Gap analysis for drug development policy-making: An attempt to close the gap between policy and its implementation

The domestication of the African Union model law on medical products regulation: Perceived benefits, enabling factors, and challenges

Introduction

In 2016, the African Union (AU) Model Law on Medical Products Regulation was endorsed by AU Heads of State and Government. The aims of the legislation include harmonisation of regulatory systems, increasing collaboration across countries, and providing a conducive regulatory environment for medical product/health technology development and scale-up. A target was set to have at least 25 African countries domesticating the model law by 2020. However, this target has not yet been met. This research aimed to apply the Consolidated Framework for Implementation Research (CFIR) in analysing the rationale, perceived benefits, enabling factors, and challenges of AU Model Law domestication and implementation by AU Member States.

Methods

This study was a qualitative, cross-sectional, census survey of the national medicines regulatory authorities (NRAs) of Anglophone and Francophone AU Member States. The heads of NRAs and a senior competent person were contacted to complete self-administered questionnaires.

Results

The perceived benefits of model law implementation include enabling the establishment of an NRA, improving NRA governance and decision-making autonomy, strengthening the institutional framework, having streamlined activities which attract support from donors, as well as enabling harmonisation, reliance, and mutual recognition mechanisms. The factors enabling domestication and implementation are the presence of political will, leadership, and advocates, facilitators, or champions for the cause. Additionally, participation in regulatory harmonisation initiatives and the desire to have legal provisions at the national level that allow for regional harmonisation and international collaboration are enabling factors. The challenges encountered in the process of domesticating and implementing the model law are the lack of human and financial resources, competing priorities at the national level, overlapping roles of government institutions, and the process of amending/repealing laws being slow and lengthy.

Conclusion

This study has enabled an improved understanding of the AU Model Law process, the perceived benefits of its domestication, and the enabling factors for its adoption from the perspective of African NRAs. NRAs have also highlighted the challenges encountered in the process. Addressing these challenges will result in a harmonised legal environment for medicines regulation in Africa and be an important enabler for the effective operation of the African Medicines Agency.

Effects of Cultural Intelligence and Imposter Syndrome on School Belonging through Academic Resilience among University Students with Vocational Backgrounds

Background: University students with vocational qualifications encounter more severe cultural, academic, and self-evaluated challenges in the transitional process than their peers with an academic pathway. This study investigated the predictive effect of cultural intelligence (CI), imposter syndrome (IS), and academic resilience (AR) on school belonging (SB) and their interplay mechanism from a positive and negative perspective. Method: We recruited 326 Chinese university students with a vocational route as the research subjects and designed a parallel mediation model to assess the hypothesized construct. Result: The participants had scores above the median in CI, AR, and SB, but they also obtained scores exceeding the median in moderate IS. CI positively and significantly predicted SB both directly and indirectly through AR, while IS negatively and significantly predicted AR. AR both partly mediated the effect of CI on SB and entirely mediated the impact of IS on SB. Conclusion: CI was the most crucial factor impacting SB, followed by AR and IS among Chinese university students with a vocational education and training (VET) pathway. Strategic interventions should be adopted to enhance their abilities to cope with diverse cultures, promote their resilience in facing academic difficulties, boost their self-achievement, and foster their sense of SB.

Cost-Effectiveness Analysis of Spending on Research and Development to Address the Needs for Innovative Therapeutic Products in Indonesia

Background

The annual gross domestic expenditure on research and development (GERD) per capita of Indonesia ($24) remains relatively lower than the annual GERD per capita of neighboring countries, such as Vietnam ($36), Singapore ($1804), Malaysia ($361), and Thailand ($111).

Objective

The aim of this study was to conduct a cost-effectiveness analysis of spending on healthcare R&D to address the needs of developing innovative therapeutic products in Indonesia.

Methods

A decision tree model was developed by taking into account four stages of R&D: stage 1 from raw concept to feasibility, stage 2 from feasibility to development, stage 3 from development to early commercialization, and stage 4 from early to full commercialization. Considering a 3-year time horizon, a stage-dependent success rate was applied and analyses were conducted from a business perspective. Two scenarios were compared by assuming the government of Indonesia would increase GERD in health and medical sciences up to 2- and 3-times higher than the baseline (current situation) for the first and second scenario, respectively. Cost per number of innovative products in health and medical sciences was considered as the incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was conducted to investigate the effects of different input parameters on the ICER.

Results

There was a statistically significant association (P-value<0.05) between countries’ GERD in medical and health sciences with the number of innovative products. We estimated the ICER would be $8.50 million and $2.04 million per innovative product for the first and second scenario, respectively. The sensitivity analysis showed that the success rates in all stages and total GERD were the most influential parameters impacting the ICER.

Conclusion

The result showed that there was an association between GERD in medical and health sciences with the number of innovative products. In addition, the second scenario would be more cost-effective than the first scenario.