibility for rational drug use must rest with the member governments, operating through national regulatory authorities and assisted in their work by guidelines on minimum requirements for national drug regulation prepared by WHO. The Dag Hammarskjold Foundation organized a seminar on Another Development in Pharmaceuticals as an independent contribution to the international debate on this global issue. The seminar emphasized that development should be need-oriented, self-reliant, and based on structural transformations. Governments view the pharmaceutical crisis as 1 facet of the more general problem of spiralling health costs which put an intolerable burden on already overstretched welfare services. The pharmaceutical industry sees the crisis largely in terms of excessively restrictive regulations which stifle innovation of products. Some doctors and pharmacists feel that increased regulatory measures will erode their rights to prescribe and to control the supply and information to patients. On the other hand, some clinical pharmacologists and administrators express concern about excessive, irrational and uneconomic prescribing and its effects on public health. Consumer groups define the problem in terms of an overbearing and greedy business community. The general public fail to understand the effects of pharmaceuticals.
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