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Essential medicines for mothers and children: a key element of health systems. Access to medicines and public pharmaceutical policy.
Entre Nous. 2009; (68):14-15.Medicines, when used appropriately, are one of the most cost effective interventions in health care. European countries spend an important part of their health budget on medicines, from 12% on average for the EU countries to more than 30% for the Newly Independent States (NIS) countries. Whereas in EU countries the larger part of the medicines expenditures are publicly funded through taxes and/or social health insurance, in the NIS and in the south eastern European countries it is often the patients who have to pay directly for the drugs themselves. This means that many patients simply do not get the drugs they need because they cannot afford them, and also may force families to incur enormous expenses as they sell their belongings in order to pay for their drugs and their health care.
Perspectives on Global Development and Technology. 2004; 3(1-2):131-152.This paper considers influences of globalization on three relevant health policy issues in South Africa, namely, private health sector growth, health professional migration, and pharmaceutical policy. It considers the relative role of key domestic and global actors in health policy development around these issues. While South Africa has not been subject to the overt health policy pressure from international organizations experienced by governments in many other low- and middle-income countries, global influence on South Africa's macroeconomic policy has had a profound, albeit indirect, effect on our health policies. Ultimately, this has constrained South Africa's ability to achieve its national health goals. (author's)
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)
Bulletin of the World Health Organization. 2006 May; 84(5):338.The context for this theme collection is the publication of the report of the Commission on Intellectual Property Rights, Innovation and Public Health. The report of the Commission -- instigated by WHO's World Health Assembly in 2003 -- was an attempt to gather all the stakeholders involved to analyse the relationship between intellectual property rights, innovation and public health, with a particular focus on the question of funding and incentive mechanisms for the creation of new medicines, vaccines and diagnostic tests, to tackle diseases disproportionately affecting developing countries. In reality, generating a common analysis in the face of the divergent perspectives of stakeholders, and indeed of the Commission, presented a challenge. As in many fields -- not least in public health -- the evidence base is insufficient and contested. Even when the evidence is reasonably clear, its significance, or the appropriate conclusions to be drawn from it, may be interpreted very differently according to the viewpoint of the observer. (excerpt)
Bulletin of the World Health Organization. 2006 May; 84(5):371-375.Most countries have acceded to at least one global or regional covenant or treaty confirming the right to health. After years of international discussions on human rights, many governments are now moving towards practical implementation of their commitments. A practical example may be of help to those governments who aim to translate their international treaty obligations into practice. WHO's Essential Medicines Programme is an example of how this transition from legal principles to practical implementation may be achieved. This programme has been consistent with human rights principles since its inception in the early 1980s, through its focus on equitable access to essential medicines. This paper provides a brief overview of what the international human rights instruments mention about access to essential medicines, and proposes five assessment questions and practical recommendations for governments. These recommendations cover the selection of essential medicines, participation in programme development, mechanisms for transparency and accountability, equitable access by vulnerable groups, and redress mechanisms. (author's)
In: Global health and governance. HIV / AIDS, edited by Nana K. Poku and Alan Whiteside. Basingstoke, England, Palgrave Macmillan, 2003 Dec. 109-122.Today in much of Africa economic growth has slowed and living standards for the majority have suffered in the face of rising unemployment and mass poverty, resulting in incomes that are presently below the 1970 level. One problem that has been the focus of much attention and contention over the past 20 years is the huge foreign debt owed by African countries to bilateral donors and multilateral institutions. Debt servicing is consuming a disproportionate amount of scarce resources at the expense of the provision of basic services to the poor. In order to receive help in servicing their debts, countries must agree to implement structural economic reforms. This often entails drastic cuts in social expenditures, the privatisation of basic services, and the liberalisation of domestic trade consistent with WTO rules. These policy decisions have had a direct impact on the capacity of African countries to promote, fulfill and protect the right to health of their citizens. This is further compounded by ill-conceived privatisation of basic services such as water and health services, without any regard for the ability of the poor to access these essential services at a cost they can afford. Finally, adherence to WTO trade rules, which often comes as an extension of liberalisation policy, hampers the capacity of African governments to produce or purchase less expensive generic drugs for their citizen without fear of retaliation from the developed countries. (author's)
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)
IN POINT OF FACT 1991 Jun; (76):1-3.This paper describes the serious effect of diarrheal and acute respiratory (ARI) disease upon children under 5 years old, and international efforts undertaken by the World Health Organization (WHO) to reduce such mortality. Combined, these diseases account for more then 1/2 of all deaths in this age group, and constitute the most serious threat to their health. WHO estimates for 1990 that diarrheal illnesses caused 3.2 million childhood deaths and that ARI caused 4.3 million. While some child deaths are due to measles and pertussis, the majority is caused by pneumonia and the consequences of diarrheal illnesses. These deaths could be readily averted through the timely, effective treatment of trained health workers with essential drugs. Immunization as well as improved nutrition, particularly through the practice of exclusive breast feeding of the child's 1st 4-6 months of life, are addition weapons potentially employed against child mortality. WHO programs for diarrhea and ARI control focus upon simplified treatment guidelines, training, communication messages, drug supplies, and evaluation methodology. Despite obstacles such as the marketing of useless and/or potentially dangerous anti-diarrheal drugs and cough and cold remedies, and inappropriate breastmilk substitutes and unnecessary foods, widespread progress in program development and implementation has been made over the past decade. Increased amounts of oral rehydration therapy and solutions are available and used, while many health workers have benefited from training programs.
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.
TDR NEWS. 1999 Feb; (58):2, 4.New Medicines for Malaria Venture (MMV) is a public/private, nonprofit initiative to develop 1 new drug against malaria every 5 years. It will operate under the umbrella of Roll Back Malaria, a new project launched by World Health Organization (WHO) Director General, Dr. Gro Harlem Brundtland. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) helped establish the MMV through its product R&D unit, and there has been considerable industrial input. The World Bank and the Global Forum for Health Research are other international agencies involved in the initiative, while several philanthropic organizations such as the Rockefeller Foundation and the Wellcome Trust have also played major roles. MMV will create a fund and operate by financing and resourcing a limited number of projects in a manner compatible with industrial procedures. The fund is mainly supported financially by the public sector, while a funding commitment of US$15 million/year rising to US$30 million a year is being sought. Companies are providing mainly in-kind support.
AFRICA HEALTH. 1997 Nov; 20(1):7.UNAIDS has launched an 'HIV Drug Access Initiative' in the Ivory Coast, Uganda, Chile, and Vietnam; the pilot project will attempt to improve access to HIV drugs. Public and private sector efforts will be coordinated. The Glaxo Wellcome, Hoffman-La Roche, and Virco pharmaceutical companies will participate. Each country will 1) adapt its present system with regard to HIV and 2) establish both an HIV drug advisory board and a non-profit company which will import the drugs. Health ministries within each country will be required to find sources of funding for the programs. Uganda will probably use funds from its sexually transmitted disease (STD) program, which is supported by the World Bank; the Ivory Coast will combine corporate contributions, new tariffs, and non-profit insurance system monies into a 'solidarity fund.' UNAIDS funds will be used for oversight and evaluation. UNAIDS also released a review of 68 studies which examined the impact of sex education on the sex behavior of young people; it indicated that, in 65 of the studies, sex education did not increase the sexual activity of youth. UNAIDS concluded that quality programs helped delay first intercourse and often reduced the number of sexual partners, resulting in reduced rates of STDs and unplanned pregnancy. UNAIDS further concluded that effective sex education should begin before the onset of sexual activity, and curriculums should be focused. Openness in communicating about sex should be encouraged, and social and media influences on behavior should be addressed. Young people should be taught negotiating skills (how to say 'no' to sex and how to insist on safer sex).
Arlington, Virginia, Partnership for Child Health Care, 1995. , 11,  p. (Trip Report; BASICS Technical Directive: 008-GU-01-015; USAID Contract No. HRN-6006-Q-08-3032)As part of a series of activities designed to reduce morbidity and mortality from acute respiratory infections in children under the age of 5 in Guatemala, a consultant from the BASICS (Basic Support for Institutionalizing Child Survival) program visited Guatemala in 1995 to analyze, modify, and field test the protocol developed by the USAID Mission to document the degree to which drugs prescribed for pneumonia are available in the community through the private sector. This field report provides background information and describes the current situation in Guatemala in terms of availability of drugs in the public sector through the Ministry of Health, the Drogueria Nacional, municipalities, and the Pan American Health Organization. Relevant activities in the private sector are also described, including the for-profit businesses as well as services provided by UNICEF, the European Union, and nongovernmental organizations. A brief overview of one health area gives an example of the current situation. The result of this consultancy visit was the determination that the situation merited adjustment of the originally requested study and that the survey as designed would likely require modification and application within target communities. Included among the appendices is the original protocol developed for assessing community drug availability.
Tropical Doctor. 1984 Jan; 14(1):3-7.On April 27, 1982 the Ministry of Health of the government of Bangladesh, set up an 8-man expert committee to evaluate all the registered pharmaceutical products presently available, and to formulate a draft National Drug Policy. Objectives are: 1) to provide support for ensuring quality and availability of drugs; 2) to reduce drug prices; 3) to eliminate useless, nonessential, and harmful drugs from the market; 4) to promote local production of finished drugs; 5) to ensure coordination among government branches; 6) to develop a drug monitoring and information system; 7) to promote the scientific development and application of unani, ayurvedic, and homeopathic medicines; 8) to improve the standard of hospital and retail pharmacies; and 9) to insure good manufacturing practices. 16 criteria were agreed on as guidelines for evaluating the drugs on the country's market. Drugs in Bangladesh have been classified into 3 categories. The 1st is drugs that are positively harmful. They should be banned immediately and withdrawn from the market. There are 265 locally manufactured drugs and 40 imported drugs in this category. The 2nd, drugs to be slightly reformulated by eliminating some of their requirements. There are 134 drugs in this category. The 3rd is drugs that do not conform to 1 or more of the 16 criteria/guidelines. There are over 500 drugs in this category. The new drug policy will produce a saving of 800 million taka (US $32.4 million). Drug supply in Bangladesh is a problem. The public sector distributes 20% of the total. In the private sector, drugs are supplied through import and local production. Investment for research by the pharmaceutical companies is essential. The principles laid down by the International Federation of Pharmaceutical Manufacturers Associations for the supply of good medicine needs to be put into practice.
In: Shirley O, ed. A cry for health. Poverty and disability in the Third World. Frome, England, Third World Group for Disabled People, 1983. 73-8.Disability in developing countries is largely a social, political and economic disease, a symptom of underlying conditions of great injustice and inequality. The author asks to what extent do the multinational corporations (MNCs) sustain poverty and disability in developing countries. MNCs usually operate within environments where the emphasis in national development and growth is overwhelmingly on the security and prosperity of the relatively welathy minority. There is no international supervision over MNCs at all and control within the developing country tends to be weak since home governments have a vested interest in earning foreign exchange. Also, MNCs are extremely effective in making and marketing goods and in persuading people that these goods bring advantage to them. The multinational pharmaceutical industry represents concentrated capacity and wealth; just 10 companies control 25% of the world's total drug production while the top 110 companies control 90% of the total. By contrast, the average developing country represents concentrated incapacity and ill-health. There is distortion of national health priorities in many developing countries in that most of the drugs which are bought and sold are not essential. In addition, multinational drug companies usually observe lower standards in developing countries than elsewhere. An example is provided of the sale of Lomotil to control diarrhea in developing countries by G.D. Searle, a pharmaceutical manufacturer. Lomotil is an anti-diarrheal drug; it doesn't treat the condition that caused the diarrhea in the 1st place. It was found by the World Health Organization that this drug was not appropriate for the type of diarrhea found in developing countries, and a leaflet was produced by the US Food and Drug Administration to that effect.