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  1. 1

    UN Commission on Life-Saving Commodities for Women and Children: Commissioners' report.

    United Nations. Commission on Life-Saving Commodities for Women and Children

    New York, New York, United Nations Commission on Life-Saving Commodities for Women and Children, 2012 Sep. [25] p.

    The United Nations Commission on Life-Saving Commodities for Women and Children presents a new plan and set of recommendations to improve the supply and access of life-saving health supplies.
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  2. 2

    The USAID | DELIVER project improves patient access to essential medicines in Zambia. Success story.

    John Snow [JSI]. DELIVER

    Arlington, Virginia, JSI, DELIVER, 2011 Feb. [2] p.

    Success story on a logistics system pilot project in Zambia that set out to cost-effectively improve the availability of lifesaving drugs and other essential products at health facilities.
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  3. 3
    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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  4. 4

    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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  5. 5

    Report to the Prime Minister. UK Working Group on Increasing Access to Essential Medicines in the Developing World. Policy recommendations and strategy.

    Short C

    London, England, Department for International Development [DFID], 2002 Nov 28. [11] p.

    This report outlines the discussions and conclusions of the Working Group. It supports specific action on the R&D agenda, and outlines an ambitious international agenda to facilitate a framework for voluntary, widespread, sustainable, and predictable differential pricing as the operational norm1. It proposes, as a short-term goal, to have significant international commitment to an overarching framework for differential pricing in place in time for the 2003 G8 Summit in France. (excerpt)
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  6. 6

    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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  7. 7

    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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  8. 8

    Support for treatment programs with Mectizan: the NGO experience.

    Foster A

    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. 57.

    Christoffel-Blindenmission (CBM) is an interdenominational Christian service organization for blind and disabled persons in many of the world's poorest developing countries. It supports more than 300 eye care programs in approximately 70 countries at an annual cost of US $15-16 million. Funded by many individual donors, fund raising activities are conducted in Europe, North America, and Australia. CBM operates through 8 regional offices: 3 in Asia, 3 in Africa, and 2 in Latin America. Program development and evaluation are the responsibility of regional representatives, each of whom uses the services of a medical consultant. CBM's program support is usually long term, based on a recipient's annual budget application and evaluation. Since 1988, CBM has been distributing 200,000 tablets of Mectizan each year to voluntary hospitals in 14 African countries to treat patients with onchocerciasis. CBM also supports community-based treatment programs in Ecuador and Zaire, and, in collaboration with OCP, in Sierra Leone. Plans for 1993 include establishing a program for 600,000 people in the Central African Republic (CAR) in collaboration with the CAR Ministry of Health and the River Blindness Foundation. As an organization, CBM identifies 5 specific barriers to be overcome in developing and sustaining programs of treatment with Mectizan: 1) Poor communication systems in the endemic areas, which require development of an appropriate infrastructure. 2) Lack of health knowledge, which requires a community awareness action. 3) Limited availability of financial resources in the worst-affected countries, requiring a mobilization of funds for long-term commitment. 4) Inadequately-trained personnel, requiring staff training as an integral part of all programs. 5) Affected communities have so many health problems that integration of distribution of Mectizan with already existing or developing primary health care activities is becoming increasingly important.
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  9. 9

    Support for treatment programs with Mectizan: the NGO experience.

    Pizzarello LD

    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. 61.

    Helen Keller International (HKI), founded in 1915, is the oldest US organization dedicated to blindness prevention in the developing nations. HKI's early work in xerophthalmia was followed by extensive programs in the provision of primary eye care and cataract services. More recently, the organization has become involved in onchocerciasis control programs. Their philosophy is to provide the kind of technical assistance that builds sustainable infrastructure within a national health program. They prefer to work in countries that have priorities in blindness prevention programs; and where those do not exist, they strive to develop them in cooperation with local authorities. In Burkina Faso and Niger, HKI is working with the local governments to implement surveillance systems that can detect reappearance of onchocerciasis in previously infected areas. In Mexico, HKI will be working with the existing onchocerciasis control program to develop an information system that can improve the efficiency of distributing Mectizan. In Cameroon, HKI is coordinating a program for distributing Mectizan in the Sanaga River Valley; and in Brazil, they are discussing a collaborative program of onchocerciasis control among Indians living on the Venezuela-Brazil border. In each country, they are trying to develop a cadre of persons at the national and local levels who can assume responsibility for programs of treatment with Mectizan as soon as possible. Previous experience with the distribution of vitamin A to control xerophthalmia taught that successful programs exist at the community level only when they involve the people themselves, as well as the health professionals. HKI believes that private, volunteer organizations are uniquely qualified to develop community-based interventions in cooperation with governments and multinational organizations. Such programs in the onchocerciasis-endemic areas will result in economic improvement, self-sufficiency, and improved health.
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  10. 10

    Support for treatment programs with Mectizan: the NGO experience.

    Thylefors B

    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. 49-50.

    For optimal treatment compliance, the large-scale distribution of a drug such as Mectizan presupposes a well-structured support system through both governmental and nongovernmental channels, together with proper education and awareness at the community level. Beginning at the international level, the purpose and effectiveness of programs of treatment with Mectizan in onchocerciasis-endemic countries must be publicized to all development agencies and the community of international nongovernmental organizations. Within the United Nations system and related organizations, the specialized agencies concerned, such as the United Nations Development Programme, the Food and Agriculture Organization of the United Nations, the International Labor Organization, The World Bank, UNICEF, and, in particular, the World Health Organization, are well placed to initiate programs of treatment with Mectizan as part of development work having a bearing on health. Nongovernmental organizations can play a very significant role in various contexts for development of treatment programs by means of: advocacy, at the international, national, and community levels; project expertise and experience from work in developing countries; flexible, grassroots approaches that allow for tackling practical problems in a pragmatic manner; valuable experience from training health personnel and working with local staff in a wide variety of settings; being efficient resource mobilizers; and the possibility and experience of working with the local community considering particular needs and resources. At the national level, it is important that there be proper awareness of the socioeconomic impact of onchocerciasis. The Ministry of Health should play the main coordinating role with respect to support from NGOs and agencies. A policy of integration with primary health care should be implemented.
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  11. 11

    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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  12. 12

    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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  13. 13

    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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  14. 14

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

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


    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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  15. 15

    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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  16. 16

    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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  17. 17

    The World Bank Population, Health and Nutrition Department, Policy and Research Division fiscal year 1986-1988 work program.

    World Bank. Population, Health and Nutrition Department

    [Unpublished] [1986]. iii, 9, 5 p.

    This note presents the work program of the Policy and Research Division of the World Bank Population, Health, and Nutrition Department for the fiscal years 1988. Although this note was prepared mainly for internal review purposes in the department and in the Bank, it has been circulated outside the Bank to increase awareness of the department policy and research activities. This note 1) lists department staff, 2) gives a brief overview of the department's work, 3) relates the history of the department, and 4) describes the department's activities by objectives. The department's objectives comprise 1) population, 2) population in Sub-Saharan Africa, 3) health, 4) pharmaceuticals, 5) nutrition, 6) intersectoral links, and 7) poverty alleviation. The principal population activities include work on the role of the private sector in family planning, incentives for small family size, cost-effective approaches to the delivery of family planning services, and a population lending review. Work on population in Sub-Saharan Africa centers on adolescent fertility and spatial population distribution. The work program in health reviews health financing and the cost-effectiveness of alternative health interventions. Research on pharmaceuticals examines a range of potential policy interventions on the demand and supply side. A nutrition paper is being prepared on the cost-effectiveness of nutrition interventions, especially as part of primary health care. Intersectoral issues include the links between population, health, and nutrition on one hand and other sectors, such as agriculture and education on the other hand. Work on poverty alleviation examines the extent to which population, health, and nutrition projects should reach out to poor client groups. Research activities in each of these 7 areas are described. An annex lists recent staff papers on these subjects.
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  18. 18

    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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  19. 19

    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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  20. 20

    The cold chain game.

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

    Geneva, Switzerland, WHO, EPI, 1984. 24 p. (Logistics and Cold Chain for Primary Health Care 12; EPI/LOG/84/12)

    This booklet is a guide for those who already have played the cold chain game, a game for teaching logistics for primary health care, and who want to organize their own game. The cold chain game was developed originally by the Expanded Program on Immunization (EPI) as a method of teaching people how to distribute vaccine effectively. In this booklet, the game has been adapted to teach how to distribute chloroquine tablets as well as vaccines. The cold chain game is designed for 5-10 people or 11-20 people depending on how it is organized. 2 or 3 supervisors are needed, one to direct the game and the others to assist the participants. The game's purpose is learning. The players learn by discovering the problems of trying to manage a cold chain and solving thse problems by themselves. The players take on the roles of cold chain workers, storekeepers, supervisors and learn the complex nature of these tasks. This booklet describes what the game is designed to teach, how to set up the game, how to run the game, and how to devise one's own cold chain game.
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  21. 21

    How to distribute supplies.

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

    Geneva, Switzerland, WHO, EPI, 1984 Oct. 12 p. (Logistics and Cold Chain for Primary Health Care 3; EPI/LOG/84/3)

    This booklet considers 4 important aspects of good distribution of supplies: decide a delivery interval; decide a delivery method; choose the transport; and make a timetable. In a system that works well, supplies never run out, there is never too much of any supply, the expiration date is never passed, the cost of the distribution is as low as possible; and in the case of vaccines, they are kept cold all the time. The design of a good delivery depends on: what storage facilities exist; what transport exists; how many people can be trained in the different skills needed; what volume and weight of supplies need to be delivered; and many other factors that only can be decided locally. It is necessary to estimate the volume and the weight of the supplies required in order to make a decision about the distribution means. There are 2 ways of distributing supplies: collection and delivery. In many places, both methods are used. There are 3 types of transport that may be chosen: public, project vehicle, and hired vehicle. The type of transport is not limited to motor vehicles. Boats, trains, carts, bicycles, and walking may be used. In certain cases, it may be justified to use domestic air service. However the distribution system is planned, it is important to make a timetable so that it will operate regularly and properly. The module includes diagrams and exercises.
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  22. 22

    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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  23. 23

    Essential drugs and developing countries: a review and selected annotated bibliography.

    Mamdani M; Walker G

    London, England, London School of Hygiene and Tropical Medicine, Evaluation and Planning Centre for Health Care, 1985 Winter. 97 p. (EPC Publication No. 8)

    Many developing countries spend sizeable sums on the purchase of drugs yet an estimated 60-80% of their populations, particulary in rural areas, do not have constant access to even the most essential drugs. The provision of adequate amounts of effective drugs to treat the most important and common disease conditions is crucial if health services are to be effective and credible. Many problems are associated with the provision and utilization of therapeutic drugs in developing countries: inequitable access to cost-effective safe drugs; inequitable production and consumption with market concentration in the hands of a few multinationals encouraging competition based on product differntion and not price; escalating drug costs; inefficient procurement, distribution, management; and irrational prescription and consumption. To combat these problems, the essential drug concept was introduced by the WHO in 1977. In 1981, WHO established a special Action Program on Essential Drugs. This is a worldwide collaborative program that aims at urging member states to adopt national drug policies, as well as helping developing countries procure and use essential drugs. Several countries have implemented some of the suggestions of the Drug Action Program. Though some progress has been made towards achieving an increase in the use and availability of cost-effective drugs, very few countries have succeeded in decreasing the use of unsafe drugs and those of low cost-effectiveness. Effective legislation is a prerequisite to the effective use of drugs. Recommended action for governments of developing countries to involve the private sector include: creating incentive for increased domestice production; controlling promotional practices; and exerting price controls.
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  24. 24

    The decision makers. [editorial]

    Senanayake P

    British Journal of Family Planning. 1984 Jul; 10(37):37.

    This editorial takes a broad, international look at the worldwide implications of decisions taken in the United Kingdom (U.K.) and the US with regard to family planning. National authorities, like the U.K. Committee for Safety of Medicines (CSM) of the US Food and Drug Administration, address issues concerning the safety of pharmaceutical products in terms of risk/benefit ratios applicable in their countries. International repercussions of US and U.K. decision making must be considered, especially in the area of pharmaceutical products, where they have an important world leadership role. Much of the adverse publicity of the use of Depo-Provera has focused on the fact that it was not approved for longterm use in the U.K. and the US. It is not equally known that the CSM, IPPF and WHO recommeded approval, but were overruled by the licensing agencies. The controversy caused by the Lancet articles of Professors with family planning doctors. At present several family planning issues in the U.K., such as contraception for minors, have implications for other countries. A campaign is being undertaken to enforce 'Squeal' laws in the U.K. and the US requiring parental consent for their teenagers under 16 to use contraceptives. In some developing countries, urbanization heightens the problem of adolescent sexuality. Carefully designed adolescent programs, stressing the need for adequate counseling, are needed. Many issues of international interest go unnoticed in the U.K. International agencies, like the WHO and UNiCEF, have embarked on a global program to promote lactation both for its benficial effects on an infant's growth and development and for birth spacing effects. It may be of benefit to family planning professionals in the U.K. to pay attention to international activity in such issues.
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  25. 25

    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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