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Lancet. 2003 Nov 29; 362(9398):1773.December 1 is the 16th World AIDS Day. The major theme of the past year has been on strengthening the campaign for cheap antiretroviral drugs. This thrust, some critics maintain, has been to the detriment of HIV prevention efforts. Perhaps the most ambitious HIV/AIDS development in the past year has been WHO’s focus on the “3 by 5” target—a commitment to provide antiretroviral drugs to 3 million people in developing countries by the end of 2005. For many the “3 by 5” initiative, if successfully implemented, will bring a longer life. But how useful is this and other antiretroviral-based initiatives to those people with AIDS in the developing world who will die today, tomorrow, or in the very near future? For these people, the stark reality is that it is too late for antiretroviral treatment; what they need, yet rarely receive, is palliative care. (excerpt)
HEALTH FOR THE MILLIONS. 1995 Jan-Feb; 21(1):29-33.In India, the standard regimen (SR) for treating tuberculosis consisted of a 2-month intensive treatment by 2-3 inexpensive drugs followed by a 10-month course using 2 drugs. In the 1980s, this course was shortened to 6 months owing to the powerful drugs rifampicin and pyrazinamide. Thiacetazone was also replaced by the more expensive but less toxic ethambutol. The result was a short-course chemotherapy (SCC) employing 4 drugs for 2 months, followed by 2-3 drugs for 4 months of follow-up. The SCC is being pilot-tested as the Revised National Tuberculosis Program (RNTP); this RNTP strategy is being implemented in Delhi, Bombay, and Mehsana with the assistance of the Swedish international agency. The World Bank also endorsed RNTP, as SCC regimens under it were cost-effective. The SR and SCC regimens were also compared for Malawi, Mozambique, and Tanzania, and relatively minor differences were found in lives saved for expenditures. The claim that the rates of default under SR and SCC remain unchanged over time and the cure rates of the regimens must be challenged. The estimated cure rates of 60% for SR and 85% for SCC do not correspond to the reality in India, where 41% of patients completed treatment under SR versus 47% under SCC. The cost of treatment under SR does not have to be a 5-drug regimen; re-treatment can be a 3-drug regimen, whereby the cost would be lower than assumed. The Ministry of Health and Family Welfare (MHF) was probing 253 district SCCs even in 1992-93 and accepted SCC because the World Health Organization recommended a vastly improved administration for implementation and there was a felt need from patients for speedy cure. If the SCC is administered properly, it may increase the cure rate, even if cost-ineffective; if poorly managed, increased drug resistance of TB bacteria could result, which may be the present situation.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1986 Jun. , 31,  p. (USAID Contract No. DPE-5927-C-00-5068-00)In the mid 1980s, the Government of The Gambia (GOTG) sought funds from the World Bank and other donors to restructure and strengthen its health system. Since the World Bank thought that recurrent cost obligations that the GOTG would find unacceptable should accompany the implementation of the National Health Project (NHP), this study was undertaken. The Italian Government agreed to fund US $9.8 million to NHP, most of the funds going to renovating and refurbishing the pediatric ward and central laboratory at Royal Victoria Hospital in Banjul. Trends in health sector expenditures showed that the devaluation of the dalasi continued to bring about shortfalls in nonsalary costs, especially in drugs and dressings. Therefore the GOTG must address the shortfalls before even considering expansion of the already inefficient health delivery system. It also needs to develop a cost recovery system for drugs which maintains a reliable source and adequate supplies of drugs in the proper amounts, effectively distributes the drugs, and manages the finances effectively. The GOTG should also develop the Ministry of Health's ability to coordinate donor support and to develop a process of budgeting, spending, and planning. The study team also recommended consolidating staff rather than expand staff in light of financial constraints. A flotation policy and exchange rates less favorable to the dalasi may grant the GOTG more access to exchange within the banking system.
Bulletin of the Pan American Health Organization. 1983; 17(2):201-3.A field study to ascertain the status of drug delivery systems for primary health care centers in Latin America was conducted by the Pan American Health Organization (PAHO) in 1980-81. Countries studied included Bolivia, Ecuador, Peru, Honduras, Panama, and the Dominican Republic. The planning and purchasing functions of the drug distribution systems were found to be highly centralized, failing to take local morbidity patterns or drug demand levels into account. Storage areas lacked adequate equipment and were poorly designed. Personnel were insufficiently trained and were found to ignore procedures regarding the handling of damaged or expired drugs. Also noted was a lack of adequate equipment for transporting medicines to rural clinics. A widespread characteristic was the lack of formal supervision and control (excluding fiscal) at national, regional, and local levels. Many essential drugs were unavailable at the local level, and formulations with unjustified associations and products for which there are more advantagous substitutes were found. These results were presented at the PAHO-sponsored Regional Workshop on Administration and Supply of Essential Drugs held in 1981. The workshop made 5 recommendations to governments: 1) every national health plan should include a national drug policy; 2) the drug policy should encompass a registry of all drugs sold, a list of essential drugs by level of care, quality control measures, educational activities for personnel, proper financing, and an evaluation methodology; 3) an integrated system for managing drug distribution should be designed; 4) information on essential drugs, legislation, pricing, and quality control should be exchanged among regions; and 5) centers should participate in the WHO-developed quality certification system. In addition, it was recommended that PAHO should: 1) participate in developing a system of regional cooperation, 2) identify regional centers for training personnel in the management of drug distribution systems, 3) stimulate development of training programs, and 4) support operational research on drug distribution systems.
In: Bannerman RH, Burton J, Ch'en Wen-Chieh. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva, Switzerland, World Health Organization, 1983. 194-206.There is a genuine interest now being taken in phytotherapy and medicinal plants throughout the world. In industrialized countries there is a trend of going back to nature or wanting to combat the chemical pollution of the body provoked by inopportune chemotherapy or by the misuse of convenience drugs of chemical origin; third world countries are primarily concerned with providing their peoples with adequate coverage of their essential drug needs. A new type phytotherapy is proposed, to produce phytotherapeutic preparations for use in modern medical practice from the resources of traditional medication. In view of difficulties experienced by developing countries in meeting their needs for essential drugs, 4 measures might be taken to encourage utilization for primary health care of their vast local resources: 1) a real health policy option at national and regional level; 2) determination of priorities regarding health problems and definition of possible solutions; 3) goal-oriented applied scientific research on medicinal plants, incorporating properly planned programs; 4) effective implementation of these programs with regard to technical and financial resources and appropriate personnel. Cooperation among developing countries, with the industrialized countries and with organizations of the United Nations system is recommended. A table illustrates integrated overall organization.