To give is better than to receive: compliance with WHO guidelines for drug donations during 2000-2008

Lifecycle of surgical devices: Global, environmental, and regulatory considerations

BACKGROUND

Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income (LMICs) countries.

OBSERVATIONS

This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices.

CONCLUSION

There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges.

TRIAL REGISTRATION NUMBER

Not applicable.

Medicine donations: a review of policies and practices

BACKGROUND

To help promote the effective delivery of drug donations, the World Health Organization (WHO) developed the Guidelines for Medicine Donations. The need for revisions is timely given the large-scale influx of medicine donations since the start of the COVID-19 pandemic. This study analyses current policies of donors and recipients that are commensurate with the recommendations in the Guidelines and examines current practices, challenges, and revision suggestions.

RESULTS

A search for medicine donation policies of donors and recipients was conducted in May/June 2022 and repeated in January 2023. Potential donor countries were identified from the high-income countries on the United Nation's (UN) List of G20 Countries. Potential pharmaceutical company donors were selected from those with 2021 revenue of $30 billion or greater. Potential non-government organization donors came from the WHO list of non-governmental organizations (NGOs) and two other sources. Potential recipient countries were those on the UN List of Least Developed Countries. These four lists were supplemented with actual donors and recipients identified from the literature. All policies retrieved were screened to identify which of the 12 recommendations from the WHO Guidelines were incorporated. We identified 38 policies from 1 donor country, 6 brand-name multinational pharmaceutical companies, 6 NGOs and 25 recipient countries. Most policies incorporated all 12 recommendations. Twenty-five of the 38 policies were developed in 2010 or later. The majority of actual donors and recipients did not have policies that were publicly available. A rapid literature review for publications from 2010 onwards identified challenges in implementing the WHO Guidelines and suggested for revisions. Challenges included: (1) information management; (2) medication presentation; (3) influence from the pharmaceutical industry; (4) donation sustainability; and (5) the belief that donations are inherently good.

CONCLUSIONS

Our findings suggest that both donors and recipients could further align their policies with the existing Guidelines and both groups should be consulted on any revisions to ensure that their experiences are reflected and their needs are addressed. While the current WHO Guidelines for Medicine Donations are a solid base for medical humanitarian efforts, evidence points to the need for an update to meet current challenges.

Material convergence issue in the pharmaceutical supply chain during a disease outbreak

Purpose

Pharmaceutical donations are a practical approach to increase medicine availability during disasters such as disease outbreaks. However, often donated pharmaceuticals are inappropriate and unsuitable. This convergence of inappropriate pharmaceuticals is a severe operational challenge and results in environmental hazards. This study explores the pharmaceutical supply chains (PSCs) during a disease outbreak to relieve the negative impact of the material convergence problem (MCP).

Design/methodology/approach

This study adopts a situation-actors-process learning-action-performance (SAP-LAP) linkage framework to understand the PSC dynamics. The problem-solving component of the SAP-LAP analysis provides the strategies catering to MCP. The findings from the SAP-LAP helped to develop the causal loop diagram (CLD). This study conducts several experiments on the proposed strategies by integrating CLD into a stock and flow diagram. Later, a disease outbreak case study accessed the pharmaceutical donations effect on PSC performance.

Findings

The study synthesises and evaluates propositions and strategies to incorporate circular economy (CE) principles in PSC. This study proposed two strategies; one to sort and supply and the other to sort, supply and resell. The reuse policy improves humanitarian organisations' finances in the simulation study. This study verified the operational improvement of PSC by reducing the transport and storage burden due to MCP.

Originality/value

This study comprehensively approaches the issue of drug donation and uniquely produced several propositions for incorporating a CE perspective in PSC. The study also proposed a unique simulation approach to model the donation arrivals in response to a disease outbreak using susceptible, exposed, infectious and recovered modelling.

Medical donations are not always free: an assessment of compliance of medicine and medical device donations with World Health Organization guidelines (2009–2017)

Medicine and medical device donations have the potential to improve access to healthcare in some of the poorest parts of the world, but can do more harm than good. World Health Organization guidelines advise donors on how to make effective and useful donations. Our objective was to assess compliance of recent medicine or medical device donations with WHO guidelines from 2009 onwards. We searched media, academic and gray literature, including industry and organizational documents, to identify reports describing specific incidences of the donation of medicines or devices. We collected data on donation characteristics and guideline compliance. We identified 88 reports describing 53 donations. Most did not comply with at least some items in WHO guidelines and no reports provided sufficient information to assess compliance against all items. Donations that fail to comply with guidelines may be excessive, expired and/or burden recipient countries with storage and disposal costs. It was estimated that 40–70% of donated medical devices are not used as they are not functional, appropriate, or staff lack training. More effective donations involved needs assessments, training and the use of existing distribution networks. The donation of medicines and medical devices is frequently inadequately reported and at times inappropriate. Guidelines need to be enforced to ensure effective donations.

Translating medicines to patients: A novel methodology for quantifying the global medical supplies and donations program

BACKGROUND

International medical donation programs can help alleviate the burden of illness and serve as a safety net for the global health care system. However, to our knowledge no studies have assessed the number of individuals served through medical donation programs. As such, this study aimed to evaluate the impact of the Americares Foundation's (Americares) medical donation program in terms of the number of patients served.

METHODS

We conducted an outcome evaluation study in 34 health facilities in 10 countries that receive medical donations from Americares. Medical records were randomly sampled at each participating facility and evaluated for types of medications and number of courses of prescribed treatments. Facility level data and donation inventory data were also collected. We developed an algorithm for converting quantities of donated medicines into the number of individuals served at the facility level. These estimates were then extrapolated to the country and region levels to assess the total impact of medications donated in 2015. Probabilistic sensitivity analysis was conducted to derive 95% credible ranges for projected estimates and to assess model uncertainty.

RESULTS

Records of 3,205 unique patients were reviewed, encompassing 10,449 medical visits. The average number of medications and courses of treatments prescribed per visit were 2.63 and 2.68, respectively. The average medication destruction rate ranged from 0% to 24% at facilities, with a cross-country average of 7%. For the 10 countries included in the study, we project that 700,377 unique individuals were served through the program (95% credible range: 518,401-905,982). Scaled across all regions receiving Americares donations, we project that the program supported an estimated 5.1 million beneficiaries, including 484,188 chronic care and 4.65 million acute care patients.

CONCLUSIONS

This study provides a novel methodology for medical donation programs seeking to estimate one of their key outcomes-patients served-and global reach. Rigorous assessments of program outcomes can provide important insights into the value of medical donation initiatives.

TRIAL REGISTRATION

Human subjects approval was received from the University of Washington Institutional Review Board (Approval #52316; 7/19/2016).

Donation programme of returned medicines: role of donors and point of view of beneficiaries

Background

Donation of returned medicines is a debated health policy issue as it is discouraged by WHO, but accepted in some countries.

Methods

Lessons learned from a donation programme of returned medicines carried out in Europe were documented.

Results

The donation programme we reviewed followed a strict protocol for collection, sorting and distribution of returned drugs, in order to avoid the major limitations associated with unused medicine donations. Over a period of 3 years, 23 145 boxes of medicines were donated to 14 organizations operating in Europe, Africa and Latin America.

Conclusions

The donations covered about one-third of the volume of medicines used by beneficiary organizations. The programme helped to decrease expenditure by both patients and health facilities.

Assessment of the scope and practice of evaluation among medical donation programs

Background

Medical donation programs for drugs, other medical products, training and other supportive services can improve access to essential medicines in low- and middle-income countries (LMICs) and provide emergency and disaster relief. The scope and extent to which medical donation programs evaluate their impact on recipients and health systems is not well documented.

Methods

We conducted a survey of the member organizations of the Partnership for Quality Medical Donations (PQMD), a global alliance of non-profit and corporate organizations, to identify evaluations conducted in conjunction with donation programs.

Results

Twenty-five out of the 36 PQMD organizations that were members at the time of the survey participated in the study, for a response rate of 69 %. PQMD members provided information on 34 of their major medical donation programs. Half of the donation programs reported conducting trainings as a part of their donation program. Twenty-six (76 %) programs reported that they conduct routine monitoring of their donation programs. Less than 30 % of donation programs were evaluated for their impact on health. Lack of technical staff and lack of funding were reported as key barriers to conducting impact evaluations.

Conclusions

Member organizations of PQMD provide a broad range of medical donations, targeting a wide range of public health issues and events. While some level of monitoring and evaluation was conducted in nearly 80 % of the donation programs, a program’s impact was infrequently evaluated. Opportunities exist to develop consistent metrics for medical donation programs, develop a common framework for impact evaluations, and advocate for data collection and analysis plans that collect meaningful metrics.

[Preparedness of pharmaceutical assistance for disasters: a study in five Brazilian municipalities]

A number of Brazilian municipalities have been affected by disasters in recent years. Municipal managers need to invest in preparedness to mitigate the impact of events and to restrict damages. Disaster preparedness should be conducted on various fronts, including the health sector, of which pharmaceutical services (PS) are a part. The scope of this paper is to describe and analyze PS preparedness in municipalities recently stricken by disasters. For this purpose, an investigation of a cross-sectional design involving various sources (official documents, newspaper articles, public databases and interviews with key PS informants) was conducted in five municipalities in two different regions. Analysis was based on an instrument with a logical model and indicators. Despite the fact that these municipalities are historically disaster-prone, very few measures of PS preparedness were encountered, which is clear evidence that management of PS has not been achieved. It is to be hoped that this presentation of the experiences of these municipalities might foster PS preparedness in other Brazilian municipalities.

Ethical Issues in Pediatric Global Health

Children are vulnerable to the priorities and decision-making of adults. Usually, parents/caregivers make the difficult healthcare decisions for their children based on the recommendations from the child's healthcare providers. In global health work, healthcare team members from different countries and cultures may guide healthcare decisions by parents and children, and as a result ethical assumptions may not be shared. As a result, ethical issues in pediatric global health are numerous and complex. Here we discuss critical ethical issues in global health at an individual and organizational level in hopes this supports optimized decision-making on behalf of children worldwide.

The Professionalization of International Disaster Response: It Is Time for Midwives to Get Ready

Disasters and humanitarian emergencies due to natural or human origins result in severe and often prolonged suffering of the affected population. Midwives have a role to play in providing assistance because women and their infants experiencing such crises have unique vulnerabilities and needs. This article introduces midwives and other women's health care practitioners to international humanitarian emergency response efforts and describes preparation and training activities they can undertake to get ready to volunteer with an international health aid agency. Various clinical realities and challenges are discussed, including recommended priorities for providing reproductive health care in disaster zones. Common ethical dilemmas in crisis health care settings are also reviewed. By arriving in the field well prepared to participate and collaborate, midwives can make substantial contributions to the safety, health, and comfort of women and their families who have experienced a natural disaster, armed conflict, or disease epidemic.

Availability, prices and affordability of essential medicines in Haiti

Background

Haiti is the poorest country in the Western Hemisphere and faces numerous challenges, including inadequate medication access for its residents. The objective of this study was to determine the availability, prices, and affordability of essential medicines in Haiti and compare these findings to other countries.

Methods

We conducted a cross–sectional nationwide survey in 2011 of availability and consumer prices of 60 essential medicines in Haiti using a standardized methodology developed by the World Health Organization and Health Action International. The survey was conducted in 163 medicine outlets in four health care sectors (public, retail, nonprofit and mixed sectors). Medicine prices were expressed as ratios relative to the International Reference Price. Affordability was calculated by comparing the costs of treatment for common conditions with the salary of the lowest paid government worker and was compared to available data from four Latin American countries.

Results

For generic medicines, the availability in public, retail, nonprofit and mixed sectors was 20%, 37%, 24% and 23% of medications, respectively. Most of the available medicines were priced higher than the International Reference Price. The lowest paid government worker would need 2.5 days’ wages to treat an adult respiratory infection with generic medicines from the public sector. For treatment of common conditions with originator brands (OB) purchased from a retail pharmacy, costs were between 1.4 (anaerobic bacterial infection) and 13.7 (hyperlipidemia) days’ wages, respectively. Treatment of pediatric bacterial infections with the OB of ceftriaxone from a retail pharmacy would cost 24.6 days’ wages. Prices in Bolivia, Colombia, Mexico and Nicaragua were frequently lower for comparable medications.

Conclusions

The availability of essential medicines was low and prices varied widely across all four sectors. Over 75% of Haitians live on less than US$ 2.00 /day; therefore, most medication regimens are largely unaffordable. Inclusion of essential medications on the national formulary and working with organizations responsible for importing medications into Haiti, particularly drug donation agencies, are important first steps to increasing medication access.