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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.
Reproductive Health Matters. 2009 May; 17(33):91-104.This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
Trips and public health: solutions for ensuring global access to essential AIDS medication in the wake of the Paragraph 6 Waiver.
Journal of Contemporary Health Law and Policy. 2008 Fall; 25(1):142-65.In 2003, the World Trade Organization (WTO) proposed a waiver to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), known as the "Paragraph 6 Waiver," in order to create flexibility for developing countries and to allow easier importation of cheap generic medication. ... To the companies who own pharmaceutical patents, the notion that a government can use their product without the permission of the patent holder seems unfair and counterproductive. ... Canada was one of the first countries to enact legislation for the sole purpose of exporting generic drugs to developing countries and its experience is indicative of the problems presented by compulsory licensing and the Paragraph 6 Waiver. ... Exact amounts and methods for determining remuneration vary but presumably a fair system would compensate patent holders for the loss of their patent rights while maintaining the system's cost effectiveness for countries issuing the compulsory licenses. (excerpt)
Public-private partnerships: Managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India. Lessons and implications from three case studies.
Geneva, Switzerland, World Health Organization [WHO], 2007.  p.Strengthening management capacity and meeting the need for reproductive and child health (RCH) services is a major challenge for the national RCH program of India. Central and state governments are using multiple options to meet this challenge, responding to the complex issues in RCH, which include social, cultural and economic factors and reflect the immense geographical barriers to access for remote and rural population. Other barriers are also being addressed, including lessening financial burdens and creating public-private partnerships to expand access. For example, the National Rural Health Mission was initiated in order to focus on rural populations, although departments of health face a number of challenges in implementing this initiative. In this document, we focus on a key area: the development of management capacity for working with the private sector. We synthesize the lessons learnt from three case studies of public-private partnerships in RCH: two are state initiatives, in Gujarat and Andhra Pradesh, and the third is the national mother nongovernmental organization scheme. The case studies were conducted to determine how management capacity was developed in these three public-private partnerships in service delivery, by examining the structure and process of partnerships, understanding management capacity and competence in various public-private partnerships in RCH, and identifying the means for developing the management capacity of partners. (author's)
Geneva, Switzerland, UNAIDS, 2007 Mar. 4 p. (UNAIDS Policy Brief)Nearly 40 million people in the world are living with HIV. In countries such as Botswana, Swaziland, and Lesotho people living with HIV make up a quarter or more of the population. People living with HIV are entitled to the same human rights as everyone else, including the right to access appropriate services, gender equality, self-determination and participation in decisions affecting their quality of life, and freedom from discrimination. All national governments and leading development institutions have committed to meeting the eight Millennium Development Goals, which include halving extreme poverty, halting and beginning to reverse HIV and providing universal primary education by 2015. GIPA or the Greater Involvement of People Living with HIV is critical to halting and reversing the epidemic; in many countries reversing the epidemic is also critical to reducing poverty. (excerpt)
Bethesda, Maryland, Abt Associates. Private Sector Partnerships-One [PSP-One], 2006 Dec. 48 p. (Technical Report No. 6; USAID Contract No. GPO-I-00-04-00007-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-754)Government health sectors in many countries face an uphill battle to reach the Millennium Development Goals (MDGs) set for 2015. In the last six years, Ministries of Health (MOHs) in many less developed countries (LDCs) have been unable to invest sufficiently in their health systems. To achieve the MDGs despite inadequate resources, new approaches for delivering critical clinical services must be considered. This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in LDCs' ability to reach MDGs. This paper examines factors that support or constrain private practice midwives' (PPMWs') ability to offer expanded services in order to inform the policy and donor communities about PPMWs' potential. Data was collected through literature reviews, stakeholder interviews, and field-based, semi-structured interviews in Ghana, Indonesia, Peru, Uganda, and Zambia. Ghana, Indonesia, and Uganda were chosen because they are countries where PPMWs provide expanded services. Peru and Zambia were selected as examples where midwives have struggled to develop private practices or they provide expanded services despite issues about midwives' roles and legal sanctions for private practices. (excerpt)
Toolkit to improve private provider contributions to child health: introduction and development of national and district strategies.
Washington, D.C., Academy for Educational Development [AED], Support for Analysis and Research in Africa [SARA], 2005 Jun. 50 p. (USAID Development Experience Clearinghouse DocID / Order No: PN-ADF-758; USAID Contract No. AOT-C-00-99-00237-00)June 2002, the World Bank published a discussion paper titled Working with the Private Sector for Child Health. The paper--developed with technical assistance from the USAID Bureau for Africa, Office of Sustainable Development (AFR/SD) through the Support for Analysis and Research in Africa (SARA) project--lays out a framework for analyzing the contributions of the private sector in child heath. The framework, outlined below, is designed to serve as a basis for assessing the potential of different components of the private sector at country level. The framework identifies the following components of the private sector as being important for child health: Service providers (formal sector, other for-profit, employers, non-governmental organizations [NGOs], private voluntary organizations [PVOs], and traditional healers); Pharmaceutical companies; Pharmacies; Drug vendors and shopkeepers; Food producers; Media channels; Private suppliers of products related to child health, e.g. ITNs; Health insurance companies. (excerpt)
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):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)
Geneva, Switzerland, UNAIDS, 2004 Jul.  p.In monitoring resource flows for HIV and AIDS, it has proven easier to collect information on donor governments, multilateral agencies, foundations and nongovernmental organizations (NGOs) than to obtain reliable budget information on domestic outlays for HIV and AIDS in affected countries. As a result, UNAIDS has focused significant efforts on strengthening the capacity of countries to monitor and track expenditures for HIV and AIDS. This report summarizes the latest information available on HIV-related spending in 26 countries. Seventeen of the countries are from the Latin America and Caribbean (LAC) region. Resource tracking in the LAC region, as well as in Thailand, Burkina Faso and Ghana has benefited from the leadership of the Regional AIDS Initiative for Latin America and the Caribbean (SIDALAC), which helped implement the National AIDS Account (NAA) approach. Beginning with pilot projects in three countries in 1997–1998, NAA has now been extended throughout the region, in large part due to the provision of extensive technical assistance by countries involved in the early pilot projects. NAA uses a matrix system that describes the level and flow of health expenditures on AIDS. The NAA model: a) identifies key actors in HIV and AIDS activities; b) uses existing data or makes estimates for specific services or goods purchased; c) analyses domestic (public and private) and international budgets; d) determines out-of-pocket expenditures; and e) assesses the financial dimensions of the country’s response to AIDS. (excerpt)
The role of the health sector in supporting adolescent health and development. Materials prepared for the technical briefing at the World Health Assembly, 22 May 2003.
Geneva, Switzerland, World Health Organization [WHO], 2003. 15 p.I am very pleased to be here, and to be part of the discussion on Young Peoples Health at the World Health Assembly, for two reasons: because of the work we have been doing in adolescent health over the past years together with the Member States of the European Region of WHO, the work in cooperation with other UN agencies, especially UNICEF, UNFPA, and UNAIDS on adolescent health and development. Secondly, because Youth is a priority area of work of German Development Cooperation, and of the German Agency for Technical Cooperation, where I am working presently. Indeed, we have devoted this years GTZ´s open house day on development cooperation to youth I would also like to take this opportunity to remember the work of the late Dr. Herbert Friedman, former Chief of Adolescent Health in WHO, whose vision of the importance of working for and with young people has inspired many of the national plans and initiatives which we will hear about today. In many countries of the world, young people form the majority of populations, and yet their needs are being insufficiently met through existing health and social services. The health of young people was long denied the public, and public health attention it deserves. Adolescence is a driving force of personal, but also social development, as young people gradually discover, and question and challenge the adult world they are growing into. (excerpt)
Journal of the Indian Medical Association. 2003 Mar; 101(3):150-151.Tuberculosis (TB) remains a serious public health problem in spite of DOTS programme recommended by WHO. One person dies from TB in India every minute. Revised National TB Control Programme (RNTCP) is playing a major role in global DOTS expansion. DOTS coverage has expanded from 2% of the population in mid-1998 to 57% by the end of January, 2003. RNTCP has made a significant contribution to public health capacity. The programme has saved the people of India hundreds of millions of dollars. Monitoring the clinical course using smear microscopy and accurately reporting treatment outcomes is essential in well-functioning DOTS programme. RNTCP has invested heavily and made significant strides in maintaining and improving quality DOTS. State and district level programme reviews are a key component of the process. RNTCP has established guidelines for the involvement of the private sector and medical colleges. A member by ongoing technical activities will improve RNTCP’s surveillance and monitoring systems. However a challenge lies with the programme and a collective effort is welcome. (excerpt)
Health for the Millions. 2004 Jan; 30(4-5):23-27.In 1978, a potential breakthrough in global health rights took place at an international conference organized by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in Alma Ata in erstwhile USSR(now Almaty in Kazakhstan). In this Alma Ata Declaration, 134 countries subscribed to the goal of 'Health for All by the Year 2000'. They affirmed WHO's broad definition of health as 'a state of complete physical, mental and social well-being'. The world's nations--together with WHO, UNICEF, and other major funding organizations--pledged to work towards meeting people's basic health needs through the comprehensive and remarkably progressive primary healthcare (PHC) approach. Principals and methods garnered from the barefoot doctors' methodology in China and from experiences of small, struggling community-based health programmes in The Philippines and countries of Latin America. The linkage of many of these enabling initiatives to social transformation movements helps explain why the concepts underlying PHC have been praised as well as criticized for being 'revolutionary'. (excerpt)
Sexual Health Exchange. 2003; (1): p..At the end of 2OO1, an estimated 40 million adults and children were living with HIV/AIDS worldwide, of whom 8.6 million in the Asia-Pacific region - more than any other region besides sub-Saharan Africa. Sixty percent of Asia-Pacific HIV infections were in India alone, translating into almost 4 million people living with HIV/AIDS (PLWHA), the second largest number after South Africa. Although India's adult HIV-prevalence rate is low at about 0.8%, this converts into staggering numbers due to India's enormous population. HIV is spreading among highly vulnerable groups such as sex workers and truck drivers, and beyond, among the general population. (author's)