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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.
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
The Global Drug Facility: a unique, holistic and pioneering approach to drug procurement and management.
Bulletin of the World Health Organization. 2007 May; 85(5):325-420.In January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006-2015, which describes the actions and resources needed to reduce tuberculosis (TB) incidence, prevalence and deaths. A fundamental aim of the Global Plan is to expand equitable access to affordable high-quality anti-tuberculous drugs and diagnostics. A principal tool developed by the Stop TB Partnership to achieve this is the Global Drug Facility (GDF). This paper demonstrates the GDF's unique, holistic and pioneering approach to drug procurement and management by analysing its key achievements. One of these has been to provide 9 million patient-treatments to 78 countries in its first 6 years of operation. The GDF recognized that the incentives provided by free or affordable anti-tuberculosis drugs are not sufficient to induce governments to improve their programmes' standards and coverage, nor does the provision of free or affordable drugs guarantee that there is broad access to, and use of, drug treatment in cases where procurement systems are weak, regulatory hurdles exist or there are unreliable distribution and storage systems. Thus, the paper also illustrates how the GDF has contributed towards making sustained improvements in the capacity of countries worldwide to properly manage their anti-TB drugs. This paper also assesses some of the limitations, shortcomings and risks associated with the model. The paper concludes by examining the GDF's key plans and strategies for the future, and the challenges associated with implementation. (author's)
Malaria treatment policy: technical support needs assessment. Malaria Action Coalition (MAC) Senegal Mission report, March 14-21, 2005.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005. 18 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADF-437)African countries are undergoing a period of dramatic change in their national malaria treatment policies as more of these countries adopt artemisinin-based combination therapy (ACT). Successful implementation of the new ACT policies presents many challenges and most countries will require technical assistance from a variety of sources, both internal and external. The Malaria Action Coalition (MAC) partnership brings together three partners that have considerable expertise in many of the areas related to ACT implementation, which complements expertise brought by other Roll Back Malaria (RBM) partners. The U.S. Agency for International Development (USAID) has made a commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to provide technical assistance through MAC. This mission was therefore designed to assess the progress of Senegal toward implementing the new ACT policy and to determine what, if any, additional technical support it may need to successfully complete the implementation. It is expected that the successful implementation of the ACT policy will contribute to the attainment of the RBM goals for the prevention, treatment, and control of malaria in sub-Saharan Africa through coordinated technical support. (excerpt)
Bulletin of the World Health Organization. 2006 May; 84(5):405-411.Since the first WHO Model List of Essential Medicines was adopted in 1977, it has become a popular tool among health professionals and Member States. WHO's joint effort with the United Nations Committee on Economic, Social and Cultural Rights has resulted in the inclusion of access to essential medicines in the core content of the right to health. The Committee states that the right to health contains a series of elements, such as availability, accessibility, acceptability and quality of health goods, services and programmes, which are in line with the WHO statement that essential medicines are intended to be available within the context of health systems in adequate amounts at all times, in the appropriate dosage forms, with assured quality and information, and at a price that the individual and the community can afford. The author considers another perspective by looking at the obligations to respect, protect and fulfil the right to health undertaken by the states adhering to the International Covenant of Economic, Social and Cultural Rights (ICESCR) and explores the relationship between access to medicines, the protection of intellectual property, and human rights. (author's)
'Combine incentives for research with access to medication for the poor' -- Kofi Annan meets with pharmaceutical companies; AIDS treatment in developing countries.
UN Chronicle. 2001 Mar-May; 38(1): p..Secretary-General Kofi Annan met with six of the world's leading pharmaceutical companies on 5 April in Amsterdam, the Netherlands to agree on what further steps need to be taken to improve access of developing countries to better health care, and HIV (human immunodeficiency virus) and HIV-related medicines, as part of further action to combat acquired immune deficiency syndrome (AIDS), including prevention, education and research. The Secretary-General met with the Chief Executive Officers and senior executives of Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffman-La Roche and Pfizer. He was joined at the meeting by Gro Harlem Brundtland, Director-General of the World Health Organization, and Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).The pharmaceutical companies have made significant progress individually in providing an expanded number of drugs to combat AIDS, including antiretrovirals and treatments for opportunistic infections. Prices have come down substantially as a result of the companies' individual actions. Mr. Annan urged them to continue and accelerate these initiatives. Special emphasis was placed on the least developed countries, particularly those in Africa, as well as the need for continued country-by-country negotiations in other developing countries. All recognized that qualified non-governmental organizations and appropriate private companies offering health care to employees and local communities should also be considered for increased accessibility to HIV/AIDS medicines. (excerpt)
Lancet Infectious Diseases. 2003 Sep 1; 3(9):530.According to Raviglione the antituberculosis drugs used with the directly observed therapy short-couse (DOTS) made it possible to cure tuberculosis in over 80 000 Africans living with HIV last year. However more than 200 000 Africans with HIV died from tuberculsosis because they had no access to anti-tuberculosis drugs and DOTS. Tuberculosis was notably absent from the scientific programme at the HIV meeting. “In Africa it strikes us as peculiar how politicians and academics can speak of their ‘AIDS initative’ or ‘their tuberculosis programme’ as if the two diseases are not related,” said Winstone Zulu, a Zambian man infected with HIV, who had been recently cured of tuberculosis. “We see them together conspiring and collaborating to steal away our health.” (excerpt)
Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative. [Prestation de services, couverture des coûts et équité dans une région au Burkina-Faso exploitant l'Initiative de Bamako]
Bulletin of the World Health Organization. 2003 Jul; 81(7):532-538.Objective: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. Methods: Qualitative and quasi-experimental quantitative methodologies were used. Findings: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at ‘‘case’’ health centres but increased by 30.5% at ‘‘control’’ health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. Conclusion: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentivesmust be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. (author's)
Unintended consequences: drug policies fuel the HIV epidemic in Russia and Ukraine. A policy report prepared for the UN Commission on Narcotic Drugs and national governments.
New York, New York, Open Society Institute, International Harm Reduction Development program, 2003. 16 p.Taking action now to reduce HIV transmission rates and treat those already infected is critical. With the goal of avoiding adverse effects on social welfare and public health, the Russian and Ukrainian governments should reconsider how they interpret international treaties. Policy changes should be made in the following areas: Harm reduction. The governments should play an active role in establishing and supporting a large, strategically located network of harm reduction programs that provide services for IDUs, including needle exchange, HIV transmission education, condom distribution, and access to viable treatment programs such as methadone substitution. Similar services should be available in all prisons. Education. Simple, direct, and dear information about HIV transmission should be made available to all citizens-especially those most at risk. Similarly, society at large should be educated about the realities of drug use and addiction as part of an effort to reduce stigma. Discrimination and law enforcement abuse. Public health and law enforcement authorities should take the lead in eliminating discrimination, official and de facto, toward people with HIV and marginalized risk groups such as drug users. Authorities must no longer condone or ignore harassing and abusive behavior, including physical attacks, arrest quotas, arbitrary searches, detainment without charges, and other violations of due process. HIV-positive people, including IDUs, should be included in all policy discussions related to them in the public health and legal spheres. Legislation. Laws that violate the human rights of people with HIV and at-risk groups should be repealed or restructured to better reflect public health concerns. Moving forward with the above strategies may make it appear that the governments are backing away from the goals and guidelines of the UN drug conventions. They may be criti- cized severely by those who are unable or unwilling to understand that meeting the goals of the conventions, some of which were promulgated more than 40 years ago, is far too great a price to bear for countries in the midst of drug use and HIV epidemics. Governments ultimately have no choice, though, if they hope to maintain any semblance of moral legitimacy among their own people. (excerpt)
WHO must continue its work on access to medicines in developing countries. Il faut que l'OMS poursuive son travail en vue de l'accès aux médicaments dans les pays en développement.
Lancet. 2003 Jan 4; 361(9351):3.The driving force behind all of WHO’s actions should be public health, with no compromises accepted that would ultimately prevent those needs from being effectively and swiftly met. In the face of rising infectious diseases such as AIDS, TB, and malaria, and the increasing marginalisation of health problems that do not affect the developed world, the importance of an international, independent organisation that is brave, aggressive, and vocal in its defence of global public health has never been more important. (excerpt)
The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.
Bulletin of the World Health Organization. 2002; 80(6):471-6.The development of WHOs directly observed treatment, short course (DOTS) strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation, and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multi-country projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programs. In 1998, an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multi-drug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. The authors discuss the prerequisites for success, the shortcomings of this WHO-supported program, and future challenges and needs. (author's)
Immediate and growing needs for help to a fragile new democracy: health in the Russian Federation with emphasis on children and women. Report of a UNICEF / WHO collaborative mission with the participation of UNFPA, UNDP, and WFP, 17 February - 2 March 1992.
[Unpublished] 1992 Mar 17. , 45,  p.From February 17 to March 2, 1992, the World Health Organization and UNICEF conducted a fact-finding mission to the Russian Federation to assess the health of the population, particularly of women and children. These international agencies found a unique situation in which economic adjustment to a market economy has created shortages in this developed nation similar to those encountered in developing countries. After an introductory section, the second section of this report provides background information on the Russian Federation, its economic situation, social protection mechanisms, and social statistics. Section 3 provides an assessment of the state of the health services, immunization programs, pharmaceuticals and equipment, nutrition, and the food situation. The next section discusses the organization of the public school system which may be used to provide nutritional supplements and health education. The rapid decline in environmental quality is then discussed, and examples are provided of some of the effects of this deterioration. The sixth section briefly mentions the three types of nongovernmental organizations available for partnerships and strategic alliances with international donors. Section 7 summarizes the recommendations of the mission. Six areas of assistance (each with several related recommendations) were identified: 1) to support those activities which will allow economic transition to be sensitive to the needs of vulnerable groups and social issues; 2) to provide emergency supplies to the health system through international channels and to foster the rapid rehabilitation of selected national production and distribution systems; 3) to provide technical assistance for the restructuring of the health system; 4) to establish monitoring systems to identify and protect vulnerable groups; 5) to engender support for donor coordination and the facilitation of international assistance; and 6) to support nongovernmental organizations and private partnerships as they attempt to strengthen social safety nets. A basic budget (which totals US $164 million and is separated into urgent and priority needs) is provided. Annexed information includes the construction and utilization of a food basket to monitor food prices, data on breastfeeding, and the highest priority needs for vaccines, drugs, and supplies.
CONTRACEPTIVE TECHNOLOGY UPDATE. 1989 Jun; 10(6):77-81.Although generic oral contraceptives (OCs) are bioequivalent to brand-name formulations, many family planning professionals do not prescribe the significantly lower-priced generics. The Planned Parenthood Federation of America, for example, has refused to approve generic OCs for use in the organization's clinics, presumably because of concerns about their equivalent efficacy and safety. However, much of this skepticism may be fueled by misleading marketing by brand-name OC manufacturers. Sales representatives have reportedly told clinicians that generic OCs can be as much as 20% different from brand-name formulations, despite evidence collected by the US Food and Drug Administration confirming that there is virtually no difference except in terms of inert ingredients. In the case of many formulations, the variability between the generic and brand-name products is no different than the variability found between different lots of the same brand-name drug. Another obstacle to wider use of generic OCs is that discounts for large volume purchases make brand-name OCs the best buy for family planning clinics. Clinicians also note that clients complain of minor side effects whenever OC brands are changed, even if the compounds are the same. As the price of medication continues to rise, the more widespread availability of generic OCs will be especially important for teenagers and other low-income clients.
Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
World Health. 1984 Jul; 3-5.In 1977 the World Health Organization (WHO) began a peaceful revolution in international public health by asking a group of experts which drugs were really necessary to take care of most health problems. The conclusion was that about 200 drugs and vaccines could be considered essential in good medical practice. Most of them were of proven efficacy, with well-known therapeutic properties, and most were no longer protected by patent rights and could be mass produced at a reasonable cost to patients. The Model List of Essential Drugs, although revised twice since 1977, has needed only minor adjustments and is still limited to about 220 essential drugs and vaccines. More than 80 countries in the 3rd world have adapted the model list to their requirements. Country experience demonstrates that using a limited number of essential drugs poses no threat to public health. In response to problems of drug supply and drug use in developing countries, country application of the philosophy of essential drugs has become the centerpiece of a global program designed to make sure that a limited number of essential drugs of good quality are available at prices that poorer patients can afford. A strategy, drawn up toward the end of the 1970s and which eventually became the Action Program on Essential Drugs and Vaccines, addresses the complexity of the world of pharmaceutical products and their utilization. It focuses on essential drug availability in primary health care. If a limited number of essential drugs cannot be delivered on a regular basis to rural areas and the poorer sections of cities, the whole strategy of health for all by the year 2000 will face a partial or even total failure. The Action Program on Essential Drugs and Vaccines is becoming a worldwide effort, with many partners involved. Countries decide for themselves on the pharmaceutical policy they want to follow. Many have chosen an essential drug policy and some have accelerated their programs with external technical and financial collaboration. Physicians and other health workers who prescribe, and dispensing pharmacists, are obvious partners for the Action Program. New information and training must be provided for students of medicine, pharmacy, and pharmacology before an improvement in the fine art of prescribing medicine can be expected. Patients, supported by better information and follow-up, should also accept more responsibility for their own use of drugs.
Who Chronicle. 1984; 38(2):47-59.The 73rd session of the World Health Organization's (WHO) Executive Board met in January 1984 to review progress in implementing strategies for health for all by the year 2000, based on information emanating from the countries themselves. This monitoring function was assigned to the Board by the World Health Assembly in 1981 and calls for the Board to evaluate progress towards health for all at regular intervals and to report back to the Health Assembly. The 1st country reports together with comments of the regional committees and relevant information provided by theSecretariat were examined in November 1983 by the Board's Program Committee. Emphasis at this stage was placed on reviewing the relevance of national health policies to the attainment of health for all and the progress being made in implementing national strategies. Actual evaluation of the strategies will begin in 1985. As many of the country reports submitted were not as complete or as accurate as they could have been, the overall progress report submitted were not as complete or as accurate as they could have been, the overall progress report suffered from a lack of detailed and precise informattion on many important aspects that were crucial to national health for all strategies. Dr. Brandt, presenting the Program Committee's views, told the board that the report did indicate that a high level of political sensitization had occurred and that the political will to attain the goal of health for all existed in a large majorithy of the countries that had reported. The report indicated that to a large extent the Secretariat had met its responsibilities. It was the Member States that had to shoulder the responsibility and reaffirm their commitment by action. The Program Committee's progress report points to the existence of specific technical needs, particularly in national capability to carry out health policies. Among the areas requiring strengthening are information analysis and management, financial analysis, assessment of status of public information, competence in planning and management, effective involvement of relevant sectors in health, and measurement of intersectoral action for health. The Board urged Member States to give highest priority to the continuing monitoring and evaluation of their health for all strategies and to assume full responsibility for this process. In regard to the action program on essential drugs and vaccines, priority in the last 2 years has gone to training and manpower development, the dissemination of experience and information, cooperation in the procurement and production of essential drugs, technical cooperation among developing countries, and contracts with nongovernmental organizations and the pharmaceutical industry. During the far ranging discussion that ensued in the Executive Board, members addressed themselves in considerable detail to numerous aspects of the action program. The Board approved a new and carefully phased procedure for the review of substances to be recommended for international drug control.
[Geneva, Switzerland], WHO, 1982. 17 p. (HRG/CRU.1/Rev.1/Mtg.1)In 1979, a WHO team collaborated with national personnel in The Gambia in developing a comprehensive primary health care (PHC) plan of action for the period 1980/81 - 1985/86. In his address to the legislature in August, 1980, the president declared that the plan involved the active participation of local communities and emphasized programs for health promotion and disease prevention. This monograph reports on a meeting of the Gambian Ministries of Economic Planning and Industrial Development and of Health, Labor and Social Welfare in June 1982. Improvements in rural health are a basic need. In order to provide PHC, it was fully realized that a strong supportive infrastructure was essential. The village sensitization program was considered as vital for success. Not 1 village has rejected PHC or its responsibilities. The training program for community health nurses, village health workers and traditional birth attendants was proceeding according to plan for the various levels. Recognizaing that an efficient drug supply was essential, concomitant action had been taken to reorganize the central store. Another essential element without which success could not be achieved related to provision of transport and facilities for their maintenance, so that communications could be assured with rural areas. The need for a radio network to link 6 staions and 26 sub-stations was stresses. The list of participants and the agenda are attached as are the requirements for external support for the planned provision of PHC which were considered by the participants of the meeting.