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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)
Repositioning family planning: Guidelines for advocacy action. Le repositionnement de la planification familiale: Directives pour actions de plaidoyer.
Washington, D.C., Academy for Educational Development [AED], 2008. 64 p.Countries throughout Africa are engaged in an important initiative to reposition family planning as a priority on their national and local agendas. Provision of family planning services in Africa is hindered by poverty, poor access to services and commodities, conflicts, poor coordination of the programmes, and dwindling donor funding. Although family planning enhances efforts to improve health and accelerate development, shifting international priorities, health sector reform, the HIV/AIDS crisis, and other factors have affected its importance in recent years. Traditional beliefs favouring high fertility, religious barriers, and lack of male involvement have weakened family planning interventions. The combination of these factors has led to low contraceptive use, high fertility rates in many countries, and high unmet needs for family planning throughout the region. Family planning advocates must take action to change this situation. Family planning, considered an essential component of primary health care and reproductive health, plays a major role in reducing maternal and newborn morbidity and mortality and transmission of HIV. It contributes to the achievement of the Millennium Development Goals and the targets of the Health-for-All Policy for the 21st century in the Africa Region: Agenda 2020. In recognition of its importance, the World Health Organisation Regional Office for Africa developed a framework (2005-014) for accelerated action to reposition family planning on national agendas and in reproductive health services, which was adopted by African ministers of health in 2004. The framework calls for increase in efforts to advocate for recognition of "the pivotal role of family planning" in achieving health and development objectives at all levels. This toolkit aims to help those working in family planning across Africa to effectively advocate for renewed emphasis on family planning to enhance the visibility, availability, and quality of family planning services for increased contraceptive use and healthy timing and spacing of births, and ultimately, improved quality of life across the region. It was developed in response to requests from several countries to assist them in accelerating their family planning advocacy efforts.
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)
In: The global family planning revolution: three decades of population policies and programs, edited by Warren C. Robinson and John A. Ross. Washington, D.C., World Bank, 2007. 155-174.In Jamaica, as in many countries, the pioneers of family planning were men and women who sought to improve the well-being of their impoverished women compatriots, and who perhaps were also conscious of the social threats of rapid population growth. When, eventually, population control became national policy, the relationship between the initial private programs and the national effort did not always evolve smoothly, as the Jamaican experience shows (see box 10.1 for a timeline of the main events in relation to family planning in Jamaica). A related question was whether the family planning program should be a vertical one, that is, with a staff directed toward a sole objective, or whether it should be integrated within the public health service. These issues were not unique to Jamaica, but in one respect Jamaica was distinctive: it was the setting for the World Bank's first loan for family planning activities. Family planning programs entailed public expenditures that were quite different from the infrastructure investments for which almost all Bank loans had been made, and the design and appraisal of a loan for family planning that did not violate the principles that governed Bank lending at the time required a series of decisions at the highest levels of the Bank. These decisions shaped World Bank population lending for several years and subjected the Bank to a good deal of external criticism. For that reason, this chapter focuses on the process of making this loan. (excerpt)
AIDS is not a business: A study in global corporate responsibility -- securing access to low-cost HIV medications.
Journal of Business Ethics. 2007 Jun; 73(1):65-75.At the end of the 1990s, Brazil was faced with a potentially explosive HIV/AIDS epidemic. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceutical companies, the government of Brazil was able to negotiate price reductions for HIV medications and develop local production capacity, thereby averting a public health disaster. Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dynamic negotiation and an interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better. (author's)
Public-private mix for TB care and control. Focus on Africa. Report of the fourth meeting of the Subgroup on Public-Private Mix for TB Care and Control, 12-14 September 2006, Nairobi, Kenya.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2007. 27 p. (WHO/HTM/TB/2007.378)The Subgroup on Public-Private Mix for DOTS Expansion (PPM Subgroup) was established by the global Stop TB Partnership's DOTS Expansion Working Group (DEWG) to help promote and facilitate active engagement of all relevant public and private health care providers in TB control. The members of the Subgroup include representatives from the private sector, academia, country TB programme managers, policy-makers, field experts working on the issue, international technical partners and donor agencies. At the first meeting of the Subgroup in November 2002, generic regional and national Public-Private Mix (PPM) strategies were developed and endorsed. The Subgroup's second meeting, which was held at the WHO Regional Office for South-East Asia in New Delhi in February 2004, reviewed the growing evidence base emerging from numerous PPM initiatives. This meeting also broadened the scope of PPM to include the involvement of public sector providers not yet linked to national tuberculosis programmes (NTPs). Consequently, PPM has since stood for the engagement of all public and private health care providers through public-private, public-public and private-private collaboration in TB control. The third meeting of the Subgroup, held in Manila in April 2005, identified barriers and enablers for scaling up and sustaining PPM, and discussed how to mainstream PPM into regular TB control planning and implementation. The Subgroup's current fourth meeting in Nairobi, Kenya, in September 2006 had PPM for TB control in Africa as the main focus. The problems related to the HIV epidemic, human resources for health and health sector reforms pose special challenges to countries in Africa. The meeting examined how successful PPM approaches within Africa could be scaled up and how approaches applied in other regions could be adapted to African settings. Based on a global overview, the African experience in diverse country settings and field visits to examine working PPM models and after a great deal of deliberations and discussions, the Subgroup made recommendations which are presented in Section 6 of the report. A large part of the funding for the meeting was provided by USAID's Tuberculosis Control Assistance Program (TB CAP). (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)
Bulletin of the World Health Organization. 2006 Jun; 84(6):428.Tuberculosis care, a clinical function consisting of diagnosis and treatment of persons with the disease, is the core of tuberculosis control, which is a public health function comprising preventive interventions, monitoring and surveillance, as well as incorporating diagnosis and treatment. Thus, for tuberculosis control to be successful in protecting the health of the public, tuberculosis care must be effective in preserving the health of individuals. There are three broad mechanisms through which tuberculosis care is delivered: public sector tuberculosis control programmes, private sector practitioners having formal links to public sector programmes (the public--private mix), and private providers having no connection with formal activities. In most countries, programmes in both the public sector and the public--private mix are guided by international and national recommendations based on the DOTS tuberculosis control strategy -- a systematic approach to diagnosis, standardized treatment regimens, regular review of outcomes, assessment of effectiveness and modification of approaches when problems are identified. (excerpt)
New York, New York, UNDP, Bureau for Development Policy, HIV / AIDS Group, . 8 p.Twenty years on, the HIV/AIDS epidemic continues to spread without respite. Almost 40 million people are living with HIV and AIDS, half of them women. The impact of HIV/AIDS is unique because it kills adults in the most productive period of their lives, depriving families, communities, and nations of their most productive people. Adding to an already heavy disease burden in poor countries, the epidemic is deepening poverty, reversing human development, worsening gender inequalities, eroding the capacity of governments to provide essential services, reducing labour productivity, and hampering pro-poor growth. The epidemic is quickly becoming the biggest obstacle to achieving the Millennium Development Goals. (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)
Bulletin of the World Health Organization. 2006 May; 84(5):337-424.Developing countries are failing to make full use of flexibilities built into the World Trade Organization's (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to overcome patent barriers and, in turn, allow them to acquire the medicines they need for high priority diseases, in particular, HIV/AIDS. First-line antiretroviral (ARV) drugs for HIV/AIDS have become more affordable and available in recent years, but for patients facing drug resistance and side-effects, second-line ARV drugs and other newer formulations are likely to remain prohibitively expensive and inaccessible in many countries. The problem is that many of these countries are not using all the tools at their disposal to overcome these barriers. Medicines protected by patents tend to be expensive, as pharmaceutical companies try to recoup their research and development (R&D) costs. When there is generic competition prices can be driven down dramatically. The TRIPS Agreement came into effect on 1 January 1995 setting out minimum standards for the protection of intellectual property, including patents on pharmaceuticals. Under that agreement, since 2005 new drugs may be subject to at least 20 years of patent protection in all, apart from in the least-developed countries and a few non-WTO Members, such as Somalia. Successful AIDS programmes, such as those in Brazil and Thailand, have only been possible because key pharmaceuticals were not patent protected and could be produced locally at much lower cost. For example, when the Brazilian Government began producing generic AIDS drugs in 2000, prices dropped. AIDS triple-combination therapy, which costs US$ 10 000 per patient per year in industrialized countries, can now be obtained from Indian generic drugs company, Cipla, for less than US$ 200 per year. This puts ARV treatment within reach of many more people. (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)
Structural adjustment in sub-Saharan Africa. Report on a series of five senior policy seminars held in Africa, 1987-88.
Washington, D.C., World Bank, 1989.  p. (EDI Policy Seminar Report No. 18)In June 1986, the National Economic Management Division of the World Bank's Economic Development Institute (EDI) designed a series of senior policy seminars on structural adjustment for Sub-Saharan Africa. The exercise led to three seminars in 1987: Lusaka I, Lusaka 11, and Abidjan I, and, after redesign, two more in 1988: Victoria Falls and Abidjan 11. Seminar participants were invited in teams typically composed of ministers, governors, permanent secretaries, senior advisors, and a significant number of senior technical staff of central banks, the core ministries of finance and planning, and spending ministries such as agriculture and industry. Twenty seven countries participated in the seminars. Of these, six participated in two separate seminars (see annex A). This report is a synthesized record of the five seminars and is likely to be of interest to all those interested in the reform process in Sub-Saharan Africa, namely, the seminar participants, other similarly placed policymakers, advisors to these policymakers, executives of the public and private sectors, staff of academic institutions, and the staff of international organizations such as the World Bank (the Bank) and the International Monetary Fund (the Fund) involved in studying the political economy of structural adjustment. (excerpt)
BMJ. British Medical Journal. 2005 Nov 12; 331(7525):1104.By 2010, poor developing countries will continue to suffer from a shortfall in supplies of low cost antiretroviral drugs (ARVs) for patients with HIV/AIDS unless rational measures are taken quickly, a top World Health Organization official has warned. “We’re going to reach a crisis in terms of supply very very soon . . . of [antiretrovirals] throughout the developing world because the scale-up is happening very very quickly,” Dr Jim Yong Kim, WHO’s outgoing director for HIV/AIDS, told the BMJ. The issue now for the public health world, he said, in the aftermath of the recent summit of the G8 (the world’s most industrialised countries) in Scotland, was that a potential eight to 10 million people will need treatment. In July, the leaders of the G8 agreed at the Gleneagles summit “to provide as close as possible to universal treatment for AIDS by 2010.” (excerpt)
Habitat Debate. 2000; 6(3): p..Large-scale corruption in developed and developing countries is closely connected to contracting-out, concessions, and privatization. The encouragement of privatization of public services and infrastructure by the World Bank and others has multiplied the potential scale of this business. At the same time it has multiplied the incentives for multinational companies active in these sectors to offer bribes in order to secure concessions and contracts. One of the sectors most at risk is water and sanitation. The concessions invariably involve long-term monopoly supply of an essential service, with considerable potential profit. Often, major construction works are involved, which are themselves a source of profit. (excerpt)
Africa Recovery. 2003 Dec;  p..On 28 November the British Broadcasting Corporation (BBC) posted an online audio interview with UN Secretary-General Kofi Annan about the struggle against HIV/AIDS. The transcript of this important broadcast appears below in its entirety. It has been edited slightly for clarity. The Secretary-General was speaking to Ms. Carrie Gracie on "The Interview" programme for BBC World Service radio. It is reproduced with the permission of the BBC. BBC: Over the past two weeks the BBC World Service has been running an AIDS season and we've heard many aspects of the illness. But today we want to get a sense of your personal contribution and whether you think that you're winning the battle. So I want to start by asking you about the enemy. When did you first realize what a serious enemy you were up against with AIDS? Annan: I think it was when I discussed the issue with the World Health Organization [WHO] and UNAIDS [the Joint UN Programme on HIV/AIDS] and looked at the figures and the statistics and the devastation it was causing in many African countries, and at the attitude of the leaders. We needed leadership. We needed leadership at all levels. But it was most important to get the presidents and the prime ministers speaking up and that was not happening. I thought we should do whatever we can to raise awareness and to get them involved. (excerpt)
Washington, D.C., Futures Group, Options for Population Policy, 1993 Feb. , 24 p. (Policy Paper Series No. 2)While in 1960, 9% of 415 million married women of reproductive age in less developed countries were using some form of fertility control, by 1990, the proportion had increased to 51% of 716 million women. Contraceptive use has expanded most in East and Southeast Asia and in Latin America. There has been also progress in South Asia, the Middle East, and North Africa. China accounts for over 40% of current users in the developing world. An approach to strategic planning at the sector level is outlined. OPTIONS for Population Policy II is a 5-year project funded by the Office of Population of the USAID. The goal of the project is to help USAID-assisted countries formulate and implement policies that address the need to mobilize and effectively allocate resources for expanding family planning (FP) services. The titles of the working papers published as part of an ongoing Policy Paper Series focusing on various aspects of operational policy in FP include: 1) Assessing Legal and Regulatory Reform in FP; 2) Strategic Planning for the Expansion of FP; 3) Policy Issues in Expanding Private Sector FP; 4) Communicating Population and FP Information: Targeting Policy Makers; and 5) Cost Recovery and User Fees in FP. Sector-level strategic planning is a 5-step process: 1) assessment of the current situation in the population/FP sector and examination of future prospects in the sector; 2) identification of the alternative program approaches that could be employed to achieve stated goals and objectives; 3) review and ranking of these programs for the selection of the one which best suits the needs and conditions of the country; 4) commitment by the decision makers to an action plan to implement the chosen program expansion strategy; and 5) agreement on arrangements for monitoring and periodic evaluations of programs.