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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)
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1993; (829):i-v, 1-74.A study group was convened at World Health Organization (WHO) headquarters over December 10-17, 1991, to evaluate recent changes in the financing of health services. Specifically, they were to review, compare, and analyze the principal types of change in health financing which countries have implemented over the past decade; review evidence on the effects of these changes on the provision and utilization of health services including health status where possible; make conclusions on the contribution of different methods of financing to the functioning of health systems based on primary health care; and recommend strategies and actions which countries and WHO could use to improve the performance of health systems by changes in financing, and to support the prospective and retrospective appraisal of financing options. To that end, the group looked at changes in the mix of sources of finance for the health sector; changes in the methods of paying care providers; changes in the relative roles of government, care providers, purchasers, and consumers in organizing and delivering health services; consequences of these changes; and approaches to evaluating financing changes. The group found common trends toward liberalization, increased use of nongovernment financing sources, and greater emphasis upon market mechanisms and incentives to help structure health sector operations. While these trends may be evident, however, the exact form of changes in health care financing has varied according to the structure of the existing health system and the political viability of change in the system in different countries; reforms may complement each other or have negative effects upon one another. Policy objectives must be carefully defined before making broad decisions about changes in financing. Further, as the interactions between market-driven systems and government policy and practice are considered, one must not lose sight of the government's role in policymaking, regulation, information gathering, and dissemination. Governments also finance vector control, water supply, and the control of infectious diseases. Recommendations are made to countries, WHO, and other international agencies concerned with health.
The International Dialogue on Micronutrient Malnutrition: Forum on Food Fortification, 6-8 December, 1995, Ottawa, Canada.
Arlington, Virginia, Partnership for Child Health Care, 1995.  p. (Trip Report; BASICS Technical Directive: 000 HT 56 011; USAID Contract No. HRN-6006-C-00-3031-00)The International Dialogue on Micronutrient Malnutrition: Forum on Food Fortification, convened in Ottawa, Canada, in 1995, promoted partnership between the private and public sectors aimed at eliminating global malnutrition through strategies such as food fortification and supplementation. Participants agreed on the goal of eliminating micronutrient malnutrition by the year 2000, with an emphasis on iodine, iron, and vitamin A deficiencies. Achievement of this goal will entail, for each country, a needs assessment and discussion of the role of micronutrient fortification, establishment of a hierarchy of foods to reach the maximum population at risk, and dialogue to provide a link for technology and information exchange. The public sector will assist in the development of standards, provide incentives, and contact industry, while the private sector will provide scientific research and development, conduct market research, develop appropriate products, and disseminate and market the products; the role of international organizations will be to provide financial support and serve as liaison between the public and private sectors.
In: Women in the age of economic transformation. Gender impact of reforms in post-socialist and developing countries, [edited by] Nahid Aslanbeigui, Steven Pressman and Gale Summerfield. London, England, Routledge, 1994. 77-94.The author presents evidence that the World Bank's privatization of health care delivery has failed to improve the quality or quantity of health services in sub-Saharan Africa. Health care service has instead deteriorated and become more scarce. Since women have greater health care needs, especially during and after pregnancy, they have suffered the most from the attempt to limit the public provision of health care. Women's ability to influence health sector reforms is, however, hampered by their lack of political power, the weakened state, and the new role of the Bretton Woods organizations in setting national policies at the international level. Women are excluded from all decision-making jobs at the four highest levels of government in 21 African countries. Although African women join organizations in large numbers, they have only minimal impact upon state policies. There is no suggestion in the literature that women have succeeded in influencing the provision of social services by the private sector. Women's best hope in influencing international policy to make them become more responsive to women's needs is to make their voices heard in large international forums such as the Fourth World Conference on Women to be held in Beijing in September 1995.
BMJ. British Medical Journal. 1993 Sep 18; 307(6906):729-30.The former Minister of Health responds to an earlier, inaccurate article about the dispute between some emergency ward physicians and the public sector in Chile. Even though the economy appears to be healthy, 38% of the population are poor. Chile has had a longterm social policy addressing socioeconomic problems in health and in education, resulting in impressive health indicators (e.g., in 1990, 97% immunization rate for children under 5 years of age. The Pinochet regime whittled away at the strong national health service, however, including a large reduction in staff in the mid-1970s and a 40% reduction in expenditures (and a response to the economy adjustment crisis). These actions became time bombs which exploded in May 1990, 2 months after the inauguration of the 1st democratically chosen president in years. The health unions and, later, physicians asked for higher wages. In late 1992, the government increased salaries by 35% in real terms and 100% in nominal terms. Between 1990 and 1993, 6000 people, which included 1200 physicians for rural areas, were added to the public sector staff. The government increased investment in equipment (around 10,000 pieces of equipment, including 10 CAT scans) and in infrastructure by 240%. 190 public hospitals are undergoing repair and renovation. 2 small hospitals have opened. 4 large regional hospitals are scheduled for completion in 1993 and 1994. During the 3 years of democracy, the public sector budget increased 50% in real terms. The World Bank has provided assistance for a health sector reform project to meet the challenges that accompany the demographic and epidemiologic transition, transitions from a planned to a market economy and from dictatorship to democracy, a cultural transition, and behavioral changes. Politicians and physicians do not necessarily support reforms, however, sometimes resulting in changes in ministers, such as the author of this article.
Washington, D.C., World Bank, Population, Health and Nutrition Dept., 1986 Dec 31. 124 p.In the current environment of general budget stringency in developing countries, it is unrealistic to push for more public spending for health services. The answer to this health crisis is to relieve government of much of the responsibility for financing those kinds of health services for which the benefits to society as a whole (as opposed to direct benefits to the users of the service) are low, freeing public resources to finance those services for which benefits are high. The intent is to relieve government of the burden of spending on health care for the rich, freeing public resources for more spending for the poor. Individuals with sufficient income should pay for their curative care. The financing and provision of these "private" health services should be shifted to a combination of the nongovernment sector and a public sector reorganized to be more financially self-sufficient. A shift such as this would increase the public resources available for those types of health services which are "public goods" and currently are underfunded "public" health programs, such as immunization, vector control, some prenatal and maternal care, sanitary waste disposal, and health education. Also such a shift would increase the public resources available for simple curative care and referral for the poor who now only have limited access to low quality services of this nature. Government efforts to cover the full costs of health care for everyone from general public revenues have contributed to 3 sets of problems in the health systems of many countries: an allocation problem -- insufficient spending on cost-effective health activities; an internal efficiency problem -- inefficient public programs; and an equity problem -- inequitable distribution of benefits from health services. 4 policies for health financing are proposed to raise revenues for important health programs, increase the efficiency of public health services, and make the system better serve the poor. These are: charging users of public health facilities; providing insurance or other risk coverage; strengthening nongovernmental health activities; and decentralizing government health services. A table summarizes the effects of each of the 4 options for reform in alleviating health sector problems.
New York, N.Y., United Nations Fund for Population Activities [UNFPA]  54 p. (Population Profiles No. 20)This review traces how various population programs in Africa have evolved since the 1960s. Before the establishment of the United Nations Fund for Population Activities (UNFPA) in the late 1960s, the efforts of private groups or non-governmental organizations in the areas of family planning, are highlighted. The vital contribution of private donors in facilitating the work of the Fund in Africa is given emphasis throughout the review. Early studies show that family planning activities in Africa, and governmental population policies fall into a definite pattern within the continent and that the distribution of colonial empires was a major determinant of that pattern. In most of Africa, the 1st stirrups of the family planning movement began during the colonial period. During the 1960s there was marked increase in the demand for family planning services. Lack of official government recognition and not enough assistancy from external sources made early family planning programs generally weak. The shortage of trained personnel, the unsureness of government support, opposition from the Roman Catholic Church to population control, and the logistics of supplying folk in remote rural areas who held traditional attitudes, all posed serious problems. The main sectors of the Fund's activities are brought into focus to illustrate the expansion of population-related programs and their relevance to economic and social development in Africa. The Fund's major sectors of activity in the African region include basic data collection on population dynamics and the formulation and implementation of policies and programs. Family planning, education and communication and other special programs are also important efforts within the Fund's multicector approach. The general principles applied by UNFPA in the allocation of its resources and the sources and levels of current finding are briefly discussed and the Fund's evaluation methodology is outlined. A number of significant goals have been achieved in the African region during the past 15 years through UNFPA programs, most prominently; population censuses, data collection and analysis, demographic training and reseaqrch, and policy formulation after identification of need. This monograph seeks to provide evidence for the compelling need for sustained commitment to population programs in Africa, and for continuing international support and assistance to meet the unmet needs of a continent whose demographic dynamism is incomparably greater than that of any other part of the world.