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Southern Med Review. 2011 Dec; 4(2):15-21.Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, .  p. (USAID Contract No. HRN-C-00-00-00019-00)The Global Fund to Fight AIDS, TB and Malaria aims to attract, manage, and disburse resources that will make a significant and sustainable impact on the three focal diseases. The Global Fund has also stated its commitment to support programs that address the three diseases "in ways that contribute to the strengthening of health systems." The Global Fund is likely to have a variety of direct and indirect effects upon health care systems that could be positive or negative in nature. To be effective and sustainable in the long run, interventions will depend upon well-functioning health systems. This is true not only for the Global Fund, but also for other initiatives, such as the World Bank Multisectoral AIDS Program (MAP), the President's Emergency Plan for AIDS Relief, and others that aim to substantially increase the scale of response to specific diseases, particularly HIV/ AIDS. (excerpt)
Towards the creation of strategic partnerships: improving access to drugs for HIV / AIDS. Report of a consultative meeting, 30 June - 2 July 1997, Salle C, WHO, Geneva.
Geneva, Switzerland, UNAIDS, 1998. 20 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/98.40)From January 1996, the UNAIDS Secretariat has been in consultation with key players in the pharmaceutical industry, NGOs, people living with HIV, UN, major bilateral donors, country representatives and National AIDS Programme Managers on issues relating to access to drugs for HIV/AIDS. This meeting, held on 30 June to 2 July 1997, was the climax of this consultative process. The meeting brought together people living with HIV/AIDS, NGO representatives, National AIDS Programme Managers and UN representatives. With a modified version of the Search Conference approach, the following questions were raised: What are the current and future issues on access to drugs for HIV/AIDS at country and global levels? What partnerships should be created at country level to address these issues? What should be the content of these partnerships at country level? What should the UN do at global and country level to support these partnerships? To foster regional exchange of experience as well as enhance regional specificity, participants were assigned groups on a regional basis. (excerpt)
Geneva, Switzerland, UNAIDS, 1998 Oct.  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)
In: While the world sleeps: writing from the first twenty years of the global AIDS plague, edited by Chris Bull. New York, New York, Thunder's Mouth Press, 2003. 401-412.Public concern over the global AIDS epidemic, particularly in Africa, has grown enormously in recent years, but there is considerable debate about what the international community can and should do about it. Especially controversial has been the high cost of antiretroviral drugs used to extend the lives of people with AIDS. The pharmaceutical companies that make these drugs price them beyond reach of the world's poor, but in November 2001 at the WTO meeting in Doha, Qatar, these companies were forced to accede to pressure from developing-country governments, nongovernmental organizations, and activists, and allow poor governments to adjust certain rigid patent rules applying to vaccines and drugs in order to protect public health. Despite this apparent triumph of international pressure, far more needs to be done. A coalition of governments and nongovernmental organizations, led by the UN, recently launched the Global Fund Against AIDS, Tuberculosis, and Malaria (referred to here as the Global Fund), and its performance will test how well such a global institution can confront the most serious health crises of our time, and perhaps in all of human history. (excerpt)
AIDS plan would cut drug costs for poor. [Plan para el SIDA reduciría los costos de fármacos para las personas de bajos recursos]
Washington Post. 2003 Oct 25; A01.The World Health Organization will disclose next week the first details of a global AIDS strategy to bring low-cost drugs to 3 million people in poor countries, a plan that top officials said will eventually include endorsement of pills that combine three HIV drugs in a single tablet. The endorsement of the three-in-one pills is expected to be controversial because they could violate a variety of patents. Only about 300,000 people are receiving AIDS medicine in the regions targeted by WHO. (excerpt)
Bulletin of the World Health Organization. 2003 Oct; 81(10):774-775.A landmark deal that waives international trade rules may work if implemented in good faith, experts say. Poor countries with no manufacturing capability of their own will be allowed to import cheap copies of patented essential drugs under a complex procedure. (excerpt)
Economists tell scientists AIDS drug projects can be scaled up. Calls for more money dominate the agenda but economists say more can be done with current funds.
Lancet. 2003 Jul 19; 362(9379):215.Economists said at the international AIDS conference on HIV pathogenesis and treatment in Paris on July 14 that nations with a high HIV/AIDS burden should spend more of their resources on antiretrovirals, a move which directly contradicts current medical opinion. The medical community has said that handing out antiretrovirals would be a waste of resources; could worsen drug resistance; and instead it urged preventative measures. Three pilot studies presented at the meeting from the Ivory Coast, Senegal, and Uganda—funded by UNAIDS—found that with a little help to set up medical infrastructure, drugs can be delivered, even to remote areas, without increasing drug resistance. (excerpt)
Cambridge, Massachusetts, Harvard Center for Population and Development Studies, 2002 Apr. ix, 205 p. (Harvard Series on Population and International Health)This book presents the results of the workshop. The essays in this volume offer some fresh perspectives on partnerships, probe some troubling questions, and provide empirical evidence of both benefits and challenges of public-private partnerships. The participants in the meeting also achieved some progress in creating a shared vocabulary, or at least shared understanding, on points of contention, suggesting that dialogue among partisans in public health can help move debates about critical issues forward. (excerpt)
New York Times on the Web. 2002 Mar 21;  p..In a move that could help bring down the price of AIDS medicines for poor countries, the WHO released its first list of manufacturers of safe AIDS drugs. The list includes 41 different formulations of drugs, among are 11 antiretroviral drugs and five for infections that often accompany AIDS. Of the total, 26 come from major manufacturers: GlaxoSmithKline, Bristol-Myers Squibb Company, Roche Holding, and Abbott Laboratories. However, 10 were from Cipla Limited, the generic drug maker based in Bombay, India, that was the first to try breaking Western patent monopolies by offering AIDS therapy for $350 a year to charities and African governments. Cipla products accepted by WHO include the antiretrovirals nevirapine, zidovudine, and lamivudine. It is said that the list will encourage price competition in poor nations by telling health officials which of the hundreds of generic suppliers make safe drugs. Up to 100 more applications from manufacturers are awaiting approval from the WHO and UN.
Global issues on the agenda at the World Health Assembly. Discussion of HIV / AIDS, leprosy, access to drugs.
JAMA. 2001 Jul 4; 286(1):29-30.During the World Health Assembly in May 2001, some of the high-priority issues are discussed including HIV/AIDS, the WHO policy on medicines, leprosy, and recommendations for infant and young child feeding. In particular, the worldwide HIV/AIDS pandemic and the Global Fund to fight specific diseases in developing countries were subjects of particular interest. In terms of policy on drugs, the main point under discussion was to ensure that public health issues are taken into account as countries develop patent legislation. The secondary issue was the revised drug strategy. A special briefing was also conducted, pointing to great progress in controlling leprosy. Moreover, the main issue in infant and young feeding tackled during the meeting is the promotion and support of breast-feeding.
Initiating co-trimoxazole prophylaxis in HIV-infected patients in Africa: an evaluation of the provisional WHO / UNAIDS recommendations.
AIDS. 2001; 15(9):1143-8.The objective was to evaluate the proposed WHO/Joint UN Programme on HIV/AIDS (UNAIDS) criteria for initiating cotrimoxazole prophylaxis in adult HIV-infected patients in Africa [WHO clinical stages 2-4 or CD4 count < 500 times 1 million/l or total lymphocyte count (TLC) equivalent]. An observational cohort study of 5-year follow-up was conducted in adult HIV clinics, University of Cape Town, South Africa. Effect of prophylactic low dose cotrimoxazole (480 mg/day or 960 mg 3 times per week on survival and morbidity was assessed in patients stratified by WHO clinical stage, CD4 T-lymphocyte count or TLC. Patients receiving antiretroviral therapy were excluded. Cotrimoxazole reduced mortality [adjusted hazard ratio (AHR), 0.56; 95% confidence interval (CI), 0.33-0.85; P > 0.001] and the incidence of severe HIV-related illnesses (AHR, 0.52; 95% CI, 0.38-0.68; P < 0.001) in patients with evidence of advanced immune suppression on clinical (WHO stages 3 and 4) or laboratory assessment (TLC < 1250 times 1 million/l or CD4 count < 200 times 1 million/l). No significant evidence of efficacy was found in patients with WHO stage 2 or CD4 count 200-500 times 1 million/l/TLC 1250-2000 times 1 million/l. If the authors had applied the WHO/UNAIDS recommendations 88.3% of their patients would have received cotrimoxazole prophylaxis at initial clinic visit. Cotrimoxazole in HIV-infected adults from an area in which Pneumocystis carinii pneumonia is uncommon demonstrated a survival benefit consistent with previous randomized trials. Further studies are needed to assess the optimal time of commencement of prophylaxis, as widespread cotrimoxazole use will lead to increasing antimicrobial resistance to other major pathogens in Africa. (author's)
AIDS Weekly. 2001 May 21-28; 9-10.The government of Burundi has become a member of the agreement to increase access to HIV/AIDS medicines in partnership with the pharmaceutical industry and five UN agencies. Burundi is the seventh African country to sign an agreement of this kind under the Joint UN Programme on AIDS (UNAIDS) Accelerating Access Initiative (AAI), following an announcement by Mali earlier in April 2001. This announcement coincides with National AIDS Day in Burundi. In order to ensure the long-term sustainable supply of quality AIDS medicines, the National AIDS Program, headed by Dr. Joseph Wakana, on behalf of the government, has secured an agreement with four of the five research-based pharmaceutical companies participating in the UNAIDS initiative: GSK, Merck, Boehringer Ingelheim, and Bristol-Myers Squibb. As a result of this agreement, Burundi will receive antiretroviral medicines at heavily discounted prices. As part of this agreement, GSK is offering a preferential price of US$2 per day for its product Combivir, which represents a 90% reduction on the world average price. The agreement will allow the Burundi Government to increase the number of patients four-fold in the next 12 months, through offering a range of therapeutic options to patients and physicians at preferential prices. This announcement brings the number of African countries participating in the AAI to seven: Uganda, Senegal, Cote d'Ivoire, Rwanda, Cameroon, Mali, and now Burundi. The Initiative is supported by the WHO, UN Children's Fund, the World Bank, the UN Population Fund, and UNAIDS. (full text)
AIDS Weekly. 2001 Jun 18; 11-2.Instead of approving radical proposals for wider international access to cheap HIV/AIDS drugs, the WHO adopted a resolution urging for greater efforts toward tackling the epidemic. The resolution asked WHO Director-General Gro Harlem Brundtland to maintain close collaboration with the international community and the private sector with the aim of improving the availability of medicines for HIV/AIDS, including antiretroviral therapy. On the other hand, the proposals, raised by Brazil, had called for legislative protection of local production of cheaper generic drugs. It also demanded that WHO take a more active role in promoting access to AIDS/HIV drugs and set up a price databank that would allow countries to shop around more easily among different pharmaceutical companies. However, the resolution, widely criticized by health activists, was adopted by consensus and drawn up jointly by the European Union and Brazil. It is noted that since the debate on access to essential drugs exploded, some leading pharmaceutical companies cut prices on HIV/AIDS medication, at the same time wanting to protect their patent rights against competition from cheaper generic versions.
New drug initiative announced. Pilot study to distribute HIV treatment, prophylaxis in developing world.
AIDSLINK. 1997 Nov-Dec; (48):4-5.On November 5, 1997, the Joint UN Programme on HIV/AIDS (UNAIDS) announced the launching of the "UNAIDS HIV Drug Access Initiatives." The initiative will make available a range of HIV/AIDS-related drugs, including antiretrovirals for underlying HIV infection, antimicrobials for the prevention and treatment of opportunistic infections, and antibiotics for the treatment of sexually transmitted diseases. The long-term goal of the initiative is to facilitate a mutually beneficial relationship between pharmaceutical companies and health care providers to continue increasing access to drug therapies to persons with HIV/AIDS in developing countries. For this to succeed, each country must establish an HIV-related national drug policy. The activist group Act-Up Paris raised the issue of participant selection and the inappropriate allocation of funds. Despite criticisms, the UNAIDS proposal has given hope to people around the world living with HIV/AIDS.
Death watch, Part 5. An unequal calculus of life and death. As millions perished in pandemic, firms debated access to drugs.
WASHINGTON POST. 2000 Dec 27; A1.In response to the starkness of the global divide between the HIV-positive people and the ones saved from infection, and its growing political repercussions, the pharmaceutical industry and governments have pledged help. Five international agencies (Joint UN Programme on HIV/AIDS, WHO, UN International Children's Emergency Fund, World Bank, and UN Development Program) conducted a meeting with five pharmaceutical companies (Merck, Hoffmann-La Roche, Bristol-Myers Squibb, Glaxo Wellcome, and Boehringer Ingelheim) to negotiate global access to AIDS drugs. Although negotiations began in Geneva in 1991 and lasted for 2 years, both parties have been hesitant to reach a compromise because of one major factor--the price. These companies say they are willing to provide big discounts, yet they required that the concerned government and these international agencies should burden some of the expenses. However, it came out that even these international agencies are reluctant to invest in AIDS drugs saying that it is “cost-ineffective”. The bottomline of the negotiation is that financial resources play an important part when discussing global access to AIDS drugs and until this can be settled, millions of HIV-infected individuals will continue to suffer.
Death watch, Part 6. A turning point that left millions behind. Drug discounts benefit few while protecting pharmaceutical companies' profits.
WASHINGTON POST. 2000 Dec 28; A1.The deal between 5 major pharmaceutical companies and 5 international agencies announced on May 11, 2000 to provide affordable AIDS medicines in poor countries was considered a turning point in the world’s response to the poorest AIDS sufferers. It is noted that doubts and disputes rived the potential partners, and each side tried in some measure to subvert the other’s goals. The agencies had an unspoken aim to drive prices of patented AIDS drugs down to the level of generics, and to make those prices available as widely as possible. Meanwhile, the drug companies are negotiating variable prices in strict confidence and neither the companies nor their partners have committed in practical terms to bring treatment to significant numbers of the dying. The drug discounts proposed and implemented have benefited only a few while protecting pharmaceutical companies’ profits.
SANASO NEWSLETTER. 2000 Jan-Mar; (35):11.Following an AIDS consultation in Harare, experts agreed to recommend the use of cotrimoxazole in sub-Saharan Africa. It is noted that the drug has proved to be effective in warding off some of the infections to which HIV-infected patients are prone. The Joint UN Programme on HIV/AIDS and WHO have welcomed this recommendation for the drug's use among HIV-positive patients in Africa; however, some scientists argue that the use of the drug in sub-Saharan is questionable, because the parasitic type of pneumonia, for whose prevention the drug is routinely used in the West, is not as prevalent in Africa. In addition, concerns have been expressed that most patients in Africa will not have access to, or be able to afford alternative drugs if they develop resistance to cotrimoxazole. Despite these issues, the experts in Harare agreed to recommend the drug as a medium-term solution while awaiting the results of research into other antimicrobial agents.
BMJ (CLINICAL RESEARCH ED.). 1998 Jul 4; 317(7150):11.While most industrialized nations and a handful of developing countries are seeing the spread of HIV infection level off or even decline, infection rates are reaching alarming new highs in much of the developing world, according to the first country by country analysis by the joint United Nations Programme on HIV/AIDS (UNAIDS). Along with the widening gap in infection rates, the report also reveals a looming divide between countries where rates of new AIDS cases and deaths from AIDS are falling and countries where they are rising as people infected with the disease succumb in greater numbers than before. The major reason is uneven access to newer antiretroviral drugs, which forestall the development of AIDS. Among the report's most striking findings was new information concerning 13 countries in sub-Saharan Africa, where at least 10% of all adults are infected with HIV, with the prevalence in many capital cities 35% or more. Botswana and Zimbabwe have each reached a prevalence of 25%, a new world high. (full text)
NATURE MEDICINE. 1997 Dec; 3(12):1307.The Joint UN Program on HIV/AIDS (UNAIDS) has launched the pilot phase of an HIV drug access initiative in 4 developing countries: Viet Nam, Chile, Uganda, and the Ivory Coast. Sites were selected on the basis of their geographical diversity, political stability, commitment to the program, existing community health structures, and lack of standing AIDS programs. UNAIDS will contribute more than US$1 million to the program and pharmaceutical companies are supplying antiretrovirals, drugs to treat opportunistic infections, and antibiotics for sexually transmitted diseases at discounts of at least 50%. A national HIV/AIDS drugs advisory board will be created in each country, under the Minister of Health, to devise national policy for the provision of drugs and a nonprofit company will be established to serve as a clearinghouse for drug ordering and distribution. The goals are to develop a workable model that can be applied in other developing countries and to develop an infrastructure for ongoing, expanded care after the pilot phase.
AIDS LINK. 1993 Jun-Aug; (23):14.In Uganda, medical researchers at Makerere University in Kampala compared data on 280 HIV-seropositive people with HIV infection symptoms and CD4 lymphocyte counts less than 300, who took 150 IU/day oral interferon alpha, with 280 matched controls who took a placebo to learn whether low-dose oral interferon alpha benefits symptomatic HIV-infected patients. The study lasted 5 months. Mortality, progression of HIV infection, ability to care for oneself, symptoms, body weight, and CD4 lymphocyte counts were similar in both case and control groups. No one reverted to HIV seronegative. The findings of a smaller study in 1990 conducted by the Kenyan Medical Research Institute showed that low doses of oral interferon alpha began to alleviate AIDS symptoms within days after beginning treatment and completely alleviated symptoms in all patients within 8-10 weeks. The study reported that 18 patients reverted to HIV seronegativity. It did not have a control group. THe study lasted at least 10 weeks and consisted of 199 symptomatic and 5 asymptomatic patients. Based on the findings of the Uganda study, the World Health Organization has decided that low-dose oral interferon alpha does not help HIV-seropositive individuals and cannot rid the body of HIV.
AFRICA HEALTH. 1992 Jul; 14(5):10-1.An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
SCIENCE. 1990 Oct 12; 250:200.Researchers in Kenya claim that small doses (100 unites) of oral alpha interferon depressed symptoms in AIDS patients and, in 10% of patients, all signs of HIV infection disappeared. President apap Moi promotes these findings. AIDS patients from other African countries and the US have since gone to Kenya seeking treatment. Yet the Western biomedical establishment is not showing much enthusiasm, not even the man who introduced the notion of using low dose oral alpha interferon to treat AIDS to the principal investigator. WHO has supported a sequence of rapid test of alpha interferon in other African countries. Experts at WHO headquarters believe alpha interferon is unproven as an AIDS drug and requires more study. Both the Kenyan study and the WHO studies were uncontrolled studies. Further the patients in the studies received different formulations of alpha interferon. WHO now calls for properly controlled formulations of alpha interferon. WHO now calls for properly controlled clinical trials. In New York City and Amarillo, Texas, 2 such small trials are indeed occurring. So far, however, preliminary data do not indicate changes in T cell counts. Thus alpha interferon has not caused improvement in immune status. US National Institute of Allergy and Infectious Diseases researchers have injected large doses of recombinant forms of alpha interferon in asymptomatic HIV infected subjects and viral production slowed down. In fact, the risk of developing opportunistic infections decreased. A phase III clinical trial of injectable alpha interferon alone and with the nucleoside analogs AZT and ddI is under way. Further millions of units of injectable alpha interferon is now used to treat people with Kaposi's sarcoma and genital warts. Kenyan officials are so confident of alpha interferon's ability to treat AIDS that it plans on mass producing it and patent the formulation. Yet a US veterinarian in Texas already has several patents on it.
NEW AFRICAN. 1989 Jul; (262):4, 6.The author from UNICEF's Bamako Initiative management unit provides an overview of child and maternal health in Africa in terms of survival, primary health care, and immunization. There is a summary of the Bamako Initiative of 1987 by African Health Ministers. 172 out of 1000 children born will die by the age of 5 versus 120 out of 1000 for all developing countries. Maternal mortality is 30-200 times greater than in the industrialized world, and poor maternal health leads to low birth weight babies and neonatal illness. Malnutrition is an exacerbating factor. AIDs among the 25% of females of reproductive age means that approximately 1 out of every 10 urban children is born with the AIDs virus. Drug shortages abound. The African government support at the Alma Ata Conference in 1978 shifted primary health care (PHC) into the community. The approach which is based on trained health workers aims to address preventive and curative care by also improving sanitation and water access, nutrition, and education. UNICEF has doubled it funding for Africa, and provided training, drugs and medical supplies, and efficient service systems based on situational analysis. The African Health Ministers Lusaka Resolution of 1986 marked the increase in immunization from 5% to 50% of children <1 in 1988. UNICEF and WHO have helped promote oral rehydration therapy; treatment for diarrhea has increased from 4% in 1984 to 12% in 1986. AIDs education is gaining a foothold in Tanzania and Uganda as examples. Teacher training has involved 2500 primary teachers and 2400 secondary teachers through the end of 1988. The Bamako Initiative strengthened child and maternal services within PHC by asking for UNICEF and WHO funding for basic drugs. The approach is part of a long term strategy to strengthen primary health care through self supported financing. There is confidence that progress has been made and determination to build for the future. The Bamako Initiative targeted the year 2000 for distributing good quality essential drugs to the community which upon sale has helped pay for 85% of operating costs and supplies. Generic supplies purchased in bulk would be sold at low cost, which is far less that what is currently paid. 100 million is needed for this effort alone.
JOHNS HOPKINS MAGAZINE. 1989 Feb; 41(1):10-1.The reuse of unsterilized syringes is spreading AIDS, hepatitis B and the African Ebola-Marburg virus. In the US 25% of the AIDS cases are related to intravenous drug abuse. In developing countries syringe reuse is related to poor health care delivery systems. In these countries syringes are used over 5 times before sterilization; in some countries the syringes are distributed by people who sell injections of vitamins and antibiotics. In 1986 Halsey challenged the medical community to design a syringe that would not transmit these diseases, and shortly thereafter a separate challenge was issued by the World Health Organization. The requirements of this syringe are its self destruction after use, little requiring retraining of medical personal, and no more than 1 cent to the cost, and be simple to make. These challenges brought 70 various syringe entries and all but 3 were eliminated. The Hopkins syringe is similar to a regular syringe except it has a polymer insert that seals up after one use. When water flows around the polymer insert it swells and closes off the passageway preventing any liquid from flowing in or out of the syringe. Another syringe seals up in 2.5 minutes which allows the health worker time to draw and inject a patient before the syringe destructs. By using hydrogels that are already approved for use in contact lenses and food substances, the safety has been tested. Companies looking at production costs estimate that the polymer insert will add only 1/4 of a cent to the cost of a syringe.