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Mori AT. Mandatory health insurance for the informal sector in Tanzania-has it worked anywhere! FRONTIERS IN HEALTH SERVICES 2023; 3:1247301. [PMID: 37849823 PMCID: PMC10577424 DOI: 10.3389/frhs.2023.1247301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
Many countries in sub-Saharan Africa are struggling to expand voluntary health insurance schemes to raise finances toward achieving universal health coverage. With more than three-quarters of the population without any insurance, the government of Tanzania has unsuccessfully tried to pass a Bill proposing a mandatory, nationwide scheme to cover the large and diverse informal sector. The Bill proposed an annual premium of ∼150 USD for a household of six or 65 USD per person. Studies in Tanzania and Kenya have shown that the majority of people in the informal sector are unwilling and unable to pay premiums as low as 4 USD, mostly due to poverty. Mandatory health insurance for the informal sector is not common in this region, mostly because it is difficult to enforce. Successful insurance schemes have included significant subsidies from tax revenues. Tanzania should not seek to raise funds for health through an unenforceable insurance scheme but rather should consider a largely tax-funded scheme for the informal sector. Contributions through low-cost voluntary schemes can enhance social contracts, reduce out-of-pocket expenditure, and promote efficient utilization. In addition, progressive health taxes should be imposed on harmful products (tobacco, alcohol, sugary drinks, etc.) to raise more funds while addressing the increasing burden of non-communicable diseases. Furthermore, efficiency in the use of scarce health resources should be promoted through realistic prioritization of public services, the use of Health Technology Assessment, and strategic purchasing.
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Affiliation(s)
- Amani Thomas Mori
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- National Institute of Medical Research, Muhimbili Research Center, Dar es Salaam, Tanzania
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Costantine JK, Bwire GM, Myemba DT, Sambayi G, Njiro BJ, Kilipamwambu A, Ching’oro N, Shungu RS, Mganga M, Majigo MV. WHO/INRUD prescribing indicators among tertiary regional referral hospitals in Dar es Salaam, Tanzania: a call to strengthen antibiotic stewardship programmes. JAC Antimicrob Resist 2023; 5:dlad093. [PMID: 37546545 PMCID: PMC10400121 DOI: 10.1093/jacamr/dlad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
Background Antibiotic prescribing should be guided by national essential medicines lists (NEMLs) and treatment guidelines; however, there are inadequate data on antibiotic utilization patterns in tertiary hospitals in Tanzania. This study aimed to determine antibiotic prescribing patterns in tertiary hospitals in Dar es Salaam, Tanzania. Methods A retrospective cross-sectional study was conducted in three regional referral hospitals. About 200 prescription records from 2020 to 2022 were analysed at each hospital for prescribing patterns using WHO/ International Network of Rational Use of Drugs (INRUD) indicators (1993) and the AWaRe 2021 classification. Factors associated with receiving an antibiotic prescription were assessed using a logistic regression model. Facilities were ranked on prescribing practices using the index of rational drug prescribing (IRDP). Results A total of 2239 drugs were prescribed, of which 920 (41.1%) were antibiotics. An average of 3.7 ± 1.5 (optimal: 1.6-1.8) total medicines and 1.53 ± 0.78 antibiotics were prescribed per patient. About 88.0% (528) of the prescriptions contained antibiotics (optimal: 20.0%-26.8%), while 78.2% (413) of all antibiotic prescriptions contained injections (optimal: 13.4%-24.1%). Furthermore, 87.5% (462) of the antibiotics were prescribed in generic names (optimal: 100%), while 98.7% (521) conformed to the NEML (optimal: 100%). Metronidazole was the most frequently prescribed antibiotic (39.2%; n = 134), followed by ceftriaxone (37.1%, n = 127) and amoxicillin/clavulanic acid (8.5%, n = 29). Conclusions We found substantial empirical prescribing and overuse of antibiotics exceeding WHO recommendations. Antibiotic overuse varied across the hospitals. Being male, having underlying conditions such as diabetes mellitus, and/or being treated at Temeke hospital were associated with receiving an antibiotic prescription. We recommend strengthening antibiotic stewardship programmes in the studied facilities.
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Affiliation(s)
- Judith K Costantine
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - George M Bwire
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | | | - Godfrey Sambayi
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Amosi Kilipamwambu
- Department of Pediatrics, School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Novatus Ching’oro
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Rehema S Shungu
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Mathew Mganga
- Department of Health, Social Welfare, and Nutrition, President’s Office, Regional Administration and Local Government, PO Box 1923, Dodoma, Tanzania
| | - Mtebe V Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
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Nyanchoka M, Mulaku M, Nyagol B, Owino EJ, Kariuki S, Ochodo E. Implementing essential diagnostics-learning from essential medicines: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000827. [PMID: 36962808 PMCID: PMC10121180 DOI: 10.1371/journal.pgph.0000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on implementing the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. We searched eight electronic databases for studies reporting on implementing the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesised findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies. We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n = 129) studies were purely quantitative in design, comprising descriptive cross-sectional designs (60%, n = 104), 15% (n = 26) were purely qualitative, and 10% (n = 17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about EDL. The main barrier facing the EML and EDL was poorly equipped health facilities-including unavailability or stock-outs of essential in vitro diagnostics and medicines. Financial and non-financial incentives to health facilities and workers were key enablers in implementing the EML; however, their impact differed from one context to another. Only fifty-six (33%) of the included studies were of high quality. Poorly equipped and stocked health facilities remain an implementation barrier to essential diagnostics and medicines. Health system interventions such as financial and non-financial incentives to improve their availability can be applied in different contexts. More implementation study designs, such as experimental and qualitative studies, are required to evaluate the effectiveness of essential lists.
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Affiliation(s)
- Moriasi Nyanchoka
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mercy Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Pharmacology, Clinical Pharmacy, and Pharmacy Practice, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bruce Nyagol
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Ramponi F, Twea P, Chilima B, Nkhoma D, Kazanga Chiumia I, Manthalu G, Mfutso-Bengo J, Revill P, Drummond M, Sculpher M. Assessing the potential of HTA to inform resource allocation decisions in low-income settings: The case of Malawi. Front Public Health 2022; 10:1010702. [PMID: 36388387 PMCID: PMC9650047 DOI: 10.3389/fpubh.2022.1010702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023] Open
Abstract
Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly limited to assessments of efficacy and cost-effectiveness. However, the principles of HTA can be used to support a broader series of decisions regarding new health technologies. We examine the potential for this broad use of HTA in LICs, with a focus on Malawi. We develop a framework to classify the main decisions on health technologies within health systems. The framework covers decisions on identifying and prioritizing technologies for detailed assessment, deciding whether to adopt an intervention, assessing alternative investments for implementation and scale-up, and undertaking further research activities. We consider the relevance of the framework to policymakers in Malawi and we use two health technologies as examples to investigate the main barriers and enablers to the use of HTA methods. Although the scarcity of local data, expertise, and other resources could risk limiting the operationalisation of HTA in LICs, we argue that even in highly resource constrained health systems, such as in Malawi, the use of HTA to support a broad range of decisions is feasible and desirable.
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Affiliation(s)
- Francesco Ramponi
- Centre for Health Economics, University of York, Heslington, United Kingdom
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health Malawi, Lilongwe, Malawi
| | - Benson Chilima
- Public Health Institute, Ministry of Health Malawi, Lilongwe, Malawi
| | - Dominic Nkhoma
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Isabel Kazanga Chiumia
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health Malawi, Lilongwe, Malawi
| | - Joseph Mfutso-Bengo
- Health Economics and Policy Unit (HEPU), College of Medicine, University of Malawi, Zomba, Malawi
| | - Paul Revill
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Michael Drummond
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, Heslington, United Kingdom
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Bidonde J, Meneses-Echavez JF, Asare B, Chola L, Gad M, Heupink LF, Peacocke EF. Developing a tool to assess the skills to perform a health technology assessment. BMC Med Res Methodol 2022; 22:78. [PMID: 35313812 PMCID: PMC8939100 DOI: 10.1186/s12874-022-01562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background Health technology assessment (HTA) brings together evidence from various disciplines while using explicit methods to assess the value of health technologies. In resource-constrained settings, there is a growing demand to measure and develop specialist skills, including those for HTA, to aid the implementation of Universal Healthcare Coverage. The purpose of this study was twofold: a) to find validated tools for the assessment of the technical capacity to conduct a HTA, and if none were found, to develop a tool, and b) to describe experiences of its pilot. Methods First, a mapping review identified tools to assess the skills to conduct a HTA. A medical librarian conducted a comprehensive search in four databases (MEDLINE, Embase, Web of Science, ERIC). Then, incorporating results from the mapping and following an iterative process involving stakeholders and experts, we developed a HTA skills assessment tool. Finally, using an online platform to gather and analyse responses, in collaboration with our institutional partner, we piloted the tool in Ghana, and sought feedback on their experiences. Results The database search yielded 3871 records; fifteen those were selected based on a priori criteria. These records were published between 2003 and 2018, but none covered all technical skills to conduct a HTA. In the absence of an instrument meeting our needs, we developed a HTA skill assessment tool containing four sections (general information, core and soft skills, and future needs). The tool was designed to be administered to a broad range of individuals who would potentially contribute to the planning, delivery and evaluation of HTA. The tool was piloted with twenty-three individuals who completed the skills assessment and shared their initial impressions of the tool. Conclusions To our knowledge, this is the first comprehensive tool enabling the assessment of technical skills to conduct a HTA. This tool allows teams to understand where their individual strengths and weakness lie. The tool is in the early validation phases and further testing is needed. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01562-4.
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Affiliation(s)
- Julia Bidonde
- Norwegian Institute of Public Health, P.O. Box: 222 Skøyen, 0213, Oslo, Norway. .,School of Rehabilitation Sciences, College of Medicine, University of Saskatchewan, Suite 3400, 3rd Floor, 104 Clinic Pl, Saskatoon, SK, S7N 2Z4, Canada.
| | - Jose Francisco Meneses-Echavez
- Norwegian Institute of Public Health, P.O. Box: 222 Skøyen, 0213, Oslo, Norway.,Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia
| | - Brian Asare
- Ghana Ministry of Health, Ministries Accra, P.O.Box M 44, Accra, Ghana
| | - Lumbwe Chola
- Norwegian Institute of Public Health, P.O. Box: 222 Skøyen, 0213, Oslo, Norway
| | - Mohamed Gad
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Lieke Fleur Heupink
- Norwegian Institute of Public Health, P.O. Box: 222 Skøyen, 0213, Oslo, Norway
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Peacocke EF, Myhre SL, Foss HS, Gopinathan U. National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis. PLoS Med 2022; 19:e1003944. [PMID: 35275938 PMCID: PMC8956172 DOI: 10.1371/journal.pmed.1003944] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/25/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. METHODS AND FINDINGS We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Supporting the Use of Research Evidence (SURE) framework, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. CONCLUSIONS This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. PROTOCOL REGISTRY PROSPERO CRD42018104112.
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Affiliation(s)
- Elizabeth F. Peacocke
- Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Sonja L. Myhre
- Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Unni Gopinathan
- Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Hollingworth S, Fenny AP, Yu SY, Ruiz F, Chalkidou K. Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:39. [PMID: 34233710 PMCID: PMC8261797 DOI: 10.1186/s12962-021-00293-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00293-5.
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Affiliation(s)
- Samantha Hollingworth
- School of Pharmacy, University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia. .,Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economics Research, University of Ghana, Accra, Ghana
| | - Su-Yeon Yu
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Francis Ruiz
- iDSI, London School of Hygiene and Tropical Medicine, London, UK
| | - Kalipso Chalkidou
- The Global Fund To Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
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Odoch WD, Dambisya Y, Peacocke E, Sandberg KI, Hembre BSH. The role of government agencies and other actors in influencing access to medicines in three East African countries. Health Policy Plan 2021; 36:312-321. [PMID: 33569583 PMCID: PMC8101087 DOI: 10.1093/heapol/czaa189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/31/2022] Open
Abstract
The WHO Model List of Essential Medicines (MLEM) has since 1977 helped prioritize and ensure availability of medicines especially in low- and middle-income countries. The MLEM consists mainly of generic medicines, though recent trends point towards listing expensive on-patent medicines and increasing global support for medicines against non-communicable diseases. However, the implications of such changes for national essential medicines list (NEML) updates for access to essential medicines has received relatively little attention. This study examined how government agencies and other actors in Kenya, Uganda and Tanzania participate in and influence the NEML update process and subsequent availability of prioritized medicines; and the alignment of these processes to WHO guidance. A mixed study design was used, with qualitative documentary review, key informant interviews and thematic data analysis. Results show that NEML updating processes were similar amongst the three countries and aligned to WHO guidelines, albeit conducted irregularly, with tendency to reprioritization during procurement stages, and were not always accompanied by revision of clinical guidelines. Variations were noted in the inclusion of medicines against cancer and hepatitis C, and the utilization of health technology assessment (HTA). For medicines against diseases with high global engagement, such as HIV/AIDS and TB, national stakeholders had more limited inputs in prioritization and funding. Furthermore, national actors were not influenced by the pharmaceutical industry during the NEML update process, nor were any conflicting agendas identified between health, trade and industrial policies. Hence, the study suggests that more attention should be paid to the combination of HTAs and NEMLs, particularly as countries work towards universal health coverage, in addition to heightened awareness of how global disease-specific initiatives may confound national implementation of the NEML. The study concludes with a call to strengthen country-level policy and procedural coherence around the process of prioritizing and ensuring availability of essential medicines.
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Affiliation(s)
- Walter Denis Odoch
- East Central and Southern Africa Health Community, Plot 157, Oloirien, Njiro, PO Box 1009, Arusha, Tanzania
- African Centre for Health Systems Development, Plot 2703, Block 208, Bombo Rd, Kampala, Uganda
| | - Yoswa Dambisya
- East Central and Southern Africa Health Community, Plot 157, Oloirien, Njiro, PO Box 1009, Arusha, Tanzania
| | | | | | - Berit Sofie Hustad Hembre
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
- Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo Norway
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Koduah A, Asare BA, Gavor E, Gyansa-Lutterodt M, Andrews Annan E, Ofei FW. Use of evidence and negotiation in the review of national standard treatment guidelines and essential medicines list: experience from Ghana. Health Policy Plan 2020; 34:ii104-ii120. [PMID: 31723963 DOI: 10.1093/heapol/czz107] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
Understanding how countries review their national standard treatment guidelines (STGs) and essential medicines list (EML) is important in the light of ever-changing trends in public health and evidence supporting the selection and use of medicines in disease management. This study examines the 2017 STGs and EML review process, the actors involved and how the list of medicines and disease conditions evolved between the last two editions. We examined expert committee reports, stakeholder engagement reports and the last two editions (2010, 2017) STGs and EML. The review process occurred in both bureaucratic and public arenas where various actors with varied power and interest engaged in ways to consolidate their influence with the use of evidence from research and practice. In the bureaucratic arena, a national medicines selection committee inaugurated by the Minister of Health assessed the 2010 edition through technical sessions considering the country's disease burden, hierarchical healthcare structure and evidence on safety and efficacy and expert opinion. To build consensus and ensure credibility service providers, professional bodies and healthcare managers scrutinized the assessed guidelines and medicines list in public arenas. In such public arenas, technical discussions moved towards negotiations with emphasis on practicability of the policies. Updates in the 2017 guidelines involved the addition of 64 new disease conditions in the STG, with the EML including 153 additional medicines and excluding 56 medicines previously found in the 2010 EML. Furthermore, the level of care categorization for Level 'A' [i.e. community-based health planning and services (CHPS)] and Level 'M' (i.e. midwifery and CHPS with a midwife) evolved to reflect the current primary healthcare and community mobilization activities for healthcare delivery in Ghana. Ghana's experience in using evidence from research and practice and engaging wide stakeholders can serve as lessons for other low and middle-income countries.
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Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Brian A Asare
- Ghana National Drugs Programme, Ministry of Health, Accra, Ghana
| | - Edith Gavor
- Ghana National Drugs Programme, Ministry of Health, Accra, Ghana
| | | | | | - Francis W Ofei
- Department of Internal Medicine and Therapeutics, School of Medical Sciences, College of Health and Allied Sciences, Private Mail Bag, University of Cape Coast, Ghana
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Steiner L, Maraj D, Woods H, Jarvis J, Yaphe H, Adekoya I, Bali A, Persaud N. A comparison of national essential medicines lists in the Americas. Rev Panam Salud Publica 2020; 44:e5. [PMID: 31998375 PMCID: PMC6984406 DOI: 10.26633/rpsp.2020.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives. To compare national essential medicines lists (NEMLs) from countries in the Region of the Americas and to identify potential opportunities for improving those lists. Methods. In June of 2017, NEMLs from 31 countries in the Americas were abstracted from documents included in a World Health Organization (WHO) repository. The lists from the Americas were compared to each other and to NEMLs from outside of the Americas, as well as with the WHO Model List of Essential Medicines, 20th edition (“WHO Model List”) and the list of the Pan American Health Organization (PAHO) Regional Revolving Fund for Strategic Public Health Supplies (“Strategic Fund”). Results. The number of differences between the NEMLs from the Americas and the WHO Model List were similar within those countries (median: 295; interquartile range (IQR): 265 to 347). The NEMLs from the Americas were generally similar to each other. While the NEMLs from the Americas coincided well with the Strategic Fund list, some medicines were not included on any of those NEMLs. All the NEMLs in the Americas included some medicines that were withdrawn due to adverse effects by a national regulatory body (median: 8 withdrawn medicines per NEML; IQR: 4 to 12). Conclusions. The NEMLs in the Americas were fairly similar to each other and to the WHO Model List and the Strategic Fund list. However, some areas of treatment and some specific medicines were identified that the countries should reassess when revising their NEMLs.
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Affiliation(s)
- Liane Steiner
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshanand Maraj
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Woods
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jordan Jarvis
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Yaphe
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Itunu Adekoya
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anjli Bali
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nav Persaud
- Department of Family and Community Medicine St. Michael's Hospital and the University of Toronto TorontoOntario Canada Department of Family and Community Medicine, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
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11
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Babar ZUD, Ramzan S, El-Dahiyat F, Tachmazidis I, Adebisi A, Hasan SS. The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries. Front Pharmacol 2019; 10:1375. [PMID: 31824316 PMCID: PMC6880243 DOI: 10.3389/fphar.2019.01375] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices, and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries. Methods: Data on affordability, availability, and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organization/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal, and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of innovator brand (IB) and lowest priced generic (LPG) of diabetes medicines by WHO regional groupings and by country level. Results: Lowest priced generic of metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure 1-month’s supply of IB of insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p = 0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of insulin 100 IU/ml and metformin 500 mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively. Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Sara Ramzan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Faris El-Dahiyat
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
| | - Ilias Tachmazidis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Adeola Adebisi
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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12
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Berner K, Strijdom H, Essop MF, Webster I, Morris L, Louw Q. Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation. Open Forum Infect Dis 2019; 6:ofz401. [PMID: 31660363 PMCID: PMC6785680 DOI: 10.1093/ofid/ofz401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background People with HIV-1 (PWH) exhibit a high fall incidence and increased fracture risk. As little is known about fall frequency and associated factors in PWH residing in lower-middle-income countries (LMIC), we investigated fall frequency, bone quality, and factors associated with fall history in a South African cohort. Methods Fifty PWH without obvious predisposing factors for mobility impairments attending 2 public primary care clinics in the Western Cape region participated. Demographic, clinical, and physical performance data were collected. Falls were assessed retrospectively over 12 months. Mobility and balance were evaluated using a physical performance battery. Bone mineral density was screened using quantitative ultrasound (QUS). Associations between variables and falls grouping were analyzed using chi-square tests, t tests, and Mann-Whitney U tests, and effect sizes (ES) were calculated. Results Thirty-four percent of PWH (median age, 36.6 years) reported falling during the past year, and 41.2% of fallers reported multiple falls. Fallers had more mobility problems (P = .013), higher fear of falling (P = .007), higher fracture history (P = .003), worse balance performance (P < .001), higher proportions of detectable viral loads (P = .021), and poorer bone quality (P = .040). Differences were of medium to large ES. Conclusions This exploratory study is the first to show that relatively young South African PWH without obvious predisposing factors for gait and balance impairments experience falls. The observed fall-associated factors warrant further research using larger samples and longitudinal designs to ascertain fall predictors within this population.
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Affiliation(s)
- Karina Berner
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Linzette Morris
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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13
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Gray NJ, Chanoine JP, Farmer MY, Jarvis JD, Armstrong K, Barr RD, Faunce TA, Lashley PM, Ndikumwenayo F, Hauerslev M, Karekezi CW, Klein JD. NCDs and the WHO Essential Medicines Lists: children need universal health coverage too. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:756-757. [PMID: 31537467 DOI: 10.1016/s2352-4642(19)30294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nicola J Gray
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Green Line Consulting Limited, North Harrow HA1 4LB, UK.
| | - Jean-Pierre Chanoine
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Endocrinology and Diabetes Unit, British Columbia Children's Hospital, Vancouver, BC, Canada; Global Pediatric Endocrinology and Diabetes, Vancouver, BC, Canada
| | - Mychelle Y Farmer
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Advancing Synergy, Baltimore, MD, USA
| | - Jordan D Jarvis
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; London School of Hygiene & Tropical Medicine, London, UK
| | - Kate Armstrong
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Caring & Living As Neighbours, Denistone, NSW, Australia
| | - Ronald D Barr
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Department of Pediatrics, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Thomas A Faunce
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Australian National University Law School and Australian National University Medical School, Australian National University, Canberra, ACT, Australia
| | - P Michele Lashley
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; University of the West Indies, St Michael, Barbados
| | - François Ndikumwenayo
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Burundi University, Bujumbura, Burundi; Burundi Non-Communicable Diseases Alliance, Bujumbura, Burundi
| | - Marie Hauerslev
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Regionshospitalet Holstebro, Holstebro, Denmark
| | - Catherine W Karekezi
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; Kenya Diabetes Management and Information Centre, Nairobi, Kenya; Non-Communicable Diseases Alliance Kenya, Nairobi, Kenya
| | - Jonathan D Klein
- NCD Child Task Force on Essential Medicines and Equipment, NCD Child, Itasca, IL, USA; International Pediatric Association Executive Committee, Marengo, IL, USA; Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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Abstract
OBJECTIVES Health technology assessment (HTA) is a cost-effective resource allocation tool in healthcare decision-making processes; however, its use is limited in low-income settings where countries fall short on both absorptive and technical capacity. This paper describes the journey of the introduction of HTA into decision-making processes through a case study revising the National Essential Medicines List (NEMLIT) in Tanzania. It draws lessons on establishing and strengthening transparent priority-setting processes, particularly in sub-Saharan Africa. METHODS The concept of HTA was introduced in Tanzania through revision of the NEMLIT by identifying a process for using HTA criteria and evidence-informed decision making. Training was given on using economic evidence for decision making, which was then put into practice for medicine selection for the NEMLIT. During the revision process, capacity-building workshops were held with reinforcing messages on HTA. RESULTS Between the period 2014 and 2018, HTA was introduced in Tanzania with a formal HTA committee being established and inaugurated followed by the successful completion and adoption of HTA into the NEMLIT revision process by the end of 2017. Consequently, the country is in the process of institutionalizing HTA for decision making and priority setting. CONCLUSION While the introduction of HTA process is country-specific, key lessons emerge that can provide an example to stakeholders in other low- and middle-income countries (LMICs) wishing to introduce priority-setting processes into health decision making.
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15
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Fadare JO, Ogunleye O, Obiako R, Orubu S, Enwere O, Ajemigbitse AA, Meyer JC, Enato E, Massele A, Godman B, Gustafsson LL. Drug and therapeutics committees in Nigeria: evaluation of scope and functionality. Expert Rev Clin Pharmacol 2018; 11:1255-1262. [PMID: 30451035 DOI: 10.1080/17512433.2018.1549488] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Inappropriate use of medicines remains a problem, with consequences including increasing adverse drug reactions (ADRs) and prolonged hospitalizations. The Essential Medicines List and Drug and Therapeutics Committees (DTCs) are accepted initiatives to promote the rational use of medicines. However, little is known about DTC activities in Nigeria, the most populous African country. Areas covered: A cross-sectional questionnaire-based study was conducted among senior pharmacists, consultant physicians, and clinical pharmacologists in 12 leading tertiary health-care facilities across Nigeria. Expert commentary: Six (50%, 6/12) health-care facilities had existing DTCs with three (50%) having a subcommittee on antimicrobials. Seventy-five percent had infection control committees, with presence even in centers without DTCs. Chairpersons and secretaries of the DTCs were predominantly physicians (83.3%) and pharmacists (100%), respectively. Hospital formularies were available in five facilities with DTCs, while one facility without a DTC had an Essential Medicines Committee responsible for developing and updating the hospital formulary. The evaluation of ADRs was undertaken by pharmacovigilance units in nine facilities. Overall, DTCs were present in only half of the surveyed facilities and most were performing their statutory functions sub-optimally. The functioning of DTCs can be improved through government directives and mechanisms for continuous evaluation of activities.
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Affiliation(s)
- Joseph O Fadare
- a Department of Pharmacology and Therapeutics, College of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | - Olayinka Ogunleye
- b Department of Pharmacology and Medicine , Lagos State University College of Medicine and the Teaching Hospital , Ikeja , Nigeria
| | - Reginald Obiako
- c Department of Medicine, Clinical Pharmacology Unit , Ahmadu Bello University , Zaria , Nigeria
| | - Samuel Orubu
- d Faculty of Pharmacy , Niger Delta University , Wilberforce Island , Bayelsa State , Nigeria
| | - Okezie Enwere
- e Department of Medicine , Imo State University , Orlu , Nigeria
| | | | - Johanna C Meyer
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Ehijie Enato
- h Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy , University of Benin , Benin City , Nigeria
| | - Amos Massele
- i Department of Clinical Pharmacology, School of Medicine , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa.,j Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden.,k Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Lars L Gustafsson
- j Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
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16
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Malla C, Aylward P, Ward P. Knowledge translation for public health in low- and middle- income countries: a critical interpretive synthesis. Glob Health Res Policy 2018; 3:29. [PMID: 30377666 PMCID: PMC6196454 DOI: 10.1186/s41256-018-0084-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Effective knowledge translation allows the optimisation of access to and utilisation of research knowledge in order to inform and enhance public health policy and practice. In low- and middle- income countries, there are substantial complexities that affect the way in which research can be utilised for public health action. This review attempts to draw out concepts in the literature that contribute to defining some of the complexities and contextual factors that influence knowledge translation for public health in low- and middle- income countries. Methods A Critical Interpretive Synthesis was undertaken, a method of analysis which allows a critical review of a wide range of heterogeneous evidence, through incorporating systematic review methods with qualitative enquiry techniques. A search for peer-reviewed articles published between 2000 and 2016 on the topic of knowledge translation for public health in low- and middle – income countries was carried out, and 85 articles were reviewed and analysed using this method. Results Four main concepts were identified: 1) tension between ‘global’ and ‘local’ health research, 2) complexities in creating and accessing evidence, 3) contextualising knowledge translation strategies for low- and middle- income countries, and 4) the unique role of non-government organisations in the knowledge translation process. Conclusion This method of review has enabled the identification of key concepts that may inform practice or further research in the field of knowledge translation in low- and middle- income countries. Electronic supplementary material The online version of this article (10.1186/s41256-018-0084-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Malla
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042 Australia
| | - Paul Aylward
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042 Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042 Australia
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17
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Li H, Wang S, Yue Z, Ren X, Xia J. Traditional Chinese herbal injection: Current status and future perspectives. Fitoterapia 2018; 129:249-256. [PMID: 30059719 DOI: 10.1016/j.fitote.2018.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/14/2018] [Accepted: 07/15/2018] [Indexed: 11/26/2022]
Abstract
Traditional Chinese herbal injection, frequently referred to as TCM injection, has evolved over 70 years as a treatment modality that parallels injections of pharmaceutical products. As the market reach has not been analyzed systematically in the past literature this article performed a descriptive analysis of various aspects of TCM injections based on the following data sources: (1) information retrieved from website of drug registration system of China, and (2) regulatory documents, annual reports and ADR Information Bulletins issued by drug regulatory authority. As of December 31, 2017, 134 generic names of TCM injections from 224 manufacturers were approved for sale. Only 5 of the 134 TCM injections are documented in the present version of Ch.P (2015). Most TCM injections are documented in drug standards other than Ch.P. The formulation, ingredients and routes of administration of TCM injections are more complex than conventional chemical injections. Ten TCM injections are covered by national lists of essential medicine and 58 are covered by China's basic insurance program (2017). ADR reports related to TCM injections accounts for >50% of all ADR reports related to TCMs and the percentages have been rising annually. Making traditional medicine injectable might be a promising way to develop traditional medicines. However, many practical challenges need to be overcome by further development before a brighter future for injectable traditional medicines can reasonably be expected.
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Affiliation(s)
- Haona Li
- Huaihe School of Clinical Medicine, Henan University, Kaifeng, Henan, China; Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Siwang Wang
- Department of Natural Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhihua Yue
- Chinese Pharmacopoeia Commission, Beijing, China
| | - Xuequn Ren
- Huaihe School of Clinical Medicine, Henan University, Kaifeng, Henan, China.
| | - Jielai Xia
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China.
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18
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Singh D, Luz ACG, Rattanavipapong W, Teerawattananon Y. Designing the Free Drugs List in Nepal: A Balancing Act Between Technical Strengths and Policy Processes. MDM Policy Pract 2017; 2:2381468317691766. [PMID: 30288415 PMCID: PMC6125041 DOI: 10.1177/2381468317691766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 01/05/2017] [Indexed: 11/30/2022] Open
Abstract
As more countries provide free health care, pharmaceutical reimbursement lists
are becoming a concern, especially in low- and middle-income countries. In 2007,
Nepal decreed that health is a human right and began basic health coverage for a
target group of the poor, destitute, elderly, and disabled. The Ministry of
Health and Population (MoHP) also provided 40 drugs without cost to all citizens
through the Free Drugs List (FDL) program. The FDL was later expanded from 40 to
70 drugs; however, the process of review and update remains unclear. To propose
a mechanism for future development of the FDL, we conducted a document review
and in-depth consultations with representatives from the MoHP and the World
Health Organization Country Office during a workshop in Kathmandu. The FDL
suffers from lack of an appropriate process, gaps between the listed drugs and
Nepal’s burden of disease, and no consideration of the unit costs or
cost-effectiveness of drugs included in the list. We propose a new drug
selection process that is a variant of the health technology assessment process.
This process can be applied not only in Nepal but also in other resource-limited
countries that wish to ensure their citizens’ access to essential medicines
through a pharmaceutical reimbursement list.
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Affiliation(s)
- Devika Singh
- Georgia Institute of Technology, Atlanta, Georgia (DS), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program International Unit (ACGL, WR), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program (YT), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Alia Cynthia Gonzales Luz
- Georgia Institute of Technology, Atlanta, Georgia (DS), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program International Unit (ACGL, WR), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program (YT), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Waranya Rattanavipapong
- Georgia Institute of Technology, Atlanta, Georgia (DS), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program International Unit (ACGL, WR), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program (YT), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Georgia Institute of Technology, Atlanta, Georgia (DS), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program International Unit (ACGL, WR), Department of Health, Ministry of Public Health, Nonthaburi, Thailand.,Health Intervention and Technology Assessment Program (YT), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
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19
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Nsabagasani X, Hansen E, Mbonye A, Ssengooba F, Muyinda H, Mugisha J, Ogwal-Okeng J. Explaining the slow transition of child-appropriate dosage formulations from the global to national level in the context of Uganda: a qualitative study. J Pharm Policy Pract 2015. [PMID: 26203358 PMCID: PMC4511518 DOI: 10.1186/s40545-015-0039-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2007, the Sixtieth World Health Assembly (WHA) passed a resolution entitled "Better medicines for children" and subsequently the World Health Organization (WHO) recommended the inclusion of child-appropriate dosage formulations in the essential medicines lists of member countries. However, child-appropriate dosage formulations are not highlighted in the Essential Medicines and Health Supplies List of Uganda (EMHSLU) 2012 and they are still limited in availability in public health facilities. Several stakeholders influenced the status of child-appropriate dosage formulations in the EMHSLU 2012. OBJECTIVE To explore stakeholders' views about the relevance of the globally recommended child-appropriate dosage formulations in the context of Uganda. METHODS The findings derive from thirty three in-depth interviews with stakeholder representatives and the results of a follow up validation meeting where preliminary findings were shared with stakeholders. Policy analysis and policy transfer theories were used to guide a deductive analysis for manifest and latent content. RESULTS According to stakeholders, the transition to the globally recommended child-appropriate dosage formulations has been slow in Uganda due to a number of factors. These factors include resource constraints at the global and national levels, lack of Ministry of Health (MOH) formal commitment to the adoption of the child-appropriate dosage formulations policy and a lack of consensus between those who advocated for the availability of liquid oral dosage formulations for easy administration and effectiveness and those who were more convinced by economic arguments and preferred the procurement of solid oral dosage formulations intended for adults. CONCLUSIONS The global policy for child-appropriate dosage formulations still remains to be implemented in Uganda and other low income countries. This has been due to lack of resources that hindered formal transfer of the policy from the global to the local level. To achieve this transfer there is a need for resource mobilisation at both the international and local levels, together with the revitalisation of UMTAC to enable it to take on a leadership role of the coalitions supporting child-appropriate dosage formulations.
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Affiliation(s)
- Xavier Nsabagasani
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Ebba Hansen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - Anthony Mbonye
- Ministry of Health Uganda and Department of Health, Uganda Christian University, Kampala, Uganda
| | - Freddie Ssengooba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Herbert Muyinda
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - James Mugisha
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Jasper Ogwal-Okeng
- Departments of Pharmacology and Therapeutics, Gulu University, Gulu, Uganda
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20
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Shulman LN, Mpunga T, Tapela N, Wagner CM, Fadelu T, Binagwaho A. Bringing cancer care to the poor: experiences from Rwanda. Nat Rev Cancer 2014; 14:815-21. [PMID: 25355378 DOI: 10.1038/nrc3848] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The knowledge and tools to cure many cancer patients exist in developed countries but are unavailable to many who live in the developing world, resulting in unnecessary loss of life. Bringing cancer care to the poor, particularly to low-income countries, is a great challenge, but it is one that we believe can be met through partnerships, careful planning and a set of guiding principles. Alongside vaccinations, screening and other cancer-prevention efforts, treatment must be a central component of any cancer programme from the start. It is also critical that these programmes include implementation research to determine programmatic efficacy, where gaps in care still exist and where improvements can be made. This article discusses these issues using the example of Rwanda's expanding national cancer programme.
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Affiliation(s)
- Lawrence N Shulman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA; and at Partners In Heath, 888 Commonwealth Avenue, third Floor, Boston, Massachusetts 02215, USA
| | - Tharcisse Mpunga
- Ministry of Health, Government of Rwanda, P.O. Box 84, Kigali, Rwanda; and at the University of Rwanda College of Medicine and Health Sciences, P.O. Box 59, Musanze, Rwanda
| | - Neo Tapela
- Partners In Health - Inshuti Mu Buzima, P.O. Box 3432, Kigali, Rwanda; and at the Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 USA
| | - Claire M Wagner
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Temidayo Fadelu
- Partners In Heath - Inshuti Mu Buzima, P.O. Box 3432, Kigali, Rwanda
| | - Agnes Binagwaho
- Ministry of Health, Government of Rwanda, PO Box 84, Kigali, Rwanda; Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115; and at the Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, New Hampshire 03755, USA
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21
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Nabyonga-Orem J, Nanyunja M, Marchal B, Criel B, Ssengooba F. The roles and influence of actors in the uptake of evidence: the case of malaria treatment policy change in Uganda. Implement Sci 2014; 9:150. [PMID: 25294279 PMCID: PMC4193992 DOI: 10.1186/s13012-014-0150-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uganda changed its malaria treatment policy in response to evidence of resistance to commonly used antimalarials. The use of evidence in policy development--also referred to as knowledge translation (KT)--is crucial, especially in resource-limited settings. However, KT processes occur amidst a complex web of stakeholder interactions. Stakeholder involvement in evidence generation and in KT activities is essential. In the present study, we explored how stakeholders impacted the uptake of evidence in the malaria treatment policy change in Uganda. METHODS We employed a qualitative case study methodology involving interviews with key informants and review of documents. A timeline of events was developed, which guided the purposive sampling of respondents and identification of relevant documents. Data were analysed using inductive content analysis techniques. RESULTS Stakeholders played multiple roles in evidence uptake in the malaria treatment policy change. Donors, the Ministry of Health (MoH), service providers, and researchers engaged in the role of evidence generation. The MoH, parliamentarians, and opinion leaders at the national and local levels engaged in dissemination of evidence. The donors, MoH, researchers, and service providers engaged in the uptake of evidence in policy development and implementation. Stakeholders exerted varying levels of support and influence for different reasons. It is noteworthy that all of the influential stakeholders were divided regarding the best antimalarial alternative to adopt. CONCLUSION Our results showed a diverse group of stakeholders who played multiple roles, with varying levels of support and influence on the uptake of evidence in the malaria treatment policy change. For a given KT processes, mapping the relevant stakeholders and devising mechanism for their engagement and for how to resolve conflicts of interest and disagreements a priori will enhance uptake of evidence in policy development.
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Ngalesoni F, Ruhago G, Norheim OF, Robberstad B. Economic cost of primary prevention of cardiovascular diseases in Tanzania. Health Policy Plan 2014; 30:875-84. [PMID: 25113027 PMCID: PMC4524339 DOI: 10.1093/heapol/czu088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important.
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Affiliation(s)
- Frida Ngalesoni
- Ministry of Health and Social Welfare, PO Box 9083 Dar es Salaam, Tanzania, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway,
| | - George Ruhago
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway, School of Public Health and Social Sciences, Muhimbili University, PO Box 65015 Dar es Salaam, Tanzania and
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway
| | - Bjarne Robberstad
- Center of International Health, University of Bergen, PO Box 7804, N-5020, Bergen, Norway
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Bista D, Chalmers L, Bereznicki L, Peterson G. Potential use of NOACs in developing countries: pros and cons. Eur J Clin Pharmacol 2014; 70:817-28. [PMID: 24817486 DOI: 10.1007/s00228-014-1693-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/25/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE Although vitamin K antagonists (VKAs) are effective for long-term thromboprophylaxis in atrial fibrillation (AF), their limitations have led to widespread underutilisation, especially in the developing world. Novel oral anticoagulants (NOACs) have emerged as promising alternatives to VKAs, although there are some particular considerations and challenges to their introduction in developing countries. This review summarises the current state of antithrombotic management of AF in the developing world, explores the early evidence for the NOACs and describes some of the special considerations that must be taken into account when considering the role of the NOACs within developing countries' health care systems. METHODS A literature search was conducted via PubMed and Google Scholar to find articles published in English between the years 2000 to 2014. Search terms used were "atrial fibrillation", "oral anticoagulants", "warfarin", "NOACs", "dabigatran", "rivaroxaban", "apixaban", "edoxaban", "time in therapeutic range", "International Normalized Ratio" "cost-effectiveness", "stroke", "adverse-drug reactions" and "drug-drug interactions", together with the individual names of developing countries as listed by the World Bank. We reviewed the results of randomized clinical trials, relevant retrospective and prospective studies, case-studies and review articles. RESULTS Many developing countries lack or have sporadic data on the quality of AF management, making it difficult to anticipate the potential impact of NOACs in these settings. The utilisation of anticoagulants for AF appears highly variable in developing countries. Given the issues associated with VKA therapy in many developing countries, NOACs offer some potential advantages; however, there is insufficient evidence to advocate the widespread replacement of warfarin at present. VKAs may continue to have a role in selected patients or countries, especially if alternative monitoring strategies can be utilised. CONCLUSION The evaluation of the introduction of NOACs should consider safety, budget concerns and the quality of oral anticoagulation care achieved by each country. Prospective registries will be important in developing countries to better elucidate the comparative safety, efficacy and cost-effectiveness of NOACs and VKAs as NOACs are introduced into practice.
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Affiliation(s)
- Durga Bista
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Australia,
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