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  1. 1

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

    Friel P


    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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  2. 2

    Health economics in developing countries.

    Abel-Smith B


    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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  3. 3

    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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